| Officials Warn of
WASHINGTON (Reuters Health) - Federal health officials issued
new recommendations Wednesday designed to help identify as many
as 16 million Americans who are at risk for type 2 diabetes but
do not know it.
The guidelines create an entirely new medical diagnosis called "pre-diabetes,"
a term coined to describe the millions of overweight and obese people
who have blood sugar levels suggesting an elevated risk of full-blown
Doctors have long tested obese patients over 45 years old for
diabetes using a fasting blood glucose test or an oral glucose
challenge test. Until now, a glucose score above 126 milligrams
per deciliter of blood (mg/dL) on the first test or 200 mg/dL
on the second meant a patient had diabetes.
Experts are now calling on physicians to diagnose pre-diabetes
in patients showing test results below these levels but above
normal. Obese patients younger than age 45 should also be tested
if they also have other diabetes risk factors, including a family
history of the disease, minority ethnicity, or a history of diabetes
The treatment prescription is familiar to most Americans, though
few choose to follow it: lose weight by exercising regularly and
cutting calories and fat from the diet.
New federal figures show that 17 million Americans currently
have diagnosable type 2 diabetes. The 16 million 40- to 74-year-olds
estimated to have obesity and elevated glucose levels could double
the total burden of diabetes in the US healthcare system, said
US Health and Human Services Secretary Tommy G. Thompson.
Government and private health care payers spent close to $100
billion on direct and indirect costs related to diabetes, Thompson
"You can see what it will cost the American tax payer, what
it will cost the health care system" if pre-diabetics go on to
develop full diabetes, he said.
Experts estimate that the actual number of at-risk Americans
is substantially higher, since obesity, the number-one risk factor
for diabetes, remains rampant in young adults, adolescents and
Type 2 diabetes, also called non-insulin dependent diabetes,
is the name given to the disease caused mostly in adulthood by
obesity and some genetic factors. It is different than type 1
diabetes, which is an autoimmune disorder in which the insulin-producing
cells in the body are destroyed.
Both disorders are a major risk factor for heart disease, kidney
failure, blindness and limb amputations. Many experts have abandoned
the term "adult onset" to describe type 2 diabetes since the disease
has begun to show up in obese adolescents and children.
A 3-year study completed last year showed that at-risk adult
patients who lost 5% to 7% of their body weight with moderate
diet and exercise were able to cut their risk of full diabetes
by nearly 60%.
Researchers conducting the study used counseling and education
to help patients lose weight. Experts conceded that most public
health programs and private insurance plans do not offer the kind
of support to patients that the study participants received.
"It's true that we don't have the resources to do the counseling,
but at least some people will do [the diet and exercise] on their
own," said Dr. Judith Fradkin a researcher at the National Institute
of Diabetes and Digestive and Kidney Diseases (NIDDK).
Medicare, the nation's public health insurance program for 39
million elderly and disabled persons, also does not pay for the
screening officials are recommending.
"At the present time we don't have a benefit to pay for pre-diabetes
screening," said Dr. Steven Phurrough, director of medical and
surgical services at the federal Centers for Medicare and Medicaid
Thompson urged the nation to lower their overall diabetes risk
by becoming more active and losing weight, pleading with parents
to get their children "off the PlayStations and onto the playgrounds."
He also announced that he had shed 8 of the 15 pounds he pledged
to lose as a way to set an example for the rest of the country.
Public health experts, however, have generally failed in their
decades-long efforts to get Americans to lose weight. Recent federal
figures indicate that 60% of US adults are either overweight or
obese. The total diabetes rate has tripled over the past 30 years.
Researchers blame an increasingly sedentary lifestyle and the
popular high-fat, high-calorie American fast-food diet for the
out-of-control rates. Many experts also believe that the large
portions that have become a mainstay of the US restaurant industry
are contributing to the diabetes epidemic.
"We have to make people realize that they're not getting a good
deal when they super-size it," Fradkin said in an interview.
Reference Source 89