SUNDAY, Aug. 22, 2004 (HealthDay News) -- The diabetes epidemic just got much worse, thanks to a new way of judging problem blood sugar.
The U.S. government has adopted the American Diabetes Association's revised formula for evaluating pre-diabetes, the term for borderline blood sugar readings that are likely to become full-blown diabetes without intervention.
The change, which the ADA announced in November and the Department of Health and Human Services endorsed last spring, means two out of every five adults aged 40 to 74 are now considered to have pre-diabetes.
"Every 25 seconds, someone in America is diagnosed with diabetes," HHS Secretary Tommy G. Thompson said in a statement about the revision. "These latest numbers show how urgent the problem really is. We need to help Americans take steps to prevent diabetes, or we will risk being overwhelmed by the health and economic consequences of an ever-growing diabetes epidemic."
An estimated 18 million Americans have diabetes, with 1.3 million new cases diagnosed every year. Roughly 90 percent of them have type 2 diabetes, which develops as the body gradually loses its ability to properly handle blood sugar. Diabetes is a leading cause of heart disease, blindness, kidney failure and amputations, killing more than 200,000 Americans every year.
Researchers now estimate that if Americans continue to gain weight and sit still as they currently do, one in three people born in 2000 will eventually develop diabetes.
The pre-diabetes protocol tries to spot the early signs that cells are having difficulty using glucose for energy.
A person with pre-diabetes has either impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), two tests of how efficiently the body produces and uses blood sugar.
Under previous guidelines, a person was considered to have IFG if their sugar level after an all-night fast was 110 milligrams per deciliter of blood. Now, IFG is diagnosed for sugar levels between 100 and 125 mg/dl. No change was made to the definition of IGT.
People whose IFG falls between 100 and 110 have a 20 percent higher chance of developing diabetes than those whose blood sugar is healthier. Those whose IFG is between 110 and 125 are at 40 percent greater risk. IFGs of 126 or above are considered diabetes.
The good news, experts say, is that there are ways to prevent pre-diabetes from progressing.
"Regular aerobic exercise and [keeping an] ideal body weight can basically remove the risk totally, which is the amazing thing about this," said Dr. Robert Rizza, vice president of the American Diabetes Association.
In other words, said Rizza, an endocrinologist at the Mayo Clinic in Rochester, Minn., a person diagnosed with pre-diabetes must work closely with his or her doctor to make lifestyle changes to rein in wayward glucose --- but it can be done.
Doctors have a variety of medication options for controlling blood sugar, but Rizza said there's not enough data yet to determine if the risks of these drugs would outweigh their benefits for pre-diabetics.
Since 1999, the National Institutes of Health has authorized a special research team known as the Diabetes Research Working Group (DRWG) to concentrate on finding ways to better treat and eventually find a cure for diabetes. The DRWG is an independent panel of 12 leading scientists and four lay experts in diabetes, and in October 2002 published its five-year Strategic Plan. Here's how the NIH explains the progress that has been made:
The report reflects the advice of many scientists at the forefront of diabetes research and identifies new research opportunities that have emerged since the DRWG made its recommendations. It also outlines recent advances, both clinical and basic, in type 1 and type 2 diabetes and the pre-diabetic conditions, usually asymptomatic, that precede disease onset.
- Researchers are now able to identify those at highest risk for type 1 diabetes years before the appearance of symptoms. This ability, coupled with advances in immune tolerance research and a better understanding of the autoimmune process that destroys the insulin-producing beta cells, has laid the groundwork for planned clinical trials to prevent type 1 diabetes and treat it in new-onset patients.
- Survival rates for people with type 1 diabetes are improving. Improvements in insulin formulations and delivery together with better methods for monitoring glucose control have helped patients deal with the challenge of controlling blood glucose. Clinical trials have also led to new guidelines for managing blood pressure and lipids in people with diabetes to lower risk of cardiovascular complications.
- Islet transplantation, a procedure that can restore insulin production in patients with type 1 diabetes, is a highly promising area of research. Current studies are trying to develop immunosuppressive regimens with fewer side effects and, ultimately, develop methods for achieving immune tolerance, which would educate the immune system to accept donated organs or tissues without the need for chronic immunosuppressive drugs.
- Scientists have identified several genes that contribute to diabetes susceptibility. Type 1 and type 2 diabetes are complex genetic diseases that arise from the interactions of various genes and environmental factors.
- A major clinical trial, the Diabetes Prevention Program, has clearly shown that type 2 diabetes can be prevented through modest changes in diet and exercise leading to a 5 percent to 7 percent weight loss in overweight people with pre-diabetes. About 16 million people in the United States have pre-diabetes.
More information
The American Diabetes Association has an excellent Web site with the latest information on diabetes research.
