Diabetes Watch

Pharmacy Times, Volume 0, 0

A1C Test May Be Used to Diagnose Diabetes

Health care professionals may soon beusing the A1C test as a diagnostic toolfor type 2 diabetes. The test is currentlyused to monitor blood sugar inpatients with the disease. Within thenext 6 months, a consensus by leadingdiabetes organizations will lead to thepublication of guidelines for using thetest to diagnose the disease.The American Diabetes Associationguidelines currently recommend physiciansuse the fasting glucose test inpatients who are at risk for type 2 diabetes.A less common test used is an oralglucose tolerance test.

Whereas both tests are sensitive atmeasuring real-time blood glucose levels,the results can easily be thrown off,said Daniel Einhorn, medical directorof Scripps Whittier Diabetes Instituteand vice president of the AmericanAssociation of Clinical Endocrinologists.He said the benefit of the A1C test isthat it can be taken any time of the dayand is not skewed by events of the day.The test will most likely be used alongwith other tests.

Diabetes Self-Care Improves with Online Program

A study of patients with type 2 diabetes found that givingthem the opportunity to help manage their care through aWeb-based program can greatly improve their long-term bloodsugar control.

For the study, researchers randomized 83 type 2 diabetics tousual care plus Internet intervention or usual care only. All ofthe patients had levels of the blood sugar marker glycohemoglobin(GHb) of 7% or higher, indicating poor long-term bloodsugar control.

The online program gave patients access to the same medicalrecords used by their primary physician, as well as the ability toe-mail health care providers. The program also provided feedbackon blood sugar readings, a Web site with educational informationon the disease, and an interactive journal that allowed patientsto record information on diet, exercise, and medications.

A year later, the patients in the Web-based program saw anaverage 0.7% drop in their GHb levels, compared with the usualcare group, whereas 33% of the Web program users had GHblevels 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 ofDiabetes Care.

Diagnosis Can Prompt Lifestyle Change

Middle-aged and older adults diagnosed with a serious conditionsuch as diabetes and heart disease are more likely tomake health behavior changes, found a study reported in theArchives of Internal Medicine (February 9, 2009).

For the study, the researchers analyzed data from the Healthand Retirement Study. The participants were surveyed at leasttwice between 1992 and 2000. The surveys included 20,221overweight or obese individuals younger than 75, and 7764smokers.

During the study, 18% of the smokers quit, and the averagebody mass index of overweight and obese participants roseby 0.04 units. Approximately 13% of smokers were diagnosedwith diabetes, heart disease, stroke, or cancer. About 8% of theoverweight/obese individuals were diagnosed with diabetes,heart disease, or lung disease.

The researchers found being diagnosed with health problemsprompted the patients to change their health habits. Smokersnewly diagnosed with at least 1 condition were 3.2 times morelikely to quit, compared with those without a new diagnosis.

The overweight or obese group diagnosed with at least 1condition lost an average of 2 to 3 lb, compared with patientswithout a new diagnosis.

Intense Exercise May Prevent Diabetes

A small study of men in their early 20sshowed that a few minutes of intenseexercise a week is on par with 30 minutesof moderate physical activity a dayat reducing an individual?s risk of developingtype 2 diabetes.

To investigate if high-intensity exercisemight improve insulin sensitivity moreefficiently, the men were asked to do 6sessions of exercise each including 4 to6 (30-second sprints) interspersed with4-minute rest periods.

After 2 weeks, the amount of timethe men?s blood sugar and blood insulinlevels were above normal after theydrank a solution containing 75 g ofsugar was lowered by 12% and 37%,respectively.

Medication Benefits Doubted

A new study showed that many patientswith type 2 diabetes may be doubtfulabout the safety and effectiveness oftheir medications. The findings, reportedin Diabetes Care (January 2009), werebased on surveys of 806 patients withthe disease, many of whom had lowincome, and >50% who were black.

Overall, the researchers found thatmany patients were worried aboutthe necessity of their medications forcontrolling blood sugar or high bloodpressure. Black patients exhibited moreconcerns, compared with Caucasianpatients. The study also showed that upto half of the patients underused at leastone of their medications, due mainlyto costs. Patients who worried aboutmedication safety also were more proneto skip doses.

The researchers recommended thatphysicians do a better job of reviewingmedication benefits and risks. Patientsalso should express concerns aboutpossible side effects with their physicianand bring a list of treatment questions toall medical appointments.

Parental Diabetes Impacts Type 1 Diabetes Onset

A new study examined how the familyhistory of type 2 diabetes affects the offspringwith type 1 disease. For childrenwho develop type 1 diabetes, the age atdiagnosis tends to be later if their parentshave type 2 diabetes.

For the study, the researchers lookedat data from 1860 patients with type 1diabetes. Almost one third of the participantshad parents with type 2 diabetes.The researchers reported in DiabetesCare (January 2009) that, on average,the onset of type 1 diabetes happenedat 17.2 years of age in the group witha family history, compared with 16.1years in the group without parentaldiabetes.

Saliva Test to Monitor Type 2 Diabetes Under Way

Scientists reported that they are close to developing a salivatest for monitoring type 2 diabetes, with the potential to somedayreplace blood tests.

For the first time, researchers have identified proteins inthe saliva that appear more often in patients with diabetes.Using these proteins, they are developing a test to monitor andperhaps diagnose the condition. The study, published in theJanuary 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 frequentlyin the diabetes groups, compared with those withoutthe condition.

Teens Get Out and Exercise

Moderately active teenagers burn more calories and metabolizeblood 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 teenagerswho wore accelerometers to record their movement.

The researchers found that the teenagers who were moderatelyactive over 1 week typically had a higher metabolismat rest, compared with those who were more sedentary. Theactive group also had better results on tests of glucose tolerance.The investigators concluded that additional studies arewarranted to determine if physical activity translates into lowerrates of diabetes and obesity.

Diabetes Expenses Rising

The January/February 2009 issue of HealthAffairs published a reporton the expenseof health care and found that chronicconditions are costly. Americans spentabout 40% more out of their own pocketsfor health care over the past decade. Anincrease in chronic conditions?especiallydiabetes and high blood pressure?isthe reason, said the researchers.

?Chronic conditions are more than justa health issue for the elderly. They area household economics issue for everyAmerican,? lead coauthor Kathryn Paezstated.

For the study, the researchers used datafrom the national Medical ExpenditurePanel Survey and compared the 1996and 2005 out-of-pocket health care costs.They found the average annual out-ofpocketspending on health care rose from$427 in 1996 to $741 in 2005. The mostsignificant spike in spending occurredamong patients with multiple chronicconditions, such as diabetes. Between1996 and 2005, reports of multiple chronicdiseases rose 9.7% among Americansbetween 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.