Prediabetes is useful as a risk marker. It is a signal to take metabolic health seriously. But metformin for prediabetes is a different claim. It says that changing the timing of a diagnosis is itself enough to justify medication. That is where the logic breaks.
I've given it to some women with prediabetes who are also trying to get pregnant and having difficulty. It's supposed to help with both, and the logic, as I see it, is that they may come into pregnancy in a healthier state with less chance of developing GDM.
You are a rare person who understands the philosophical, physical, and practical difference between a patient, an illness, a syndrome, a disease, a statistical population where the concept of risk as a statistical abstraction arises, and further complications that arise between keeping this particular physical person who isn’t even a patient well and hale once the person crossed over a legal threshold of becoming a patient by the virtue of algorithmic screening of biomarkers.
There is a difference between the art of keeping well, knocking the wisdom of living well for people in the community, and treating figments of statistics rather than people who came in with some complaint that warrants concern of a physician.
There is a good essay on a disease “at risk”, which is about population medicine aka public health more so than the practice of medicine, which used to begin with a person coming to a doctor with a complaint, warranting a change from a person to a patient. Applying medicine to people with no complaints is a whole other can of worms.
Well said!
I've given it to some women with prediabetes who are also trying to get pregnant and having difficulty. It's supposed to help with both, and the logic, as I see it, is that they may come into pregnancy in a healthier state with less chance of developing GDM.
Good use case
You are a rare person who understands the philosophical, physical, and practical difference between a patient, an illness, a syndrome, a disease, a statistical population where the concept of risk as a statistical abstraction arises, and further complications that arise between keeping this particular physical person who isn’t even a patient well and hale once the person crossed over a legal threshold of becoming a patient by the virtue of algorithmic screening of biomarkers.
There is a difference between the art of keeping well, knocking the wisdom of living well for people in the community, and treating figments of statistics rather than people who came in with some complaint that warrants concern of a physician.
There is a good essay on a disease “at risk”, which is about population medicine aka public health more so than the practice of medicine, which used to begin with a person coming to a doctor with a complaint, warranting a change from a person to a patient. Applying medicine to people with no complaints is a whole other can of worms.
https://blogs.bmj.com/bmj/2019/06/24/caitjan-gainty-and-grazia-de-michelle-the-disease-of-at-risk/