Faster, easier test could help reduce number of undiagnosed with diabetes and pre-diabetes.
The American Diabetes Association's (ADA) new Clinical Practice Recommendations being published as a supplement to the January issue of Diabetes Care call for the addition of the A1c test as a means of diagnosing diabetes and identifying pre-diabetes. The test has been recommended for years as a measure of how well people are doing to keep their blood glucose levels under control.
"We believe that use of the A1c, because it doesn't require fasting, will encourage more people to get tested for Type 2 diabetes and help further reduce the number of people who are undiagnosed but living with this chronic and potentially life-threatening disease. Additionally, early detection can make an enormous difference in a person's quality of life," said Richard M. Bergenstal, MD, President-Elect, Medicine & Science, ADA.
"Unlike many chronic diseases, Type 2 diabetes actually can be prevented, as long as lifestyle changes are made while blood glucose levels are still in the pre-diabetes range."
A1c is measured in terms of percentages. The test measures a person's average blood glucose levels over a period of up to three months and previously had been used only to determine how well people were maintaining control of their diabetes over time. A person without diabetes would have an A1c of about 5 percent.
Under the new recommendations, which are revised every year to reflect the most current available scientific research, an A1c of 5.7 -- 6.4 percent would indicate that blood glucose levels were in the pre-diabetic range, meaning higher than normal but not yet high enough for a diagnosis of diabetes. That diagnosis would occur once levels rose to an A1c of 6.5 percent or higher.
The ADA recommends that most people with diabetes maintain a goal of keeping A1c levels at or below 7 percent in order to properly manage their disease. Research shows that controlling blood glucose levels helps to prevent serious diabetes-related complications, such as kidney disease, nerve damage and problems with the eyes and gums.
The A1c would join two previous diagnostic tests for diabetes, Fasting Plasma Glucose (FPG) and the Oral Glucose Tolerance Test (OGTT), both of which require overnight fasting. Because the A1c is a simple blood test and does not require fasting, allowing patients this option could increase willingness to get tested, thereby reducing the number of people who have Type 2 diabetes but don't yet know it.
According to the Centers for Disease Control and Prevention, one-fourth of all Americans with diabetes, or 5.7 million people, don't realize they have it. Another 57 million have pre-diabetes and 1.6 million new diagnoses are made every year.
Showing posts with label communication diabetes. Show all posts
Showing posts with label communication diabetes. Show all posts
Thursday, April 14, 2011
Tuesday, April 12, 2011
What Are These Dry Patches on My Face?
Q: When my diabetes acts up, I notice that dry patches break out on my face. Why might this happen, and what could it be?
A: I need more information to answer your question definitively, but it could be either tinea versicolor or tinea corporis, two types of fungal infection. Unfortunately, neither really fits your description. High blood sugar levels, however, can contribute to the development of fungal infections, which are treated with antifungal creams. Next time you experience an outbreak, see your doctor for a visual diagnosis, a comprehensive examination, and treatment. Other types of rashes associated with diabetes are Acanthosis nigricans, which usually appears as a darkening around the neck and other skin folds, and Necrobiosis lipoidica, which occurs as patches that turn into yellowish plaques on the legs.
A: I need more information to answer your question definitively, but it could be either tinea versicolor or tinea corporis, two types of fungal infection. Unfortunately, neither really fits your description. High blood sugar levels, however, can contribute to the development of fungal infections, which are treated with antifungal creams. Next time you experience an outbreak, see your doctor for a visual diagnosis, a comprehensive examination, and treatment. Other types of rashes associated with diabetes are Acanthosis nigricans, which usually appears as a darkening around the neck and other skin folds, and Necrobiosis lipoidica, which occurs as patches that turn into yellowish plaques on the legs.
Monday, February 28, 2011
Only 7% of the 60 Million with Prediabetes Are Aware
Measuring glycated hemoglobin levels may be an appropriate means of catching patients with prediabetes....
Ronald Ackerman, MD, MPH, of Indiana University, and colleagues reported in Preventive Medicine that, HbA1c testing yielded similar probabilities for developing diabetes and heart disease as those estimated by using the 2003 American Diabetes Association definition for prediabetes. "The A1c test may provide a badly needed, clinically practical indicator of the composite risk for incident diabetes and cardiovascular disease," they wrote.
Fasting plasma glucose and two-hour plasma glucose, two commonly used tests for assessing diabetes and prediabetes, are limited because they require a patient to return on a separate day after an overnight fast and remain in the office for 2-3 hours which is a potential barrier to test completion, the researchers said.
Measuring HbA1c is easier -- it requires only one blood draw. In June 2009, the International Expert Committee, which represents several major diabetes groups, recommended using HbA1c to diagnose diabetes.
The recommendations of the committee have stirred up some controversy, still, the researchers said, only about 7% of patients with prediabetes -- who are thus at risk for later diabetes and heart disease -- are aware of their status.
To estimate the risks of developing diabetes and cardiovascular disease for adults with different HbA1c levels, Ackerman and colleagues assessed data from the National Health and Nutrition Examination Survey (NHANES) 2003-2006.
Among adults who met the 2003 ADA definition for prediabetes, the probabilities for developing Type 2 disease over 7.5 years and cardiovascular disease over 10 years were 33.5% and 10.7%, respectively.
The researchers found that using HbA1c alone -- with a range of 5.5% to 6.5% defining prediabetes -- would identify a population with comparable risks for diabetes and heart disease (32.4% and 11.4%, respectively).
But using a slightly higher cutoff -- beginning at 5.7% -- would identify increased risks of 41.3% for diabetes and 13.3% for heart disease.
These risks are comparable to those seen in patients enrolled in the Diabetes Prevention Program, which had an enrollment criteria of both elevated fasting plasma glucose and impaired glucose tolerance, the researchers said.
Thus, they concluded, using a bottom cutoff of 5.7% for diagnosing prediabetes may be more appropriate.
Either way, they said, HbA1c measurement "should be considered a means of identifying greater numbers of patients at risk for diabetes and heart disease" -- especially because "of its practical nature and wide availability."
The study was limited by its use of cross-sectional data, and it may be lacking in generalizability. For instance, a greater number of African Americans would be identified as having prediabetes than if using fasting plasma glucose or two-hour plasma glucose testing, the researchers noted.
Ronald Ackerman, MD, MPH, of Indiana University, and colleagues reported in Preventive Medicine that, HbA1c testing yielded similar probabilities for developing diabetes and heart disease as those estimated by using the 2003 American Diabetes Association definition for prediabetes. "The A1c test may provide a badly needed, clinically practical indicator of the composite risk for incident diabetes and cardiovascular disease," they wrote.
Fasting plasma glucose and two-hour plasma glucose, two commonly used tests for assessing diabetes and prediabetes, are limited because they require a patient to return on a separate day after an overnight fast and remain in the office for 2-3 hours which is a potential barrier to test completion, the researchers said.
Measuring HbA1c is easier -- it requires only one blood draw. In June 2009, the International Expert Committee, which represents several major diabetes groups, recommended using HbA1c to diagnose diabetes.
The recommendations of the committee have stirred up some controversy, still, the researchers said, only about 7% of patients with prediabetes -- who are thus at risk for later diabetes and heart disease -- are aware of their status.
To estimate the risks of developing diabetes and cardiovascular disease for adults with different HbA1c levels, Ackerman and colleagues assessed data from the National Health and Nutrition Examination Survey (NHANES) 2003-2006.
Among adults who met the 2003 ADA definition for prediabetes, the probabilities for developing Type 2 disease over 7.5 years and cardiovascular disease over 10 years were 33.5% and 10.7%, respectively.
The researchers found that using HbA1c alone -- with a range of 5.5% to 6.5% defining prediabetes -- would identify a population with comparable risks for diabetes and heart disease (32.4% and 11.4%, respectively).
But using a slightly higher cutoff -- beginning at 5.7% -- would identify increased risks of 41.3% for diabetes and 13.3% for heart disease.
These risks are comparable to those seen in patients enrolled in the Diabetes Prevention Program, which had an enrollment criteria of both elevated fasting plasma glucose and impaired glucose tolerance, the researchers said.
Thus, they concluded, using a bottom cutoff of 5.7% for diagnosing prediabetes may be more appropriate.
Either way, they said, HbA1c measurement "should be considered a means of identifying greater numbers of patients at risk for diabetes and heart disease" -- especially because "of its practical nature and wide availability."
The study was limited by its use of cross-sectional data, and it may be lacking in generalizability. For instance, a greater number of African Americans would be identified as having prediabetes than if using fasting plasma glucose or two-hour plasma glucose testing, the researchers noted.
Friday, December 24, 2010
When to Test Children for Diabetes
Q: My husband is a type 1 diabetic, and we didn't know that until he went for a physical and the doctor said his body was in "ketosis" (shutting itself down). We didn't expect that since he looked healthy, and we didn't recognize any symptoms except frequent urination. At what age should we have our three children (ages 13, 15, and 16) checked? Are there more obvious signs in children? Do you recommend any particular diet as a starting point for better eating? Sorry for the many questions, I am just trying to keep my info straight. Thank you very much in advance for your time in answering this. Have a great day.
— Christina, Kansas
A:
These are all great questions. Discovering that you or a loved one has type 1 diabetes can be overwhelming — and troubling to parents who worry that their children are at risk of developing the disease. How wonderful that you are thinking about trying to prevent that from happening!
There isn't a definitive answer to your question regarding early screening. First of all, even though your husband has type 1 diabetes, it does not mean that your children will invariably develop the disease. In fact, very few children of diabetic parents do. The bad news is that we do not have a way to determine who will and who won't. Second, even when we know the specific inherited tendencies for diabetes, there are many factors in the environment that are yet undiscovered triggers. If we knew these factors, we might then be able to work on reducing their influence. Third, we do not know the rate at which a person who carries the genetic risk actually develops diabetes. They may develop the disease early or it may take many years for diabetes to establish a foothold. Fourth, we do not have an effective treatment or preventive measure to stave off type 1 diabetes among those who are at greatest risk of developing it.
In light of all these factors, the best way to move forward is to do the following:
Make sure your children get regular checkups and talk to your pediatrician about new developments in early diagnosis and prevention efforts. There are ongoing studies, the results of which will teach us more about how to proceed. There might also be research projects that your children might participate in that may give them access to genetic and immunology tests not available to the general public. These tests can give you a better idea of your children's specific odds of developing diabetes.Have your children undergo blood glucose tests starting now, biannually or annually, to prevent severe symptoms such as ketosis from being the stimulus for a diagnosis.
Watch out for the following signs and symptoms: excessive thirst, frequent urination, weight loss, fatigue, or blurred vision; and much less common signs of ketosis, including nausea and vomiting, abdominal pain, lethargy, and decreased alertness and rapid breathing. These are the same signs and symptoms as in adults.While there are no specific dietary supplements or diet recommendations, a healthy lifestyle and maintaining a healthy weight will help in general. Specific recommendations depend on your children's caloric needs, activity level, and preferences. I frequently tell my patients that their first loyalty is to nutrition — making sure they have adequate nutrients (i.e., vitamins, minerals, and protein intake) necessary for survival. In the children's case, it is important to take their growth and developmental needs into account. You might consult a dietitian for specific suggestions.
Finally, coping with a diabetic parent can be a frightening experience for children. I would advise that you and your husband normalize the daily routines of his care, which include home blood glucose testing, doctor's visits, diet and exercise regimens, insulin injections, and discussing the symptoms of high and low sugar levels. This way, you can avoid crises and show your children that diabetes is a condition that can be managed as long as you take care of yourself. This knowledge will help them a great deal in the event that they are someday diagnosed with diabetes, however small the odds may be. Best wishes to you and your husband and children. I hope all goes well.
— Christina, Kansas
A:
These are all great questions. Discovering that you or a loved one has type 1 diabetes can be overwhelming — and troubling to parents who worry that their children are at risk of developing the disease. How wonderful that you are thinking about trying to prevent that from happening!
There isn't a definitive answer to your question regarding early screening. First of all, even though your husband has type 1 diabetes, it does not mean that your children will invariably develop the disease. In fact, very few children of diabetic parents do. The bad news is that we do not have a way to determine who will and who won't. Second, even when we know the specific inherited tendencies for diabetes, there are many factors in the environment that are yet undiscovered triggers. If we knew these factors, we might then be able to work on reducing their influence. Third, we do not know the rate at which a person who carries the genetic risk actually develops diabetes. They may develop the disease early or it may take many years for diabetes to establish a foothold. Fourth, we do not have an effective treatment or preventive measure to stave off type 1 diabetes among those who are at greatest risk of developing it.
In light of all these factors, the best way to move forward is to do the following:
Make sure your children get regular checkups and talk to your pediatrician about new developments in early diagnosis and prevention efforts. There are ongoing studies, the results of which will teach us more about how to proceed. There might also be research projects that your children might participate in that may give them access to genetic and immunology tests not available to the general public. These tests can give you a better idea of your children's specific odds of developing diabetes.Have your children undergo blood glucose tests starting now, biannually or annually, to prevent severe symptoms such as ketosis from being the stimulus for a diagnosis.
Watch out for the following signs and symptoms: excessive thirst, frequent urination, weight loss, fatigue, or blurred vision; and much less common signs of ketosis, including nausea and vomiting, abdominal pain, lethargy, and decreased alertness and rapid breathing. These are the same signs and symptoms as in adults.While there are no specific dietary supplements or diet recommendations, a healthy lifestyle and maintaining a healthy weight will help in general. Specific recommendations depend on your children's caloric needs, activity level, and preferences. I frequently tell my patients that their first loyalty is to nutrition — making sure they have adequate nutrients (i.e., vitamins, minerals, and protein intake) necessary for survival. In the children's case, it is important to take their growth and developmental needs into account. You might consult a dietitian for specific suggestions.
Finally, coping with a diabetic parent can be a frightening experience for children. I would advise that you and your husband normalize the daily routines of his care, which include home blood glucose testing, doctor's visits, diet and exercise regimens, insulin injections, and discussing the symptoms of high and low sugar levels. This way, you can avoid crises and show your children that diabetes is a condition that can be managed as long as you take care of yourself. This knowledge will help them a great deal in the event that they are someday diagnosed with diabetes, however small the odds may be. Best wishes to you and your husband and children. I hope all goes well.
Monday, September 13, 2010
Motivating a Teen With Type 1 Diabetes
Q: My 16-year-old son is having difficulty staying motivated to consistently take care of his diabetic needs like checking his blood sugar often and keeping a log book. His doctor hospitalized him at the start of school to establish better control — his first hospitalization since diagnosis with type 1 10 years ago. He is active in sports, likes to stay up late, eats only 15 to 30 carbs for breakfast, and is on a regimen of Lantus twice daily and Humalog for meals and highs (injections, no pump.) His last A1c was 10.3. Do you have suggestions for helping him be motivated to care for himself?
— Janelle, Nebraska
A:
That's a tough situation indeed. Many of my colleagues who care for teenaged patients have similar moments of exasperation. As you know so well, the teen years are filled with layers of complexities for kids themselves and their families. There are many issues that become priorities in any teenager's life, among them the challenges presented by their own growth and development. These issues become even more complicated for a teenager with diabetes.
Adolescence is a time of great change, and with physical growth come greater insulin requirements. And with rebellion, experimentation and the need for peer acceptance comes greater non-adherence. In addition, while trying to find and assert their own identity, teens become less reliant on mom and dad. The challenge for parents is equally great and the solutions, unfortunately, are usually time-consuming and labor-intensive.
Your son is doing certain things for which he should be congratulated, including getting involved in sports, carbohydrate counting and injecting his insulin several times a day. These are feats that many of my adult patients do not accomplish.
Motivating your son further might require one or more of the following:
1. Understanding his attitude towards frequent glucose checks and his coping and problem-solving skills will help you in identifying specific ways to help him change his behavior.
2. Assessing his knowledge-base about the need to check his sugar levels and his knowledge of glucose and insulin balance during athletic engagements can identify gaps, which can be easily addressed.
3. Understanding his priorities and academic responsibilities and showing empathy to these daily challenges can help you provide a structure that is conducive to checking blood glucose levels and diabetes self-management.
4. Exploring the barriers of checking his sugar level at school, as well as the challenges he might face from his peers about having diabetes, doing frequent glucose checks and injecting insulin, might uncover issues that he finds difficult to discuss. Since you live in a small town, there might not be many other kids living with diabetes. Perhaps your son can connect with other kids with diabetes via the Internet for peer support. A good place to start is the American Diabetes Association.
5. More importantly, understanding your communication pattern with your son and assessing its effectiveness will help you find a happy medium between too much involvement and too little engagement. Empathy is important, but so is leaving him room to make his own decisions. In other words, asking him how he can meet the challenge of good glucose control might also be more effective than telling him to make a specific change in his behavior.
6. When exploring these areas, you should enlist the help of your son's doctor as well as a psychologist or diabetes educator in your area. In addition, if you find that there are barriers at school that prevent your son from checking glucose, you should involve the school and teachers. Some teens like taking leadership roles in teaching others about diabetes, advocating for students with diabetes and organizing groups. This gives them the motivation for also managing their diabetes better. Teachers can be recruited to stage such a forum for your son and perhaps other teens. Other possible venues you might explore include religious organizations, social clubs, and community fitness centers.
Finally, this might be time to consider the insulin pump, which many teens like because it allows them better control. I wish you much luck and hope you will write back with further questions or to tell us how you and your son are doing.
— Janelle, Nebraska
A:
That's a tough situation indeed. Many of my colleagues who care for teenaged patients have similar moments of exasperation. As you know so well, the teen years are filled with layers of complexities for kids themselves and their families. There are many issues that become priorities in any teenager's life, among them the challenges presented by their own growth and development. These issues become even more complicated for a teenager with diabetes.
Adolescence is a time of great change, and with physical growth come greater insulin requirements. And with rebellion, experimentation and the need for peer acceptance comes greater non-adherence. In addition, while trying to find and assert their own identity, teens become less reliant on mom and dad. The challenge for parents is equally great and the solutions, unfortunately, are usually time-consuming and labor-intensive.
Your son is doing certain things for which he should be congratulated, including getting involved in sports, carbohydrate counting and injecting his insulin several times a day. These are feats that many of my adult patients do not accomplish.
Motivating your son further might require one or more of the following:
1. Understanding his attitude towards frequent glucose checks and his coping and problem-solving skills will help you in identifying specific ways to help him change his behavior.
2. Assessing his knowledge-base about the need to check his sugar levels and his knowledge of glucose and insulin balance during athletic engagements can identify gaps, which can be easily addressed.
3. Understanding his priorities and academic responsibilities and showing empathy to these daily challenges can help you provide a structure that is conducive to checking blood glucose levels and diabetes self-management.
4. Exploring the barriers of checking his sugar level at school, as well as the challenges he might face from his peers about having diabetes, doing frequent glucose checks and injecting insulin, might uncover issues that he finds difficult to discuss. Since you live in a small town, there might not be many other kids living with diabetes. Perhaps your son can connect with other kids with diabetes via the Internet for peer support. A good place to start is the American Diabetes Association.
5. More importantly, understanding your communication pattern with your son and assessing its effectiveness will help you find a happy medium between too much involvement and too little engagement. Empathy is important, but so is leaving him room to make his own decisions. In other words, asking him how he can meet the challenge of good glucose control might also be more effective than telling him to make a specific change in his behavior.
6. When exploring these areas, you should enlist the help of your son's doctor as well as a psychologist or diabetes educator in your area. In addition, if you find that there are barriers at school that prevent your son from checking glucose, you should involve the school and teachers. Some teens like taking leadership roles in teaching others about diabetes, advocating for students with diabetes and organizing groups. This gives them the motivation for also managing their diabetes better. Teachers can be recruited to stage such a forum for your son and perhaps other teens. Other possible venues you might explore include religious organizations, social clubs, and community fitness centers.
Finally, this might be time to consider the insulin pump, which many teens like because it allows them better control. I wish you much luck and hope you will write back with further questions or to tell us how you and your son are doing.
Subscribe to:
Posts (Atom)
