Treat Diabetes Early and Aggressively
-Experts
February 2, 2005
By Maggie Fox
Doctors need to check patients for diabetes if they
even suspect a patient may have the condition, and start
using drugs to treat it right away, according to new
guidelines released on Wednesday.
An estimated 90 percent of all patients diagnosed with
diabetes are not controlling it enough to prevent heart
disease and other complications, the experts at the
American College of Endocrinology and the American Association
of Clinical Endocrinologists said.
At-risk patients, such as the overweight, should start
getting screened at 30. If they show poor control of
blood sugar, they should go on drugs right away, the
two groups said.
"Numerous studies have shown that significant
cardiovascular disease develops years before the onset
of diabetes," the groups said in a statement.
A measure of glucose control called A1C should bring
back a result of 6.5 percent or lower, the groups said.
Fasting glucose should be 110 or below and a two-hour
glucose challenge test should come back 140 or below.
"Patients with diabetes are often in denial,"
said Dr. Jaime Davidson, an endocrinologist at the University
of Texas Southwestern Medical School in Dallas and chairman
of the guidelines conference.
If a family doctor or primary care doctor suspects
a patient may have diabetes, even a young patient, he
or she should test immediately, Davidson said.
And a fasting glucose test is no good, he said. The
patient should undergo a two-hour glucose challenge
to see how well his or her body controls blood sugar.
Insurance companies may balk at paying for the tests,
but they shouldn't, Davidson said.
"It is cheaper to pay for that today than to pay
for the first heart attack," Davidson said in an
interview.
The groups acknowledged that diet and exercise can
stop a person from becoming diabetic, but said most
patients fail.
"Lifestyle is essential. But in the real world
it doesn't really allow us to get a patient to target,"
said Dr. Harold Lebovitz of the State University of
New York, who chaired the writing committee.
"Doctors have big hearts and patients come to
them to say 'Give me another chance. Give me a diet.
Give me another three months,"' Davidson said.
But he said damage can occur during those three months.
"We prefer to get them on target from day one and
keep them there," he said.
Diabetics also need to see their doctors often. "If
they are diabetic, one time a year is not enough. Because
in that time, something is going to happen."
An estimated 20 million Americans have type-2 diabetes
and one-third do not know it, the groups said. Another
41 million have what is known as "pre-diabetes,"
which will develop into diabetes if not controlled.
Diabetes costs the economy $132 billion a year, according
to the American Diabetes Association.
"Eighty percent of the money spent is not in treating
diabetes. Eighty percent of that money is spent in treating
complications," Davidson said.
Drug treatments include metformin, the glitazone or
thiazolidinedione class of drugs which includes GlaxoSmithKline's
Avandia, and orlistat, sold under the brand name Xenical
by Roche . Orlistat is a weight loss drug that also
appears to prevent progression to diabetes.
Source:www.reuters.co.uk
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