Quaternary prevention. Prediabetes: risk, disease or overdiagnosis? The diseases which are not of great danger should not be teased by medicines (Plato, 5th century BC)
Marija Vrca Botica, Ivana Pavlić-Renar
Quaternary prevention is a contemporary critical approach to modern medicine. Its goal is the protection of patients from unnecessary medical intervention which can do more harm than good. Quaternary prevention is a part of all three preventions: primary, secondary and tertiary. Its aim is to protect a patient from overscreening and overdiagnosis which can lead to overmedicalization. As a life-long disease with diagnosis based on the agreed cutoff point of a continuous variable, diabetes is in a great risk of over-intervention. However, with a right intervention in pre-disease it is possible to postpone the disease. The challenge is to recognize the risks and intervene if they are high, the risk of disease progression is substantial, and appropriate intervention can diminish it. If the same is done for low risk it is a waste of energy and means, and the patient gains nothing but additional stress due to overdiagnosis. It has to be considered at all levels of health care, but mostly in primary care, which has been recognized by the international association of family physicians (WONCA).