Undiagnosed Diabetes

[Guest guest]

Undiagnosed Diabetes

Diabetes results from the body's failure to produce enough insulin or to use

it properly. The disease, which afflicts an estimated 17 million Americans

of all ages can be fatal, or result in blindness or amputations. A panel of

experts in the field also advises doctors to take steps to identify people

who have pre-diabetes so that preventive steps can be taken to delay the

onset of diabetes.

There are 3 main types of diabetes. Type 1 occurs in children and young

adults. Type 2 diabetes is also known as adult onset diabetes, and it

accounts for 90% to 95% of the diabetes in the U.S. Type 3 diabetes is also

called gestational diabetes and affects about 2% to 5% of pregnant women,

and usually goes away after they give birth.

The number of people with diabetes has tripled in the past 30 years, and

diabetes now ranks as one of the most expensive health problem in the U.S.

It is estimated that the disease cost about $98 billion in 1997, the last

year for which there is an estimate given by the American Diabetes

Association.

A panel of experts recommended that doctors screen patients who are

overweight and who are 45 or older for pre-diabetes. While white people have

a lower risk factor (7.8%) than do blacks (13 %), Hispanics (10.2%) or

American Indians or Alaska natives (15.1%) the testing is important for

everyone. A family history of diabetes is also important in determining both

diabetes and pre-diabetes inclinations.

There are two blood tests that identify diabetes that can also be used to

identify pre-diabetes. One of the tests measures for impaired glucose

tolerance wherein a blood-sugar measure between 140 and 199 milligrams a

deciliter indicates pre-diabetes. The other test detects impaired fasting

glucose. If the blood-sugar level after an overnight fast is between 110 and

125 milligrams per deciliter, that also indicates a pre-diabetes condition.

Dr. Edelman and colleagues (J Gen. Med. January 2002) has done

research on the prevalence and severity of undiagnosed diabetes in a

clinical outpatient setting, as opposed to a hospital in-patient setting or

a general population setting. The study involved 1253 outpatients age 45 to

65, who where healthy as far as a diagnosis of diabetes and were being seen

in the outpatient clinic.

This meant that there was no record of a diabetic diagnosis in their medical

history. These individuals were then followed for 2.5 years at the Durham

Veterans Medical Center. All were initially screened for diabetes using a

hemoglobin A1c test. If an individual obtained a score equal to or greater

than 6.0% on this test, they were then given a fasting plasma glucose test.

Using scores obtained on these two tests for diabetes diagnosis (Alc score

>7.0% and fasting plasma glucose greater than 7 mm/L), they found 4.5% of

these patients had undiagnosed diabetes. In this group, 61% had a " treatment

altering diagnosis " suggesting that they required initiation of treatment

for diabetes or a change in the treatment of a comorbid illness (i.e.,

hypertension, hyperlipidemia).

Dr. Edelman, an assistant professor of medicine at Duke University Medical

Center states: " The benefits of detecting diabetes, such as preventing heart

attacks, generally accrued 10 to 15 years after the diagnosis, but there

could be similar benefit to screening older patients. " He feels there is a

greater need to test for diabetes in older people and that people up to age

80 might benefit from diabetes screening. He indicates that treating the

diabetes may result in short-term improvement in cognition, a not so

insignificant benefit in the aging process.

Approximately 15.6 million people in US aged >20 yrs. (7.8% of the

population) suffer from diabetes mellitus. Diabetes mellitus is 10 times

more prevalent in individuals over 65 years of age than in those 20 to 40

years. The incidence of type 2 diabetes increases dramatically with

increasing age, affecting >10% of the elderly population (>65 years) in the

US. Older subjects with diabetes have more complications than younger

counterparts, as well as higher morbidity and mortality rates compared with

age-matched subjects without diabetes. The Framingham study described the

development of diabetes in later life to be associated with hypertension,

vascular lesions, elevated very-low-density lipoprotein (VLDL) cholesterol,

use of diuretics and obesity.

The patient with diabetes is twenty-five times more likely to become blind,

seventeen times more likely to develop kidney disease, twenty times more

likely to develop gangrene and two times more likely to suffer a stroke or

heart attack than age matched cohorts without disabilities.

A key objective in the treatment of diabetes is normalization of the blood

glucose level. Dietary control and exercise are a first line therapy.

Carbohydrates and glucose in particular, are an important source of energy

for most living organisms. Tissues such as the brain need glucose

constantly, and low concentrations of glucose can cause seizures, loss of

consciousness, and death.

High blood glucose concentrations, as found in poorly controlled diabetes,

can result in blindness, renal failure, cardiac and peripheral vascular

disease, and neuropathy. When these first line treatments are found

inadequate to control glucose level, pharmacologic treatment with oral

hypoglycemia agents becomes necessary. This would also indicate that blood

glucose concentrations have to be maintained within a narrow limit, not too

high or too low for optimal health.

Diabetes and its complications remain a huge health problem. Biotechnology

companies are racing to develop new therapies that aim to go beyond just

treating symptoms but attack the causes of the disease, in which the

pancreas shuts down or fails to produce the correct amount of insulin

hormone, causing dangerously high blood-sugar levels.

Amylin Pharmaceuticals Inc. is working on developing a genetically

engineered version of a hormone that is normally produced in pancreas cells

as insulin. At the same time it is trying to controll adverse side effects

such as weight gain, increased cholesterol and sudden drops in blood sugar,

a not so uncommon side effect of insulin therapy. Another company, Ligand

Pharmaceuticals of San Diego is researching a drug that intervenes directly

between insulin and the proteins it interacts with inside cells to regulate

blood glucose. It belongs to a group of drugs known as retinoids that work

within individual cells. Its goal is to block destructive oxygen-carrying

molecules that attack the pancreas, cause resistance to insulin and they

contribute to some serious side effects.

We would urge all individuals to consult with their primary care physicians,

check for diabetes and institute therapies necessary to bring glucose levels

within normal limits. Its future health benefit is worth the present

treatment.

[Guest guest]

June,

You¹re very welcome!

a

On 6/10/02 8:54 PM, " june dixon " <juner24@...> wrote:

> Extremely interesting a,lots of good info in this article. My sister has

> recently been diagnosed with diabetes so I welcome any information. Thanks

>

> Hugs

> June