Diabetes Diagnosis and Control

To help detect diabetes earlier and help prevent its complications, two medical groups last week announced new screening and treatment guidelines. Type 2 diabetes strikes 16 million Americans and has reached epidemic levels in recent years. Here's how these new recommendations could affect you:

Enough with the diabetes stories, already. This doesn't concern me. I'd know if I had the disease.

Not so fast. Because the disease is often silent, people typically have it for 10 years before it is diagnosed. By then, half of them already have cardiovascular damage. While common symptoms include frequent infections that are not easily healed, frequent urination, extreme hunger with loss of weight, unusual thirst, blurred vision, extreme weakness and tiredness, irritability and mood changes as well as high levels of sugar in the blood or urine, you can't count on these to announce the presence of diabetes.

Okay, okay. So I'll pay more attention. But what's the difference between the new recommendations and the ones I recall reading just a couple of weeks ago?

Earlier this month, a large federally sponsored trial found that simple lifestyle changes -- healthful eating, regular exercise -- could cut the risk of diabetes for people just on the brink of developing it. These latest guidelines are aimed at people who already have the disease -- though they may not know it -- and are designed to prevent the potentially life-threatening complications that can develop.

How do I know if I'm at high risk for getting diabetes?

If you recognize any of the following characteristics, you'll want to ask your doctor about getting screened for diabetes. The new guidelines define "high risk" as any of the following:

• Being overweight, which means having a BMI of 25 or higher. That's more than 128 pounds for someone who's five feet tall and more than 184 pounds for an individual who is six feet tall. (Calculate your BMI at www.nhlbisupport.com/bmi/)
   
• Being sedentary.
• Having cardiovascular disease, high blood pressure or increased blood fats known as triglycerides.
   
• Having low blood levels (less than 40 milligrams) of the so-called "good" cholesterol known as high-density lipoprotein (HDL).
   
• Having a relative with type 2 diabetes.
   
• Delivering a baby weighing more than nine pounds at birth.
   
• Having gestational diabetes, polycystic ovarian disease or a previously diagnosed impaired glucose tolerance test.

Whew! Is that all?

Not exactly. African Americans, Hispanics, Native Americans, Asian Americans and Pacific Islanders also fall into the high-risk groups for diabetes and should routinely be tested for high blood sugar at age 30, according to the new guidelines.

Wait a minute. I have a relative with diabetes and she's already doing a lot of blood sugar testing every day. Does this mean that she needs to do even more?

Not necessarily. But she may need to test at a slightly different time each day. The new recommendations advise checking blood sugar levels two hours after eating -- that's called postprandial -- rather than before meals and at bedtime. In people whose diabetes is not well controlled, blood sugar levels often soar after eating. Some experts think it's important to know how high they're going and to lower them to reduce the risk of complications. That's also why the guidelines recommend getting tested for a protein called A1C. This is the most accurate way to tell if blood sugar levels are in check. While home tests are available for A1C, they are still being standardized, so the bad news is that testing will probably have to be done by a professional medical lab.

Okay, but I'm a little puzzled. I noticed that the American Diabetes Association has not exactly jumped on this bandwagon. What gives?

It's like this: The National Institute of Diabetes and Digestive and Kidney Diseases and the Centers for Disease Control and Prevention have convened an expert panel -- which includes members of the American Diabetes Association -- to review these data and findings from the recent Diabetes Prevention Program. Neither the ADA nor the NIDDK wants to take a stand until the panel completes its work. But unofficially, experts say that the new guidelines are a good idea and that they expect all this will be resolved soon, probably in the fall. Since these new guidelines are already in use in Europe, odds are good that they will be used in the United States, too.