A1C Test May Be Used to Diagnose Diabetes
Health care professionals may soon be
using the A1C test as a diagnostic tool
for type 2 diabetes. The test is currently
used to monitor blood sugar in
patients with the disease. Within the
next 6 months, a consensus by leading
diabetes organizations will lead to the
publication of guidelines for using the
test to diagnose the disease.
The American Diabetes Association
guidelines currently recommend physicians
use the fasting glucose test in
patients who are at risk for type 2 diabetes.
A less common test used is an oral
glucose tolerance test.
Whereas both tests are sensitive at
measuring real-time blood glucose levels,
the results can easily be thrown off,
said Daniel Einhorn, medical director
of Scripps Whittier Diabetes Institute
and vice president of the American
Association of Clinical Endocrinologists.
He said the benefit of the A1C test is
that it can be taken any time of the day
and is not skewed by events of the day.
The test will most likely be used along
with other tests.
Diabetes Self-Care Improves with Online Program
A study of patients with type 2 diabetes found that giving
them the opportunity to help manage their care through a
Web-based program can greatly improve their long-term blood
For the study, researchers randomized 83 type 2 diabetics to
usual care plus Internet intervention or usual care only. All of
the patients had levels of the blood sugar marker glycohemoglobin
(GHb) of 7% or higher, indicating poor long-term blood
The online program gave patients access to the same medical
records used by their primary physician, as well as the ability to
e-mail health care providers. The program also provided feedback
on blood sugar readings, a Web site with educational information
on the disease, and an interactive journal that allowed patients
to record information on diet, exercise, and medications.
A year later, the patients in the Web-based program saw an
average 0.7% drop in their GHb levels, compared with the usual
care group, whereas 33% of the Web program users had GHb
levels lower than 7%. Only 11% of the nonuser group, however,
lowered their GHb levels below 7%.
The findings were reported in the February 2009 issue of
Diagnosis Can Prompt Lifestyle Change
Middle-aged and older adults diagnosed with a serious condition
such as diabetes and heart disease are more likely to
make health behavior changes, found a study reported in the
Archives of Internal Medicine (February 9, 2009).
For the study, the researchers analyzed data from the Health
and Retirement Study. The participants were surveyed at least
twice between 1992 and 2000. The surveys included 20,221
overweight or obese individuals younger than 75, and 7764
During the study, 18% of the smokers quit, and the average
body mass index of overweight and obese participants rose
by 0.04 units. Approximately 13% of smokers were diagnosed
with diabetes, heart disease, stroke, or cancer. About 8% of the
overweight/obese individuals were diagnosed with diabetes,
heart disease, or lung disease.
The researchers found being diagnosed with health problems
prompted the patients to change their health habits. Smokers
newly diagnosed with at least 1 condition were 3.2 times more
likely to quit, compared with those without a new diagnosis.
The overweight or obese group diagnosed with at least 1
condition lost an average of 2 to 3 lb, compared with patients
without a new diagnosis.
Intense Exercise May Prevent Diabetes
A small study of men in their early 20s
showed that a few minutes of intense
exercise a week is on par with 30 minutes
of moderate physical activity a day
at reducing an individual?s risk of developing
type 2 diabetes.
To investigate if high-intensity exercise
might improve insulin sensitivity more
efficiently, the men were asked to do 6
sessions of exercise each including 4 to
6 (30-second sprints) interspersed with
4-minute rest periods.
After 2 weeks, the amount of time
the men?s blood sugar and blood insulin
levels were above normal after they
drank a solution containing 75 g of
sugar was lowered by 12% and 37%,
Medication Benefits Doubted
A new study showed that many patients
with type 2 diabetes may be doubtful
about the safety and effectiveness of
their medications. The findings, reported
in Diabetes Care (January 2009), were
based on surveys of 806 patients with
the disease, many of whom had low
income, and >50% who were black.
Overall, the researchers found that
many patients were worried about
the necessity of their medications for
controlling blood sugar or high blood
pressure. Black patients exhibited more
concerns, compared with Caucasian
patients. The study also showed that up
to half of the patients underused at least
one of their medications, due mainly
to costs. Patients who worried about
medication safety also were more prone
to skip doses.
The researchers recommended that
physicians do a better job of reviewing
medication benefits and risks. Patients
also should express concerns about
possible side effects with their physician
and bring a list of treatment questions to
all medical appointments.
Parental Diabetes Impacts Type 1 Diabetes Onset
A new study examined how the family
history of type 2 diabetes affects the offspring
with type 1 disease. For children
who develop type 1 diabetes, the age at
diagnosis tends to be later if their parents
have type 2 diabetes.
For the study, the researchers looked
at data from 1860 patients with type 1
diabetes. Almost one third of the participants
had parents with type 2 diabetes.
The researchers reported in Diabetes
Care (January 2009) that, on average,
the onset of type 1 diabetes happened
at 17.2 years of age in the group with
a family history, compared with 16.1
years in the group without parental
Saliva Test to Monitor Type 2 Diabetes Under Way
Scientists reported that they are close to developing a saliva
test for monitoring type 2 diabetes, with the potential to someday
replace blood tests.
For the first time, researchers have identified proteins in
the saliva that appear more often in patients with diabetes.
Using these proteins, they are developing a test to monitor and
perhaps diagnose the condition. The study, published in the
January 2, 2009, issue of the Journal of Proteome Research,
examined saliva samples from patients with type 2 diabetes.
The researchers found 65 proteins that occurred twice as frequently
in the diabetes groups, compared with those without
Teens Get Out and Exercise
Moderately active teenagers burn more calories and metabolize
blood sugar better, compared with their nonactive peers,
which may guard them against type 2 diabetes. The study,
reported in Diabetes Care (January 2009), included 32 teenagers
who wore accelerometers to record their movement.
The researchers found that the teenagers who were moderately
active over 1 week typically had a higher metabolism
at rest, compared with those who were more sedentary. The
active group also had better results on tests of glucose tolerance.
The investigators concluded that additional studies are
warranted to determine if physical activity translates into lower
rates of diabetes and obesity.
Diabetes Expenses Rising
The January/February 2009 issue of Health
Affairs published a report
on the expense
of health care and found that chronic
conditions are costly. Americans spent
about 40% more out of their own pockets
for health care over the past decade. An
increase in chronic conditions?especially
diabetes and high blood pressure?is
the reason, said the researchers.
?Chronic conditions are more than just
a health issue for the elderly. They are
a household economics issue for every
American,? lead coauthor Kathryn Paez
For the study, the researchers used data
from the national Medical Expenditure
Panel Survey and compared the 1996
and 2005 out-of-pocket health care costs.
They found the average annual out-ofpocket
spending on health care rose from
$427 in 1996 to $741 in 2005. The most
significant spike in spending occurred
among patients with multiple chronic
conditions, such as diabetes. Between
1996 and 2005, reports of multiple chronic
diseases rose 9.7% among Americans
between 45 and 64 years old.
F A S T F A C T: About 60% to 70% of people with diabetes have mild-to-severe forms of nervous system damage.
F A S T F A C T: Type 1 diabetes was previously called insulin-dependent diabetes mellitus or juvenile-onset diabetes.