Uncontrolled diabetes can control your health. Help prevent these serious diabetes complications by learning the warning signs.
People with type 2 diabetes are at increased risk of many serious health problems, including heart attack, stroke, vision loss, and amputation. But by keeping your diabetes in check — that means maintaining good blood sugar control — and knowing how to recognize a problem and what to do about it should one occur, you can prevent many of these serious complications of diabetes.
Heart Attack
Heart disease and stroke are the top causes of death and disability in people with diabetes. If you experience any of the following heart attack warning signs, call 911 immediately:
-Chest discomfort that feels like pressure, squeezing, fullness, or pain in the center of your chest, lasting for a short time or going away and returning
-Pain elsewhere, including the back, jaw, stomach, or neck; or pain in one or both arms
•Shortness of breath
•Nausea or lightheadedness
Heart attack symptoms may appear suddenly or be subtle, with only mild pain and discomfort.
Stroke
Stroke warning signs may include:
Sudden numbness or weakness in the face, arm, or leg, especially if it occurs on one side of the body
-Feeling confused
-Difficulty walking and talking and lacking coordination
-Developing a severe headache for no apparent reason
If you suddenly experience any of these stroke symptoms, call 911 immediately. As with a heart attack, immediate treatment can be the difference between life and death.
Nerve Damage
People with diabetes are at increased risk of nerve damage, or diabetic neuropathy, due to uncontrolled high blood sugar. As a result, various foot and skin problems can occur, including:
•Foot problems. Nerve damage associated with type 2 diabetes can cause a loss of feeling in your feet, which makes you more vulnerable to injury and infection. You may get a blister or cut on your foot that you don't feel and, unless you check your feet regularly, an infection can develop. Untreated infections can result in gangrene (death of tissue) and ultimately amputation of the affected limb.
•Skin problems. Diabetes can make it more difficult for your body to fight infections, causing skin problems. Various skin conditions are linked to diabetes, and even the most minor cuts or sores can turn serious fast. Any bumps, cuts, or scrapes should be cleaned and treated with an antibiotic cream and monitored carefully.
If you notice any of the following symptoms, see your doctor:
•Inflammation and tenderness anywhere on your body
•Red, itchy rash surrounded by small blisters or scales
•Cuts, sores, or blisters on your feet that are slow to heal and are not as painful as you would expect
•Numbness, tingling, or burning sensations in your hands or feet, including your fingers and toes
•Sharp pain that gets worse at night
•Muscle weakness that makes walking difficult
•Bladder infections and problems with bladder control
•Bloating, stomach pain, constipation, nausea, vomiting, or diarrhea
•Erectile dysfunction in men and vaginal dryness in women
Kidney Disease
Type 2 diabetes increases your risk of kidney disease, or diabetic nephropathy, a condition in which the blood vessels in your kidneys are damaged to the point that they cannot filter out waste properly. If left untreated, dialysis (a treatment to filter out waste products from the blood) and ultimately a kidney transplant may be needed.
Typically, you won’t notice symptoms of kidney disease until it has advanced. However, if you experience any of the following symptoms, tell your doctor:
•Swelling in your ankles and legs
•Leg cramps
•A need to go to the bathroom more often at night
•A reduction in your need for insulin
•Nausea and vomiting
•Weakness and paleness
•Itching
The best way to prevent type 2 diabetes-related kidney problems is to have your urine, blood, and blood pressure monitored regularly and to keep your blood sugar and blood pressure under control.
Eye Problems
People with type 2 diabetes are at risk of several eye conditions, including diabetic retinopathy (which affects the blood vessels in the eye), glaucoma, and cataracts. If left untreated, these conditions can cause vision loss.
Call your doctor if you notice any of these warning signs:
•Blurry vision that lasts for more than two days
•Sudden loss of vision in one or both eyes
•Floaters, black or gray spots, cobwebs, or strings that move when you move your eyes
•A sensation of seeing "flashing lights"
•Pain or pressure in one or both eyes
Hyperglycemia
Hyperglycemia means you have too much sugar in your blood. High blood sugar doesn't always produce symptoms; therefore, it is important to check your blood sugar regularly, as indicated by your doctor. When symptoms of hyperglycemia occur, they may include:
•Frequent urination
•Extreme thirst
•Feeling tired and weak
•Blurry vision Feeling hungry even after eating
If you frequently have high blood sugar, tell your doctor. He or she may need to make changes to your medication and suggest diet and lifestyle modifications to help you gain and maintain better blood sugar control.
The key to preventing many of the complications of diabetes is to keep your blood sugar at a healthy level. To do this, eat right, exercise, monitor your blood sugar as recommended by your doctor, and don't smoke.
Report any unusual signs or symptoms to your doctor. Together you can work to prevent these diabetes-related health complications.
By Hedy Marks, MPH
Medically reviewed by Pat F. Bass III, MD, MPH
Showing posts with label kidney disease. Show all posts
Showing posts with label kidney disease. Show all posts
Thursday, October 20, 2011
Sunday, June 5, 2011
Antifibrotic May Slow Diabetic Nephropathy
Diabetic nephropathy may not just slow but may actually improve with the novel antifibrotic agent pirfenidone (Esbriet)....
Kidney function continued to drop in diabetic kidney disease patients without treatment, but rose significantly with a low dose of pirfenidone over one year.
Mean estimated glomerular filtration rate (eGFR) rose by an average 3.3 ml/min per 1.73 m2 with 1,200-mg pirfenidone, but fell by 2.2 ml/min per 1.73 m2 with placebo in the study (P=0.026). This kind of improvement hasn't been seen with the current standard of care with renin-angiotensin system (RAS) blockers, the researchers noted, calling the results promising.
"Even when maximized, [RAS blockers] may decrease rate of progression, but they do not arrest or reverse diabetic nephropathy," wrote Dr. Sharma, of the University of California San Diego and VA Medical Center in La Jolla.
When diabetes patients develop even low levels of kidney disease, their risk of cardiovascular and other complications requiring hospitalization goes up, Sharma explained.
Pirfenidone is under development for treatment of idiopathic pulmonary fibrosis. An FDA advisory panel gave the thumbs up to the drug early last year, but the agency ultimately turned it down, citing the need for further efficacy data.
But since fibrosis and inflammation play a role in progression of diabetic kidney damage as well, Sharma's group did an exploratory study in 77 patients with Type 1 or Type 2 diabetes and established nephropathy marked by elevated albuminuria and eGFR of 20 to 75 ml/min per 1.73 m2.
The double-blind, placebo-controlled, dose-ranging protocol randomized patients to placebo or pirfenidone at either 1,200 or 2,400 mg per day on top of their stable regimen; study participants had both their diabetes and their blood pressure under good control.
During the study, no patient in the low-dose pirfenidone group was put on dialysis by their primary provider, whereas four placebo-group patients initiated dialysis, as did one in the 2,400-mg pirfenidone group.
However, a larger study is needed to validate any difference in rates of progression to dialysis, Sharma warned. The paper also noted that a larger study was needed to replicate these results.
Change in urine albumin-to-creatinine ratio did not differ significantly among groups. Nor did the researchers find any biomarkers that could predict benefit from pirfenidone.
Sharma said his group is actively looking for such biomarkers and noted that their exploratory study is just one step on the way to a larger-scale trial to validate the benefits for diabetic nephropathy.
Practice Pearls:
Explain that an exploratory study found that 54 weeks of 1200 mg of the new antifibrotic drug, pirfenidone, improved the mean estimated glomerular filtration rate (eGFR) in patients with existing diabetic nephropathy due to Type 1 or Type 2 diabetes.
Note that the eGFR after one year was not significantly different between those receiving 2400 mg of the drug and placebo and the study had a high drop-out rate.
Journal of the American Society of Nephrology, April 2011.
Kidney function continued to drop in diabetic kidney disease patients without treatment, but rose significantly with a low dose of pirfenidone over one year.
Mean estimated glomerular filtration rate (eGFR) rose by an average 3.3 ml/min per 1.73 m2 with 1,200-mg pirfenidone, but fell by 2.2 ml/min per 1.73 m2 with placebo in the study (P=0.026). This kind of improvement hasn't been seen with the current standard of care with renin-angiotensin system (RAS) blockers, the researchers noted, calling the results promising.
"Even when maximized, [RAS blockers] may decrease rate of progression, but they do not arrest or reverse diabetic nephropathy," wrote Dr. Sharma, of the University of California San Diego and VA Medical Center in La Jolla.
When diabetes patients develop even low levels of kidney disease, their risk of cardiovascular and other complications requiring hospitalization goes up, Sharma explained.
Pirfenidone is under development for treatment of idiopathic pulmonary fibrosis. An FDA advisory panel gave the thumbs up to the drug early last year, but the agency ultimately turned it down, citing the need for further efficacy data.
But since fibrosis and inflammation play a role in progression of diabetic kidney damage as well, Sharma's group did an exploratory study in 77 patients with Type 1 or Type 2 diabetes and established nephropathy marked by elevated albuminuria and eGFR of 20 to 75 ml/min per 1.73 m2.
The double-blind, placebo-controlled, dose-ranging protocol randomized patients to placebo or pirfenidone at either 1,200 or 2,400 mg per day on top of their stable regimen; study participants had both their diabetes and their blood pressure under good control.
During the study, no patient in the low-dose pirfenidone group was put on dialysis by their primary provider, whereas four placebo-group patients initiated dialysis, as did one in the 2,400-mg pirfenidone group.
However, a larger study is needed to validate any difference in rates of progression to dialysis, Sharma warned. The paper also noted that a larger study was needed to replicate these results.
Change in urine albumin-to-creatinine ratio did not differ significantly among groups. Nor did the researchers find any biomarkers that could predict benefit from pirfenidone.
Sharma said his group is actively looking for such biomarkers and noted that their exploratory study is just one step on the way to a larger-scale trial to validate the benefits for diabetic nephropathy.
Practice Pearls:
Explain that an exploratory study found that 54 weeks of 1200 mg of the new antifibrotic drug, pirfenidone, improved the mean estimated glomerular filtration rate (eGFR) in patients with existing diabetic nephropathy due to Type 1 or Type 2 diabetes.
Note that the eGFR after one year was not significantly different between those receiving 2400 mg of the drug and placebo and the study had a high drop-out rate.
Journal of the American Society of Nephrology, April 2011.
Friday, December 31, 2010
6 Emergency Complications of Type 2 Diabetes
6 Emergency Complications of Type 2 Diabetes
Uncontrolled diabetes can control your health. Help prevent these serious diabetes complications by learning the warning signs.
People with type 2 diabetes are at increased risk of many serious health problems, including heart attack, stroke, vision loss, and amputation. But by keeping your diabetes in check — that means maintaining good blood sugar control — and knowing how to recognize a problem and what to do about it should one occur, you can prevent many of these serious complications of diabetes.
Heart Attack
Heart disease and stroke are the top causes of death and disability in people with diabetes. If you experience any of the following heart attack warning signs, call 911 immediately:
• Chest discomfort that feels like pressure, squeezing, fullness, or pain in the center of your chest, lasting for a short time or going away and returning
• Pain elsewhere, including the back, jaw, stomach, or neck; or pain in one or both arms
• Shortness of breath
• Nausea or lightheadedness
Heart attack symptoms may appear suddenly or be subtle, with only mild pain and discomfort.
Stroke
Stroke warning signs may include:
• Sudden numbness or weakness in the face, arm, or leg, especially if it occurs on one side of the body
• Feeling confused
• Difficulty walking and talking and lacking coordination
• Developing a severe headache for no apparent reason
If you suddenly experience any of these stroke symptoms, call 911 immediately. As with a heart attack, immediate treatment can be the difference between life and death.
Nerve Damage
People with diabetes are at increased risk of nerve damage, or diabetic neuropathy, due to uncontrolled high blood sugar. As a result, various foot and skin problems can occur, including:
• Foot problems. Nerve damage associated with type 2 diabetes can cause a loss of feeling in your feet, which makes you more vulnerable to injury and infection. You may get a blister or cut on your foot that you don't feel and, unless you check your feet regularly, an infection can develop. Untreated infections can result in gangrene (death of tissue) and ultimately amputation of the affected limb.
• Skin problems. Diabetes can make it more difficult for your body to fight infections, causing skin problems. Various skin conditions are linked to diabetes, and even the most minor cuts or sores can turn serious fast. Any bumps, cuts, or scrapes should be cleaned and treated with an antibiotic cream and monitored carefully.
If you notice any of the following symptoms, see your doctor:
• Inflammation and tenderness anywhere on your body
• Red, itchy rash surrounded by small blisters or scales
• Cuts, sores, or blisters on your feet that are slow to heal and are not as painful as you would expect
• Numbness, tingling, or burning sensations in your hands or feet, including your fingers and toes
• Sharp pain that gets worse at night
• Muscle weakness that makes walking difficult
• Bladder infections and problems with bladder control
• Bloating, stomach pain, constipation, nausea, vomiting, or diarrhea
• Erectile dysfunction in men and vaginal dryness in women
Kidney Disease
Type 2 diabetes increases your risk of kidney disease, or diabetic nephropathy, a condition in which the blood vessels in your kidneys are damaged to the point that they cannot filter out waste properly. If left untreated, dialysis (a treatment to filter out waste products from the blood) and ultimately a kidney transplant may be needed.
Typically, you won’t notice symptoms of kidney disease until it has advanced. However, if you experience any of the following symptoms, tell your doctor:
• Swelling in your ankles and legs
• Leg cramps
• A need to go to the bathroom more often at night
• A reduction in your need for insulin
• Nausea and vomiting
• Weakness and paleness
• Itching
The best way to prevent type 2 diabetes-related kidney problems is to have your urine, blood, and blood pressure monitored regularly and to keep your blood sugar and blood pressure under control.
Eye Problems
People with type 2 diabetes are at risk of several eye conditions, including diabetic retinopathy (which affects the blood vessels in the eye), glaucoma, and cataracts. If left untreated, these conditions can cause vision loss.
Call your doctor if you notice any of these warning signs:
• Blurry vision that lasts for more than two days
• Sudden loss of vision in one or both eyes
• Floaters, black or gray spots, cobwebs, or strings that move when you move your eyes
• A sensation of seeing "flashing lights"
• Pain or pressure in one or both eyes
Hyperglycemia
Hyperglycemia means you have too much sugar in your blood. High blood sugar doesn't always produce symptoms; therefore, it is important to check your blood sugar regularly, as indicated by your doctor. When symptoms of hyperglycemia occur, they may include:
• Frequent urination
• Extreme thirst
• Feeling tired and weak
• Blurry vision
• Feeling hungry even after eating
If you frequently have high blood sugar, tell your doctor. He or she may need to make changes to your medication and suggest diet and lifestyle modifications to help you gain and maintain better blood sugar control.
The key to preventing many of the complications of diabetes is to keep your blood sugar at a healthy level. To do this, eat right, exercise, monitor your blood sugar as recommended by your doctor, and don't smoke.
Report any unusual signs or symptoms to your doctor immediately. Together you can work to prevent these diabetes-related health complications.
By Hedy Marks, MPH
Medically reviewed by Pat F. Bass III, MD, MPH
Uncontrolled diabetes can control your health. Help prevent these serious diabetes complications by learning the warning signs.
People with type 2 diabetes are at increased risk of many serious health problems, including heart attack, stroke, vision loss, and amputation. But by keeping your diabetes in check — that means maintaining good blood sugar control — and knowing how to recognize a problem and what to do about it should one occur, you can prevent many of these serious complications of diabetes.
Heart Attack
Heart disease and stroke are the top causes of death and disability in people with diabetes. If you experience any of the following heart attack warning signs, call 911 immediately:
• Chest discomfort that feels like pressure, squeezing, fullness, or pain in the center of your chest, lasting for a short time or going away and returning
• Pain elsewhere, including the back, jaw, stomach, or neck; or pain in one or both arms
• Shortness of breath
• Nausea or lightheadedness
Heart attack symptoms may appear suddenly or be subtle, with only mild pain and discomfort.
Stroke
Stroke warning signs may include:
• Sudden numbness or weakness in the face, arm, or leg, especially if it occurs on one side of the body
• Feeling confused
• Difficulty walking and talking and lacking coordination
• Developing a severe headache for no apparent reason
If you suddenly experience any of these stroke symptoms, call 911 immediately. As with a heart attack, immediate treatment can be the difference between life and death.
Nerve Damage
People with diabetes are at increased risk of nerve damage, or diabetic neuropathy, due to uncontrolled high blood sugar. As a result, various foot and skin problems can occur, including:
• Foot problems. Nerve damage associated with type 2 diabetes can cause a loss of feeling in your feet, which makes you more vulnerable to injury and infection. You may get a blister or cut on your foot that you don't feel and, unless you check your feet regularly, an infection can develop. Untreated infections can result in gangrene (death of tissue) and ultimately amputation of the affected limb.
• Skin problems. Diabetes can make it more difficult for your body to fight infections, causing skin problems. Various skin conditions are linked to diabetes, and even the most minor cuts or sores can turn serious fast. Any bumps, cuts, or scrapes should be cleaned and treated with an antibiotic cream and monitored carefully.
If you notice any of the following symptoms, see your doctor:
• Inflammation and tenderness anywhere on your body
• Red, itchy rash surrounded by small blisters or scales
• Cuts, sores, or blisters on your feet that are slow to heal and are not as painful as you would expect
• Numbness, tingling, or burning sensations in your hands or feet, including your fingers and toes
• Sharp pain that gets worse at night
• Muscle weakness that makes walking difficult
• Bladder infections and problems with bladder control
• Bloating, stomach pain, constipation, nausea, vomiting, or diarrhea
• Erectile dysfunction in men and vaginal dryness in women
Kidney Disease
Type 2 diabetes increases your risk of kidney disease, or diabetic nephropathy, a condition in which the blood vessels in your kidneys are damaged to the point that they cannot filter out waste properly. If left untreated, dialysis (a treatment to filter out waste products from the blood) and ultimately a kidney transplant may be needed.
Typically, you won’t notice symptoms of kidney disease until it has advanced. However, if you experience any of the following symptoms, tell your doctor:
• Swelling in your ankles and legs
• Leg cramps
• A need to go to the bathroom more often at night
• A reduction in your need for insulin
• Nausea and vomiting
• Weakness and paleness
• Itching
The best way to prevent type 2 diabetes-related kidney problems is to have your urine, blood, and blood pressure monitored regularly and to keep your blood sugar and blood pressure under control.
Eye Problems
People with type 2 diabetes are at risk of several eye conditions, including diabetic retinopathy (which affects the blood vessels in the eye), glaucoma, and cataracts. If left untreated, these conditions can cause vision loss.
Call your doctor if you notice any of these warning signs:
• Blurry vision that lasts for more than two days
• Sudden loss of vision in one or both eyes
• Floaters, black or gray spots, cobwebs, or strings that move when you move your eyes
• A sensation of seeing "flashing lights"
• Pain or pressure in one or both eyes
Hyperglycemia
Hyperglycemia means you have too much sugar in your blood. High blood sugar doesn't always produce symptoms; therefore, it is important to check your blood sugar regularly, as indicated by your doctor. When symptoms of hyperglycemia occur, they may include:
• Frequent urination
• Extreme thirst
• Feeling tired and weak
• Blurry vision
• Feeling hungry even after eating
If you frequently have high blood sugar, tell your doctor. He or she may need to make changes to your medication and suggest diet and lifestyle modifications to help you gain and maintain better blood sugar control.
The key to preventing many of the complications of diabetes is to keep your blood sugar at a healthy level. To do this, eat right, exercise, monitor your blood sugar as recommended by your doctor, and don't smoke.
Report any unusual signs or symptoms to your doctor immediately. Together you can work to prevent these diabetes-related health complications.
By Hedy Marks, MPH
Medically reviewed by Pat F. Bass III, MD, MPH
Thursday, August 12, 2010
Lax Care of Foot Puncture Wounds Hikes Risk for Serious Infections
Bare feet are universally associated with summer, but for those who enjoy walking barefoot, a local foot and ankle surgeon warns that inattention to seemingly minor puncture wounds on the soles of your feet can allow serious infections to develop and spread.
Going barefoot heightens risk for puncture wounds, which require different treatment from cuts because the tiny holes often harbor foreign matter under the skin. Glass, nails, needles and seashells are common offenders. Regardless of the substance, anything that remains in the wound increases your chances for complications.
Puncture wounds in the feet too often are superficially treated, and it is best to get proper care within the first 24 hours to make sure anything that might be embedded in the wound is removed. Research shows 10 percent of puncture wounds do result in serious infection, but such complications can be prevented with prompt and appropriate medical attention.
The depth and relative cleanliness of a puncture wound are the main factors determining possible infection risk. Studies show 60 percent of patients who required incision and drainage of a puncture wound had something embedded. With the increasing prevalence of drug-resistant bacteria, even healthy people are getting potentially life-threatening Staph infections. So if you step on something and the skin is broken, get treated right away.
Proper treatment of a puncture wound involves thorough cleaning to decrease infection risk and tetanus shots often are needed. Following treatment, the wound should be monitored carefully at home.
Sometimes an infection can develop later and migrate to the bones. So if the wound stays red, swollen and sore after a few days, go back to the doctor for further treatment. In all cases, a puncture wound on your foot should never be taken lightly.
Going barefoot heightens risk for puncture wounds, which require different treatment from cuts because the tiny holes often harbor foreign matter under the skin. Glass, nails, needles and seashells are common offenders. Regardless of the substance, anything that remains in the wound increases your chances for complications.
Puncture wounds in the feet too often are superficially treated, and it is best to get proper care within the first 24 hours to make sure anything that might be embedded in the wound is removed. Research shows 10 percent of puncture wounds do result in serious infection, but such complications can be prevented with prompt and appropriate medical attention.
The depth and relative cleanliness of a puncture wound are the main factors determining possible infection risk. Studies show 60 percent of patients who required incision and drainage of a puncture wound had something embedded. With the increasing prevalence of drug-resistant bacteria, even healthy people are getting potentially life-threatening Staph infections. So if you step on something and the skin is broken, get treated right away.
Proper treatment of a puncture wound involves thorough cleaning to decrease infection risk and tetanus shots often are needed. Following treatment, the wound should be monitored carefully at home.
Sometimes an infection can develop later and migrate to the bones. So if the wound stays red, swollen and sore after a few days, go back to the doctor for further treatment. In all cases, a puncture wound on your foot should never be taken lightly.
Thursday, August 5, 2010
Diabetes Diagnosis for MI Man: Dog Ate Toe
Most pet owners would be irate if their dog bit off one of their toes, but Jerry Douthett, of Rockford, MI is nothing but grateful: this canine feat may have saved his life. Douthett was alerted to the seriousness of a bone infection in his foot, resulting from previously undiagnosed Type II diabetes, when his terrier Kiko bit off his big toe while he was passed out drunk, according to The Grand Rapids Press
"Jerry had had all these Margaritas, so I just let him sleep," his wife, Rosee, a registered nurse told the Michigan paper. "But then I heard these screams coming from the bedroom, and he was yelling, 'My toe's gone, my toe's gone!'" He suspected for months something was wrong with his foot, but the 48-year-old musician had only recently scheduled an appointment to see a doctor. Douthett was rushed to the hospital by Rosie where doctors amputated the rest of his toe and diagnosed him with Type II diabetes.
http://www.mlive.com/news/grand-rapids/index.ssf/2010/08/dog_eats_rockford_mans_big_toe.html
"Jerry had had all these Margaritas, so I just let him sleep," his wife, Rosee, a registered nurse told the Michigan paper. "But then I heard these screams coming from the bedroom, and he was yelling, 'My toe's gone, my toe's gone!'" He suspected for months something was wrong with his foot, but the 48-year-old musician had only recently scheduled an appointment to see a doctor. Douthett was rushed to the hospital by Rosie where doctors amputated the rest of his toe and diagnosed him with Type II diabetes.
http://www.mlive.com/news/grand-rapids/index.ssf/2010/08/dog_eats_rockford_mans_big_toe.html
Thursday, July 1, 2010
HbA1clevels correlate strongly to future diabetes, cardiovascular risk
An ancillary study to the ARIC (Atherosclerosis Risk in Communities) study supports the most recent (2010) ADA risk categories of hemoglobin (Hb) A1c in identifying future risk of developing diabetes and macrovascular and microvascular disease. The data were presented by Elizabeth Selvin, PhD.
The ADA now recommends the use of HbA1c for the diagnosis of diabetes and identification of persons at increased risk for diabetes. The ADA defines an HbA1c of 5.7% to less than 6.5% as “high risk” for the future development of diabetes.
In this analysis, 11,092 participants from ARIC, a large community-based epidemiologic study, without cardiovascular disease or diabetes at baseline had HbA1c measured from stored whole blood samples obtained between 1990 and 1992. Participants were followed for 15 years.
“In individuals with an A1c of 5.7% to less than 6.5%, which is the group identified as high risk for the development of diabetes and other complications, we see a very high risk of the subsequent development of diabetes. We can also see that individuals in that range are at risk for kidney disease, CHD [coronary heart disease], and stroke,” said Selvin, assistant professor of epidemiology and medicine at Johns Hopkins in Baltimore.
Compared with the reference population with an HbA1c level of 5% to less than 5.7%, those in the high-risk category of 5.7% to less than 6.5% had more than triple the risk of diagnosed diabetes, a 60% increase in the risk of CHD, a 56% increase in the risk of stroke, a 62% increased risk of end-stage renal disease, and a 42% increase in all-cause mortality, all adjusted for age, sex, race, and other potential confounders.
These risks were even greater in the cohort with HbA1c levels of 6.5% or greater at baseline.
“The vast majority of individuals with HbA1c greater than 6.5% will subsequently be diagnosed with diabetes during follow-up, and they’re at very high risk of kidney disease and have almost 4 times the risk of developing end-stage renal disease compared to those people in the normal range, and a 2-fold increased risk of developing CHD or stroke or dying during follow-up,” she said.
More than 20% of the group with HbA1c values of 5.7% to less than 6.5% and almost 80% of those with values of 6.5% or greater developed diabetes within 10 years.
The ADA now recommends the use of HbA1c for the diagnosis of diabetes and identification of persons at increased risk for diabetes. The ADA defines an HbA1c of 5.7% to less than 6.5% as “high risk” for the future development of diabetes.
In this analysis, 11,092 participants from ARIC, a large community-based epidemiologic study, without cardiovascular disease or diabetes at baseline had HbA1c measured from stored whole blood samples obtained between 1990 and 1992. Participants were followed for 15 years.
“In individuals with an A1c of 5.7% to less than 6.5%, which is the group identified as high risk for the development of diabetes and other complications, we see a very high risk of the subsequent development of diabetes. We can also see that individuals in that range are at risk for kidney disease, CHD [coronary heart disease], and stroke,” said Selvin, assistant professor of epidemiology and medicine at Johns Hopkins in Baltimore.
Compared with the reference population with an HbA1c level of 5% to less than 5.7%, those in the high-risk category of 5.7% to less than 6.5% had more than triple the risk of diagnosed diabetes, a 60% increase in the risk of CHD, a 56% increase in the risk of stroke, a 62% increased risk of end-stage renal disease, and a 42% increase in all-cause mortality, all adjusted for age, sex, race, and other potential confounders.
These risks were even greater in the cohort with HbA1c levels of 6.5% or greater at baseline.
“The vast majority of individuals with HbA1c greater than 6.5% will subsequently be diagnosed with diabetes during follow-up, and they’re at very high risk of kidney disease and have almost 4 times the risk of developing end-stage renal disease compared to those people in the normal range, and a 2-fold increased risk of developing CHD or stroke or dying during follow-up,” she said.
More than 20% of the group with HbA1c values of 5.7% to less than 6.5% and almost 80% of those with values of 6.5% or greater developed diabetes within 10 years.
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