Most Type 2 Diabetics Aren't Managing Their Disease

New public awareness campaign hopes to reverse the problem

WEDNESDAY, May 18, 2005 (HealthDayNews) -- Despite the national epidemic of type 2 diabetes, two out of three Americans with the disease don't meet the American Association of Clinical Endocrinologists' target for blood sugar goals.

That finding is contained in the association's first-of-its-kind State of Diabetes in America report. It was presented Wednesday at the group's 14th annual meeting in Washington, D.C.

Curiously, 84 percent of the 157,000 type 2 diabetics polled believe they are doing a good job of managing their diabetes by controlling their blood sugar. More than 18 million Americans have diabetes, and type 2 diabetes accounts for 90 percent to 95 percent of all diagnosed cases. There are 1.2 million new cases diagnosed each year, the association said.

"Every 25 seconds someone in the United States is diagnosed with diabetes," said Vice Admiral Richard H. Carmona, the U.S. Surgeon General. "It's the sixth-leading cause of death in the United States, costing thousands of lives and billions of dollars every year."

"We need to help Americans prevent diabetes, or we will risk being overwhelmed by the disease and the economic burden that will ensue," Carmona cautioned.

Included in the report is a state-by-state breakdown of blood sugar levels. Mississippi residents are the worst at controlling blood sugar, with 72.8 percent of type 2 diabetics failing to meet blood sugar goals. Those who have the best blood sugar control are in Montana, where only 55.2 percent of the type 2 diabetics are not managing their blood sugar, the report found.

"It is time for us to get serious," said Dr. Jaime A. Davidson, the chair of the AACE Diabetes Mellitus Implementation Conference and a clinical associate professor of internal medicine at the University of Texas Southwestern Medical School. "This is an epidemic in this country and it's not going to get better unless we all work together."

Type 2 diabetes is a disease that typically progresses over time as the body loses its ability to process the hormone insulin and regulate blood sugar. Insulin is necessary for the body to use sugar for energy for cells. Common risk factors that contribute to diabetes include weight gain, poor diet, and lack of exercise.

Blood sugar is measured by a test called the A1C, which gauges average blood sugar levels over the past two to three months, according to the report.

The American College of Endocrinologists recommends an A1C target level of 6.5 percent or less. Every 1 percent increase above this target increases the risk of serious and possibly life-threatening, diabetes-related complications such as stroke, heart attack, kidney problems, blindness and amputation of limbs.

The first line of attack in keeping blood sugar within a normal range is diet and exercise. However, when diet and exercise don't work, one or more medications may be prescribed to help control blood sugar levels.

According to the results of the survey, 98 percent of people with type 2 diabetes believe blood sugar control is important. However, 61 percent weren't aware of the A1C test. Even after they were told what it is, 51 percent didn't know their last A1C result.

To combat these problems, the AACE is launching a campaign designed to improve diabetes management. The goal is to provide diabetics with tools to help them control blood sugar levels and give them an easy-to-understand roadmap for successful diabetes management. The campaign will help people with type 2 diabetes understand what they can do to get their blood sugar numbers down.

As part of its program, the AACE is encouraging Americans with type 2 diabetes to take an oath to better control blood sugar levels. Those interested can learn more and receive a free diabetes-friendly cookbook by logging on to www.stateofdiabetes.com or calling (800) 704-4694.

"People need to be diagnosed early and need early implementation of treatment," said Dr. Lawrence Blonde, director of the Ochsner Diabetes Clinical Research Unit, part of the Ochsner Clinic Foundation in New Orleans. "These include lifestyle measures -- diet and exercise -- and medications."

"Diabetes is a self-managed disease," Blonde added. "People need self-management education."

Another health expert looks at the problem from a public health perspective. "Diabetes in America is not just one crisis, but several crises rolled into one," said Dr. David L. Katz, an associate clinical professor of public health and director of the Prevention Research Center at Yale University School of Medicine.

According to Katz, diabetes is, first, a crisis of failed prevention. "Impressive trials show that most type 2 diabetes is potentially preventable through healthful diet and physical activity patterns, as well as through judicious use of medication. Yet, we have skyrocketing rates of diabetes in the U.S."

Diabetes is also a crisis of public policy, Katz said. "In the span of less than a generation, what used to be called adult onset diabetes is now routinely diagnosed as type 2 diabetes in children under the age of 10," he said. "This is due to changes in the prevailing activity patterns of our children, changes in their diets, and changes in how these factors are influenced in schools."

Diabetes is also a crisis of health management, Katz contended. "Studies show that strict control of blood sugar can forestall the devastating consequences of diabetes," he said. "Yet this knowledge is not translating consistently into better disease management by health-care providers, or patients themselves."

And finally, diabetes is a crisis linked to economic disparities. "The new report shows that poor glycemic control nationwide is not evenly distributed, but clustered disproportionately in states with high rates of poverty and large minority populations," Katz said.

The tragedy, according to Katz, is that we know how to prevent diabetes and have the tools to enhance control of the disease. "Let us hope that by revealing to us all more clearly than ever the dangers we face, this sobering report does indeed create new opportunities to apply what we know," he said.

More information

The National Institute of Diabetes and Digestive and Kidney Diseases can tell you more about diabetes.

SOURCES: Jaime A. Davidson, M.D., chair, American Association of Endocrinologists ' Diabetes Mellitus Implementation Conference, clinical associate professor of internal medicine, University of Texas Southwestern Medical School, Dallas; Vice Admiral Richard H. Carmona, M.D., M.P.H., U.S. Surgeon General, Washington D.C.; Lawrence Blonde, M.D., director, Ochsner Diabetes Clinical Research Unit, Ochsner Clinic Foundation, New Orleans; David L. Katz, M.D., M.P.H., associate clinical professor of public health, director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; May 18, 2005, presentation, American Association of Clinical Endocrinologists' 14th annual meeting, Washington, D.C.
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