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Most type 2 diabetics failng to keep
blood sugar under control
By Lauran Neergaard
AP Medical Writer
WASHINGTON - A dismal two-thirds of the nation's 18 million Type 2 diabetics don't have their blood sugar under control, putting them at high risk of the disease's nastiest complications, even death. Yet most are unaware they're doing so poorly, frustrated diabetes specialists say.
"The report, I think, is sobering," said Dr. Lawrence Blonde of the American Association of Clinical Endocrinologists, which released the latest statistics at its annual meeting in mid-May.
Dr. Paul Jellinger, president of the American College of Endocrinology, was more blunt: "It's horrible."
Type 2 diabetes is the most common form of the illness, and experts estimate a third of the people who have it don't know. An additional 41 million have pre-diabetes, an impaired sugar tolerance that can lead to the full-blown disease.
Type 2 diabetes sneaks up on you, as the body gradually loses its ability to use insulin, a hormone crucial to converting blood sugar into energy. High glucose levels damage blood vessels and nerves - eventually leading to blindness, kidney failure, amputations of feet and legs, and heart disease. Diabetes is the nation's sixth-leading killer.
Tight control of blood sugar, either through diet and exercise alone or with a variety of medications, can prevent that damage. The best measure of control: the A1C test, a way of tracking average blood-sugar levels over two or three months.
AACE, the endocrinologists' group, defines glucose control as an A1C level below 6.5. But 67 percent of Type 2 diabetics aren't meeting that goal, concludes a new AACE analysis.
The analysis is based on the A1C measurements, reported by a laboratory database, of 157,000 people in 39 states during 2003 and 2004.
The analysis didn't calculate what the average A1C level is, so there's no way to know just how poorly controlled these patients are, acknowledged Blonde, head of diabetes research at the Ochsner Clinic Foundation in New Orleans.
But in the remaining states, Blonde checked a different database that showed between a fifth and a third of diabetics had A1C readings above 9 - not even minimal glucose control.
A normal A1C level is 5. While diabetes specialists differ on whether 6.5 or 7 signals good control, every point-drop lowers the risk of serious complications by 25 percent to 40 percent.
Yet an AACE-commissioned survey of Type 2 diabetics found that 84 percent believed they were doing a good job controlling their blood sugar, even though 61 percent went on to say they didn't know what the A1C test is.
Why the disconnect?
"The American public largely doesn't understand" this disease, said Surgeon General Richard Carmona, who urged patients "to take their treatment seriously."
The endocrinologists began a campaign May 18 for more aggressive diabetes treatment, and advised patients to do the following:
Reese described her fear at diagnosis four years ago - diabetes had cost close friends their legs and then their lives.
"I didn't want to lose my legs, because my husband, he really likes my legs," she joked, before telling how she dropped her blood sugar from triple the normal levels to an optimal A1C of 5.9 "I still got my legs, I still got my husband, he still likes my legs."isit www.alaskaopen.com. Alaska Open Imaging Center is a Blue Cross/Blue Shield, Aetna and GEHA preferred provider. The center accepts insurance, Medicaid and Medicare.
Vascular health issues need more attention
By Alex Dominquez
Associated Press Writer
BALTIMORE - A doctor's group is hoping to persuade more Americans to check on the health of their arteries and veins. While most know heart disease is the leading cause of death among Americans, and many Americans regularly check their blood pressure, less attention is paid to vascular disease.
However, most heart disease involves arteries of the heart, and vascular disease can also block arteries to the brain causing strokes, the third leading cause of death in the United States, according to American Vascular Association.
To help spread the message, the association conducted free screenings May 20 at more than 200 centers nationwide. The screenings consist of three tests - two sonograms and a comparison of the blood pressure from the arm and ankle.
The sonograms can reveal aneurysms, a ballooning of a weakened blood vessel wall, or clogging of the major arteries leading to the brain. A difference in blood pressure readings from the arm and ankle can also indicate problems with blood vessels.
The tests are not covered by Medicare or most health insurance plans, and AVA is also supporting legislation in Congress to require Medicare coverage for screening for abdominal aortic aneurisms, one of the three tests, said Dr. William Flinn, vice chairman of the AVA and the head of vascular surgery at the University of Maryland School of Medicine.
"We think stroke deaths can be significantly reduced in this country and stroke expenditures can be significantly reduced with a well thought-out screening program," he said.
The U.S. Preventive Services Task Force, a federal panel that makes recommendations about which preventive services should be incorporated routinely into primary medical care, recommends the abdominal screening only for men ages 65 to 75 who have smoked. Women should only have the abdominal screening if they have symptoms, the task force recommends.
Between 5 percent and 10 percent of those screened by the AVA through its free screening program are found to have some sort of vascular disease, Flinn said.
"And a third to half of them are not receiving what we could consider fairly basic medical therapies that could prevent their problems from getting worse," he continued.
Screening is recommend for those over age 55, especially if they have other risk factors, including high blood pressure, diabetes, high cholesterol or are smokers.
An estimated 750,000 older men and women in the United States have undiagnosed aneurysms. Nearly 15,000 people die each year from the rupture of an aortic aneurysms, making it the 10th leading cause of death in men over 50.
Stroke is also the leading cause of disability in this country with more than $50 billion spent annually on the care of stroke patients, the AVA said.
Anyone interested in arranging a screening can call 1-877-AVA-2010.
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