022 From early detection to overdiagnosis: a qualitative exploration of lived experiences with prediabetes and mild diabetes in Canada

Objectives The terms ‘prediabetes’ (6.0% ≤ A1c ≤ 6.4%) and ‘mild diabetes’ (6.5% ≤ A1c ≤ 7.0%) describe conditions where blood sugar levels are elevated but still fall within the treatment targets set by national guidelines and specialty societies for type 2 diabetes. While some view these diagnostic labels as offering opportunities for early intervention and delaying disease progression, there are concerns regarding overdiagnosis, with potential consequences including over-testing and overtreatment. Currently, there is limited understanding of patient experiences and priorities regarding the diagnosis and management of pre- or mild diabetes. Method We conducted a qualitative study engaging individuals recently diagnosed with pre- or mild diabetes, in collaboration with health services researchers, healthcare professionals, and patient research partners. Following the Patient Engagement Framework from the Strategy for Patient Oriented Research (SPOR), we worked with three patient research partners from British Columbia, Alberta, and Ontario, Canada. Together, we obtained funding, designed and conducted pre-interview surveys and interviews, and analyzed data to better understand patient experiences and priorities. We used reflexive thematic analysis, following Braun and Clarke’s approach, to develop meaning-based themes. Results Twelve adults have participated in this study so far, with four to eight more anticipated. Of all participants 66.7% had prediabetes and 33.3% had mild diabetes. The majority (58.3%) of participants were in the 40–60 years age range. We developed three main themes: i) While experiencing a range of negative emotions following initial diagnosis, participants often expressed gratitude for early detection and symptom awareness, ii) valued receiving information and education early on, and iii) desired individualized treatment approaches that aligned with their priorities, taking health equity factors into account. As an important subtheme under the third theme, while lifestyle modification was often preferred as the initial approach, many participants also acknowledged pharmacotherapy as a viable option when lifestyle changes had been maximized or could no longer be further optimized. Conclusions This study focuses on the balance between the perceived benefits of early intervention and the risks of overdiagnosis and its consequences. Understanding patient experiences and perspectives in early-stage diabetes highlights the need for shared decision-making and individualized care. Insights will guide the development of tools and resources to help both patients and clinicians shape and navigate informed, patient-centered care. Future work is needed to clarify the evidence for early diagnosis or treatment of people with pre- or mild diabetes to avoid overdiagnosis and overtreatment.

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