New definition for diabetes

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BLOOD SUGAR LEVELS previously considered normal now call for a diagnosis of diabetes-the country's leading cause of blindness, foot and leg amputations, and advanced kidney disease. Until now, the threshold for a diabetes diagnosis has been 140 milligrams of sugar (per deciliter of blood) after an 8-hour fast. But a panel of health experts convened by the American Diabetes Association says that by the time someone's fasting blood sugar, or glucose, reaches 140, a lot of the damage that can eventually lead to such problems as vision impairment, kidney shutdown, and loss of limbs has already been done-even if the person does not suffer any outward symptoms. The new, lower threshold is 126, which the Diabetes Association is confident will net many more people with diabetes before they suffer irreparable harm.

The American Diabetes Association has also adopted panel recommendations that will make it easier to test the right people for the disease. Namely, it now advises that everyone 45 and older get screened once every 3 years with a routine blood test conducted after an overnight (8-hour) fast. There is a steep rise in the incidence of the disease for people in their mid 40s and beyond.

The screening can be performed on the same sample of blood drawn to check such things as cholesterol levels. If the sugar, or glucose, level of the blood is at least 126, a second test should be conducted on a different day to confirm the initial results. Two million people with diabetes who currently are not aware of it are expected to be identified with the call for more widespread testing.

In making its new recommendations, the Diabetes Association is largely moving away from advising a second type of diabetes test. Called the oral glucose tolerance test, it requires measuring the concentration of sugar in the blood 2 hours after a person drinks a standardized sugar solution. While excellent for diagnosing the disease, it's inconvenient for both patient and physician and expensive to administer.

A Bigger Role for Treating Diabetes with Diet
One of the best aspects of a lower cut-point for a diagnosis of diabetes is that it will take some of the emphasis for treatment off drugs and insulin injections, both of which come with undesirable side effects, and shift it to changes in eating and exercise habits. "The earlier we detect the disease, the more likely lifestyle modifications are going to be effective," says James Gavin III, MD, PhD, chair of the Diabetes Association's expert committee.

Foremost among the recommended lifestyle modifications is losing excess weight. Obesity is "far and away the most common nongenetic component contributing to the development of diabetes," Dr. Gavin explains. "About 80 percent of people with the disease are obese," meaning at least 20 percent above healthy weight. In fact, if you're obese, you should get tested for the disease even if you're younger than 45.

Engaging in more vigorous physical activity is crucial, too. Exercise makes the body's cells less resistant to insulin's efforts to clear sugar from the bloodstream and get it into the various tissues, where it's needed for energy.

These lifestyle adjustments are important not just for people diagnosed with diabetes at a fasting blood sugar level of 126 but also for people in the 110 to 125 range. They are considered to have a condition known as impaired fasting glucose, which often goes on to become full-blown diabetes. But even losing as little as 10 extra pounds and taking a brisk walk a few times a week can help stave off the disease.

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