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Today, I’m writing about your risk of your risk of developing a disease. You read that right. It turns out that there is an online test, sponsored by these fine folks,

that will tell you if you are at high-risk of having prediabetes, which is, of course, a major risk factor for type 2 diabetes. Briefly, prediabetes is a state where your blood sugar is elevated, but not quite high enough to diagnose diabetes:

And prediabetes, while not quite as bad as type 2 diabetes, carries a higher-than-normal risk of heart attack and stroke, and, of course, development of diabetes proper.

There is debate in the medical community about the over-medicalization of lab values that may fall within a normal range for some people, but the development of an online risk-tool, not for diabetes, but for prediabetes, seems to put the stamp of the diabetes establishment firmly in the “prediabetes is a real disease” camp.

Personally, I’m a bit sick of the “pre” diagnoses.  Pre-cancer. Pre-hypertension. No one is ever diagnosed with pre-cholera. But, fine, as a public health issue, maybe motivating people with a bit of scary sounding medical-ese is ok.

When you visit doihaveprediabetes.org, you are presented with this friendly screen:

Basically, you answer seven risk-factor questions: family history of diabetes, BMI, that sort of thing, and then you get a score that either looks like this:

Or like this:

Now, here’s where I get worried.

According to a research letter in JAMA Internal Medicine, if you all were to go take this risk survey, 3 out of 5 of you would be deemed high risk. And if you’re over age 60, make that 4 out of 5. This translates to more than 70 million people across the US. Many of these people may have prediabetes, for what it’s worth, but many won’t.  And frankly, if 80% of people over age 60 are being told to talk to their doctor about pre-diabetes screening, maybe we should just bite the bullet and do the screening on everyone?

Of course, we don’t have data to support that type of public-health intervention. In that sense, this test represents an end-run around conventional guideline-based care.

I’ll be generous and say that those who created the nearly-always-positive test had their hearts in the right place, but I would recommend chatting with your doctor about pre-diabetes in person. Let the internet do what it was meant to do – diagnosing all your vague somatic complaints as cancer.