Here's the USA Today report:
New diabetes guidelines urge testing for all at age 45
BOSTON - New federally endorsed guidelines recommend for the first time that all adults be tested
for diabetes by age 45 to try to catch the disease before it begins its insidious destruction.
The guidelines, written by an international panel of experts, also lower the cutoff for declaring people
diabetic and change the way the disease is classified.
The National Institutes of Health, which endorsed the recommendations, estimates that they could
help identify 2 million of the 8 million Americans who have diabetes but don't know it.
The aim is to get these people started on diets, exercise programs and possibly drug treatment
before the disease starts a cascade of complications that eventually damage the eyes, heart, kidneys
and nerves.
The guidelines recommend using the readily available fasting plasma glucose test. The simple blood
test costs $5 to $10 and requires that people not eat for eight hours beforehand.
The guidelines were released Monday at a meeting of the American Diabetes Association, which
sponsored them. The World Health Organization plans to adopt them in slightly different form later
this year.
Currently, there is no across-the-board recommendation for screening people for diabetes. Instead,
doctors test patients when they have some reason to suspect they may be diabetic. Symptoms of
diabetes can include excessive thirst, frequent urination and weight loss.
"The earlier we diagnose diabetes, the more likely we are to retard its progression and the
development of complications," said Dr. James R. Gavin III of the Howard Hughes Medical Institute
in Chevy Chase, Md., who headed the committee that drew up the guidelines.
A high level of sugar in the blood is the hallmark of diabetes. Gavin said that since the last diabetes
guidelines were issued in 1979, doctors have learned that the disease begins its painless destruction
at lower sugar levels than had been thought.
About 16 million Americans have diabetes, but only about half of them have been diagnosed with
the disease. With the new guidelines, "I think we will begin to get into the missing 8 million," said Dr.
Frank Vinicor of the Centers for Disease Control and Prevention in Atlanta.
The new cutoff on the blood test does not change the total number of Americans with the disease;
the 16 million figure was based on a different type of glucose test.
Among the new guidelines:
Every adult should have a diabetes test every three years starting at 45. Those who get a high
reading should have the test repeated on another day.
Those at higher than usual risk may need to be tested earlier or more often. These include
American Indians, blacks, Asians, Hispanics and anyone who is overweight or has high blood
pressure, high cholesterol or a strong family history of the disease.
The cutoff for declaring someone diabetic should be lowered from the current 140 milligrams
of glucose per deciliter of blood plasma to 126.
Doctors should abandon the categories of insulin-dependent and non-insulin-dependent
diabetes. Insulin-dependent, which once was called juvenile diabetes, should be termed type
1. Non-insulin-dependent, traditionally known as adult-onset diabetes, should be called type
2.
Contrary to earlier recommendations, pregnant women do not need to be tested routinely if
they are white, under 25, of normal size and have no close family members with the disease.
Dr. George Alberti of the University of Newcastle upon Tyne in England said the WHO will adopt
virtually the same guidelines for use worldwide.
"This is very much a world consensus based on logic," he said.
About 700,000 Americans have type 1 diabetes. It usually results from a malfunction of the immune
system that destroys insulin producing cells in the pancreas. Victims typically lose all ability to make
insulin, often as children or young adults.
About 15.3 million people have type 2 diabetes. It is most common among older people and may
involve a combination of too little insulin production and an inability of the body to use insulin
properly.
If weight loss and exercise fail to bring the disease under control, it can be treated with a variety of
pills or insulin injections.
By The Associated Press |
