The prediabetes diagnosis is everywhere right now—on lab reports, in clinic checklists, and increasingly in fear-driven messaging that suggests you’re one step away from disaster. In this episode of the A Return to Healing Podcast, Alan and I react to a new “prediabetes awareness” ad and use it as a jumping-off point for a bigger discussion: how modern healthcare increasingly turns risk into disease, why “pre-” labels spread so easily, and what actually helps people stay well.
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A “Prediabetes” Ad That Crossed the Line
Prediabetes Diagnosis Myths and When “Risk” Becomes a Condition
Alan saw a new TV ad warning that one-third of Americans have prediabetes, that most don’t know it, and that you need to get tested immediately, or else. That kind of messaging is designed to do one thing very well: make people afraid. Fear is a powerful motivator, and can make people easier to sell to.
It’s not just drug companies doing this. In the episode, we talk about how medical associations, ad councils, and “awareness campaigns” can accidentally (or conveniently) slide into disease branding; the process of turning a broad risk category into a medical identity that demands treatment.
Here’s the key distinction most people never get:
- A risk marker can be useful.
- A diagnosis changes how you see yourself, and how the system treats you.
The problem is that “prediabetes” is often delivered like a diagnosis of an illness you definitely have, rather than a risk label that may or may not predict your future health. In practice, the label can trigger a cascade: more visits, more tests, more referrals, and more medications, often without clarity on what the label truly predicts for an individual.
That cascade is one reason we call it (in the episode) a kind of phantom diagnosis. This isn’t because glucose physiology isn’t real, but because the label can be used in a way that inflates certainty, urgency, and fear, while reducing the conversation about what helps most.
The Prediabetes Test: Where A1C Fits (and Where it’s Oversold)
Most “prediabetes” labeling comes from blood sugar measures like A1C (and sometimes fasting glucose). It can be helpful information, especially as one part of a bigger picture. But two problems show up repeatedly:
1) Numbers become prophecy
People are told, explicitly or implicitly, “You’re going to get diabetes.”
That’s not what the test says. It says you have a marker associated with increased risk, along with millions of others.
2) Labels become endpoints
Instead of asking, “What habits, environment, sleep, stress, food quality, and movement patterns are driving risk?” the system often pivots toward “What can we prescribe? What can we bill? What protocol do we follow?”
That’s how a prevention opportunity turns into a medical-industrial workflow.
Overdiagnosis in Medicine and the “Pre-” Label Machine
Prediabetes isn’t the only example. Healthcare increasingly expands categories by adding “pre-” labels that imply a ticking clock:
- pre-hypertension
- pre-CKD
- pre-osteoporosis
- pre-dementia
- and on and on
If you create a wide enough “pre-” category, you can medically capture a massive portion of the population. In the episode, Alan points out the absurd endpoint: if you stretch the definition far enough, nearly everyone becomes “at risk,” which becomes a justification for more testing and treatment. This is a core theme from our book, A Return to Healing: more medical activity doesn’t always mean better health outcomes.
The Primary Care Crisis and Why Fear-Based Prevention Fills the Vacuum
This episode starts with something heavier than prediabetes: the reality that primary care is being squeezed out of the system. When primary care is underpaid, overworked, and pushed aside, the system loses the one part of healthcare that can do prevention well: long-term relationships, context, continuity, and sane decision-making. What tends to replace that?
- protocol-driven medicine
- corporate medicine models
- “thoroughness” defined as more tests, more meds, more referrals
- and a growing role for fee-for-service incentives that reward volume, not wisdom
We also talk about how corporate groups can insert themselves into settings like long-term care, bringing in clinicians under pressure to practice checklist medicine; often without the deep experience needed to make nuanced decisions for older adults. This isn’t a knock on any one profession. It’s a systems critique: when incentives reward volume, you get volume.
Direct-to-Consumer Drug Ads Are the Gasoline on the Fire
The prediabetes ad is a perfect example of how “awareness” and advertising can blend into something that looks like public health but functions like marketing: widen the category, warn the public, drive testing, create demand for treatment, and normalize the idea that everyone needs medical management.
The irony is that the strongest prevention levers are usually boring, unsexy, and hard to monetize: better food environments, walkable communities, stress reduction, sleep, strength training, and reducing ultra-processed intake. You don’t sell those with a 30-second commercial.
What Actually Helps Prediabetes
If you’ve been labeled with prediabetes, here’s a calmer way to approach it:
1) Ask for context, not panic
- “What is my A1C?”
- “How has it changed over time?”
- “What else matters in my risk profile (waist circumference, blood pressure, lipids, sleep, family history, meds)?”
2) Be careful about turning risk into a lifelong patient identity
The goal isn’t to collect diagnoses. The goal is to stay well.
3) Focus on the big levers
The most meaningful interventions are usually lifestyle and environment based. That doesn’t mean “try harder.” It means pick actions that reliably move biology:
- improving food quality (especially reducing ultra-processed foods)
- increasing movement (including strength training)
- improving sleep
- lowering chronic stress
- addressing alcohol and nicotine
- building consistency over perfection
How We Return to Healing
If you’ve been scared by a prediabetes diagnosis, you’re not alone—and you’re not broken. But you do deserve better than fear-based messaging and a reflexive medication cascade. Watch the episode, share it with someone who’s been panicked by an A1C label, and use the questions above to bring the conversation back to reality.
Learn more about repairing the American healthcare system, by reading our book A Return to Healing.
Reviewer’s note (Dr. Alan Roth)
I reviewed this post for clarity and balance. Our goal is not to dismiss risk markers, but to push back on fear-based messaging and protocol-driven overreach. Prevention works best when it’s personalized, relationship-based, and focused on the changes that actually improve health.
Prediabetes Diagnosis Myth FAQ
Is a prediabetes diagnosis the same as having diabetes?
No. Prediabetes is typically a risk label based on tests like A1C or fasting glucose. It can signal increased risk, but it isn’t the same as diabetes, and it isn’t a guarantee of progression.
What is the prediabetes test, and what does A1C mean?
A1C is an average measure of blood sugar over roughly three months. It’s useful information, but it should be interpreted in context and over time; not as a single, fear-triggering verdict.
Do most people with prediabetes develop diabetes?
Not necessarily. Risk varies widely based on lifestyle factors, weight distribution, muscle mass, sleep, stress, medication use, and other health variables. Ask your clinician about your personal risk, not the scariest population statistic.
Why do “pre-” diagnoses spread so easily?
Because they expand the pool of “patients,” increase testing and follow-up, and fit neatly into protocol-driven, high-volume medicine. This is one form of disease branding; this is true especially when paired with fear-based public messaging.
What helps most if I’ve been told I have prediabetes?
In most cases: improving diet quality, increasing activity (especially strength training), improving sleep, reducing stress, and avoiding ultra-processed foods. Those levers tend to help overall health, not just a lab label.
When should I take prediabetes more seriously?
If your numbers are rising quickly, if you have other metabolic risk factors, if you’ve had gestational diabetes, or if you have symptoms or complications, you should get individualized guidance. The point of skepticism is not neglect; it’s clarity.
