Diabetes Watch

MARCH 01, 2009

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 sugar control.

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 sugar control.

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 Diabetes Care.

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 smokers.

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%, respectively.

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 diabetes.

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 the condition.

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 stated.

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.