New Diabetes Guidelines Focus on Prevention, Treatment

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Aug. 21, 2001 (Washington) --Two groups at the forefront of diabetes research and treatment issued new care guidelines, which are aimed at curbing the deadly disease that now afflicts an estimated 16 million Americans.

"By creating this consensus document, we send a clear message that we will accept nothing less than meticulous control for our patients," said Rhoda Cobin, MD, president of the American Association of Clinical Endocrinologists.

At a news conference here Tuesday, the American College of Endocrinology, or ACE, and the American Association of Clinical Endocrinologists, or AACE, urged tougher treatment standards to control symptoms in those who have the disorder -- specifically ratcheting down a three-month measure of blood sugar control known as A1C to 6.5% from the currently accepted 7%.

The A1C test should be the standard test, said Claresa Levetan, MD, director of diabetes education at Medstar Clinical Research Center in Washington, D.C. "If you lower that percentage by even one ... point, you will reduce your risk for diabetes-related morbidity and mortality by 25%," she said, adding that three patients in four have never heard of the crucial $15 test, even though it ought to be as familiar a term as cholesterol.

In addition, the experts want to start screening those at high risk for diabetes, particularly members of ethnic groups, at a much earlier age. It's estimated that 16 million Americans have some form of diabetes.

Diabetes is a disease that keeps the body from producing or using insulin properly and can lead to dangerous levels of sugar in the blood. While the disease can generally be controlled with drugs and diet, it's often diagnosed a decade too late, after some of the worst complications have already begun.

The end products of elevated blood sugar can damage small blood vessels, making diabetes the leading cause of blindness, amputations and kidney failure.

Both groups of specialists gathered here to review studies from around the world and make them consistent with U.S. practices, which the doctors say sometimes lag behind other nations, such as the proper A1C target number.


"Today we make diabetes history. World leaders have come here for the first time and have established clear, concise diabetes guidelines, so that patients with this disease and their physicians can know and achieve these important goals," said Levetan.

Noting that about half the people with diabetes are diagnosed with complications, the guidelines recommend that screening for high-risk groups begin at age 30, instead of waiting until age 45. According to the CDC, the rate of diabetes in this group has gone up 76% from 1990 to 1998.

"The high frequency of complications at the time of diagnosis, using current screening guidelines, mandates early diagnosis of diabetes," said Jaime Davidson, MD, a clinical associate professor of internal medicine at the University of Texas Southwestern Medical Center.

Ethnic groups appear to be at higher risk either because of genetic factors, or adopting the fat-rich diet and sedentary lifestyle of American culture, Davidson said.

There are other risk factors as well, which include a family history of diabetes, cardiovascular disease, being a member of a minority group, having diabetes while pregnant, or delivering a baby bigger than 9 pounds. Those who suspect they have the disease can get a simple blood test to measure the level of sugar in their blood. The panel recommends that the target blood sugar level be kept at less than 110 before eating and less than 140 after a meal.

"We hope that we will be diagnosing patients decades earlier than we previously had," says Levetan, who notes diabetes is a $100 billion health problem annually in the U.S.

WebMD Health News Reviewed by Gary D. Vogin, MD
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