Diabetes or Impaired Glucose Tolerance

D iagnosis has been considered a process of “labeling” with consequences that can be both positive (access to treatment) and negative (social rejection). The ultimate goal of making a diagnosis is to adequately inform the patient, thereby enhancing knowledge of the disorder, adherence to therapeutic advice, and the ability to manage illness effectively. Impaired glucose tolerance and diabetes are terms that differentiate two metabolic carbohydrate abnormalities. Establishing the optimum diagnostic levels for glycemic thresholds, however, depends on balancing the medical, social, and economic costs of labeling a patient who is not at substantial risk for developing complications versus the corresponding costs of not diagnosing “true” diabetes cases (1). Among patients who have alteration in metabolizing glucose, varying (in a controlled setting) the diagnostic criteria for diabetes and related carbohydrate disorders offers an opportunity to assess whether labeling, either as having “impaired glucose tolerance” or “diabetes,” influences patients’ knowledge of their disease, adherence to therapy, or mechanisms for coping and metabolic control. We used a clinical trial design to assess the effects of diagnostic labeling among participants randomly assigned to be informed that they had either impaired glucose tolerance or diabetes.