April 18, 2007

ADA Finally Recommends OGTT Testing -- 9 Years After They Told Doctors To Stop It

Today Diabetes in Control announced that the ADA has published a "Consensus Statement" recommending the use of the Glucose Tolerance Test in people at risk for impaired glucose tolerance!


The background to this story, discussed at length and documented at:


is that in 1998 when the ADA's experts took another look at the diagnostic criteria that ensure that half of all people diagnosed with diabetes in the U.S. already have neuropathy and other complications at the time of diagnosis, they announced it wasn't cost effective to use the Oral Glucose Tolerance Test to diagnose people with Type 2 diabetes and told doctors to diagnose diabetes using only the Fasting Plasma Glucose test.

Researchers quickly documented that this test missed diabetes in significant numbers of women and people
of color. That is because they tend to develop diabetes in a pattern where the post-prandial blood sugar becomes extremely high long before the fasting blood sugar deteriorates. These high blood sugars cause glucose toxicity that kills beta cells and it also causes neuropathy--long before the ADA's fasting test will flag diabetes.

Despite the evidence that the fasting test was inadequate the ADA refused to change its recommendation to use only the fasting test for diagnosis, despite heavy criticism and the refusal of WHO to go along with this recommendation.

Now, finally, only nine years since the ADA's revamp of their diagnostic criteria which urged doctors to eliminate this test, they've changed their mind and are now telling doctors to use the oral glucose tolerance test for people at risk of diabetes.

The reason for this--I can't call it "sudden"--change of mind, appears to be that the ADA's experts now have decided that people with Impaired Glucose Tolerance should start taking Metformin since there is a lot of evidence that this drug can slow the progression of to diabetes. This evidence, however, is quite old. It is discussed on our Oral Drugs page.

There is, in fact, a lot more evidence that if people with Impaired Glucose Tolerance cut way back on their carbohydrate intake, they can normalize their blood sugar while they still have some beta cells left and many not need any drugs. But you won't hear that from the ADA, funded as it is by big junk food, food service and Big Pharma companies.

As usual, Dr. Meyer B. Davidson is railing against this suggestion that people be given OGTTs before they have developed neuropathy and early kidney damage because this testing is expensive. (Neuropathy is a lot more expensive, especially when it progresses to impotence or amputation). Dr. Davidson, who was a part of the ADA's 1978 expert committee as well as the more recent ones, has always volubly opposed any suggestion that people with Type 2 diabetes get a timely diagnosis. He has published many opinion pieces in the medical press arguing against early diagnosis and he also opposes the use of meters by people with Type 2 diabetes to test their blood sugar at home. He has probably done more to keep people with diabetes from getting diagnosed and treated than anyone else alive. One can only hope that he will retire soon.

My guess is that the other reason that the ADA battleship is starting to turn around on the issue of timely diagnosis is that people with IGT are a huge untapped market for the drug companies. They are a particularly juicy market for their new, and extremely expensive incretin drugs. So far, at least according to my endocrinologist, it is looking like the oral incretin drugs work much better in people with IGT than those with Type 2 diabetes. That is partly because by the time you are diagnosed using the ADA's fasting glucose test and their too-high diagnostic criteria so many of your beta cells are dead that you can drown your pancreas in GLP-1 and not much will happen. So early diagnosis means more profits for the drug companies.

Given how dependent the ADA is on Big Pharma money, if their paymasters want an earlier diagnosis, they'll get it.

This is good news for people with diabetes. I've been calling for it for 4 years online, and Europeans have been using the OGTT for the last decade. With the ADA's blessing insurers will be more likely to pay for the OGGT, too.

The bad news is that once patients get diagnosed with abnormal blood sugars, the ADA will continue to tell them that all they need to get better is to eat sugary fruits, "healthy" grains and chug those $5.65 pills each day that will counter the carbs their "healthy" diet unleashes on the blood stream. That will keep their Big Pharma donors happy.

If you are diagnosed with prediabetes or impaired glucose tolerance after a glucose tolerance test, before you start popping pills, be sure to visit Jennifer's Advice to Newbies--The Best Diabetes Page on the Web.


Big Dave T said...

There's another reason why doctors got away from the Glucose Tolerance Test. Insurance companies didn't pay for it. I used to work in medical billing so I remember. It was a much more expensive test than a simple fasting glucose, and insurance companies almost always take cheaper over better when they can justify it somehow.

Hea, I have a question for you. I've been browsing diabetes blogs including the comments posted. Do you think the pharmas, or those who work for them, sometimes post comments under the guise of being a patient? Some of these comments I read look awfully suspicious. And usually they're not associated with blogs or webpages, only with an e-mail address.

I know you're a cynical Sally when it comes to the big pharmaceutical companies and so am I. Maybe I'm just being TOO paranoid.

P.S. Guess I should say I'm a cynical Sam.

Jenny said...


It is a known fact, not paranoid conjecture that the drug companies (and many other companies) hire people to join online communities pretending to be ordinary folks, and the job of these people is to promote their company's products.

It's a good strategy because the word of mouth of supposedly uninvolved people is such a strong motivator for sales.

Usually they're pretty obvious, because they are so mad-dog enthusiastic about their product and don't post about much else. They also jump in if anyone makes a negative comment about their product.

But the investors also hang out in online communities promoting stocks, and they can be confused with the shills.

Rachel said...

I was diagnosed with a OGTT, ultimately, though my A1C was above 6.0 and my fasting glucose was just over normal. I think it is the best way to diagnose because as you said, post-prandials are affected first in many cases.

And thank you for saying "boo" to the ADA recommended diet.

Jenny said...


I've been "saying boo" to the ADA diet online since 1998! When I first posted about cutting carbs as a strategy for controlling blood sugar back on the a.h.d newsgroup at that time, the belief in the need for a low fat diet was so strong that people accused me of wanting to kill people with diabetes.

The climate has changed since then. Even the ADA's own BBS has its share of people who report controlling their blood sugar by cutting carbs. But the organization itself seems to have learned nothing and its policy makers don't appear to read the research published in their own journals.