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No Two Diabetes Patients Are the Same

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Far too many are not getting the treatment that is right for them

Chances are you know one or more people who have type 2 diabetes, or perhaps you have been diagnosed with the condition yourself.

The number of Americans with diabetes is truly staggering—a new case is diagnosed every 17 seconds. And, of course, the consequences of uncontrolled diabetes are dire, including increased risk for heart attack and other cardiovascular problems…blindness…leg amputation…kidney failure…and, ultimately, premature death.

To help meet this enormous challenge, medical research has been stepped up.

Now: American researchers have joined forces with their European counterparts to devise new strategies to diagnose and manage diabetes more effectively than ever before.

What you need to know…

EASIER DIAGNOSIS

In the US, about 26 million people have diabetes. This includes roughly 19 million who have been diagnosed and an estimated seven million who are undiagnosed. Experts hope that a change in the diagnostic process will lead to more widespread testing and fewer undiagnosed cases.

Until recently, diabetes was typically diagnosed using one of two standard tests—a blood test that requires an overnight fast to measure blood glucose levels…and an oral glucose tolerance test, which involves drinking a high-sugar mixture and then having blood drawn 30 minutes, one hour and two hours later to show how long it takes blood glucose levels to return to normal.

The problem: Both of these tests are inconvenient for the patient, and they measure blood glucose levels only at the time of the test. Many people never get tested because they don’t like the idea of having to fast overnight or wait hours to complete a test.

New approach: More widespread use of the A1C test. For decades, the A1C test, which provides a person’s average blood glucose levels over a period of two to three months, has been used to monitor how well people with diabetes were controlling their disease. However, it wasn’t deemed a reliable tool for diagnosis.

Now, after major improvements that have standardized the measurements from laboratory to laboratory, the A1C test is considered a practical and convenient diagnostic option.

The A1C requires no fasting or special preparation, so it’s the perfect “no excuses” test. A1C tests analyzed by accredited labs (such as LabCorp and Quest Diagnostics) meet the latest standardization criteria.

NEW TREATMENT GUIDELINES

Recently, the American Diabetes Association and the European Association for the Study of Diabetes collaborated on recommendations for best treatment practices for type 2 diabetes. The most significant change in the new guidelines is the concept of individualized treatment.

The problem: In the past, diabetes care was based on a one-size-fits-all strategy—with few exceptions, everyone with the condition got basically the same treatment.

New approach: The recently released guidelines acknowledge that there are multiple treatment options for each patient and that the best treatment for one patient may be different from what another patient requires.

This is important because diabetes affects an enormously wide range of people. For example, diabetes can strike a thin 77-year-old woman or a 300-pound teenage boy, and their treatment needs and goals will be as different as their characteristics.

After reviewing a patient’s medical history and individual lifestyle, the doctor and patient consider treatment options together and decide on the best fit. Factors that are more explicitly spelled out in the new guidelines include…

  • Other medical conditions and medications. If diabetes treatments interact badly with a patient’s current medications, it may cause one of the medications to become ineffective…amplify the effects of the drugs…or cause allergic reactions or serious, even life-threatening side effects. This is especially true for people being treated for kidney disease or heart problems, as many diabetes medications may exacerbate those health issues.
  • Lifestyle and daily schedule. Diabetes management is easier for people who have predictable schedules. For example, a full-time worker who regularly wakes up at 7 am, eats breakfast, takes a lunch hour and is home for dinner will have simpler treatment needs than a college student who sleeps past noon, eats cold pizza for breakfast, then pulls an all-nighter.

If a physician gives standard insulin recommendations to someone who has an unusual eating and sleeping schedule, it is easy to have blood sugar drop too low—a dangerous condition called hypoglycemia. That’s why it is important that patients share as many details of their lives as possible, even if the information seems irrelevant.

BETTER TREATMENT STRATEGIES

Until recently, diabetes has been treated with a stepwise approach—starting with conservative treatment, adding medication later only when needed. This sounds good, except that new treatments are incorporated only after previous treatments fail and blood glucose rises.

The problem: Depending on scheduled doctor visits, blood sugar may remain elevated for months or even years before anyone catches the change.

New approach: Research suggests that if physicians intervene more intensively at the beginning, they have the potential to stop the progression of diabetes. With this in mind, treatment aims to decrease the rate at which the body loses insulin-producing ability…and prevent diabetes complications by not allowing blood sugar to exceed safe levels.

Under this new scenario, doctors hit diabetes full force with the patient’s individualized treatment plan (including lifestyle changes and medication), instead of with graduated, step-up treatments.

What the new guidelines mean for anyone diagnosed with diabetes: If your current diabetes treatment plan does not address the points described in this article, see your doctor. Your treatment may need to be more customized.

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Source: Ildiko Lingvay, MD, MPH, an assistant professor in the departments of internal medicine and clinical science and a practicing endocrinologist at The University of Texas Southwestern Medical Center in Dallas. Dr. Lingvay is an internationally recognized researcher who has authored several dozen articles related to type 2 diabetes, obesity and metabolic syndrome. Date: December 1, 2012 Publication: Bottom Line Health
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