Diabetes Meeting Yields Information from New Research

< Jun. 27, 2007 > -- New information from the latest diabetes research has been presented by the American Diabetes Association.

The association held its 67th Annual Scientific Sessions in Chicago earlier this week.

Nearly 21 million Americans have diabetes, a group of serious diseases characterized by high blood glucose levels that result from defects in the body's ability to produce and/or use insulin.

Type 1 diabetes is an immune-mediated disease that involves beta cell destruction usually leading to absolute insulin deficiency. Type 2 diabetes involves insulin resistance - the body's inability to properly use its own insulin.

New Measurement for A1C Test

Among the presentations at the sessions were the preliminary results from an international study showing the relationship between hemoglobin A1c (A1C) levels and average blood glucose levels.

People with diabetes check their blood sugar control frequently at home by self-monitoring blood glucose, usually by pricking their fingers for a blood sample, and getting a current reading using a simple monitor. Testing frequency varies depending on the type of diabetes and whether insulin injections are being used.

In contrast, A1C testing is a less frequently done measure of average glucose control over the prior few (2-3) months. The test is designed to measure the amount of glucose that has attached to a portion of the hemoglobin molecule in the blood. It is reported as the percent of hemoglobin molecules that has glucose attached, and the American Diabetes Association recommends a goal of less than 7 percent.

Self monitored blood glucose is not reported as a percentage and this can be confusing when comparing the two tests.

"The reporting of A1C - using that name - in percentage units, such as a goal of under 7 percent, has always presented problems in doctor-patient communications," says Dr. David Nathan, Professor of Medicine at the Harvard Medical School. "Yet this is the single most important [test] in diabetes today because it assesses both chronic glucose control and risk for complications."

Should the final results of the study replicate the early findings, physicians will likely report A1C test results in new average glucose (AG) units, so that patients will better understand the results of A1C testing.

Home Monitoring of Blood Sugar for Type 2 Diabetes in Question

British researchers presented a study which suggests that home monitoring of blood sugar levels may not be as essential to the effective care of type 2 diabetes as previously thought.

The researchers found that having patients monitor their own glucose levels at home had no effect on overall blood sugar levels. The findings do not apply to persons with type 2 diabetes who must take insulin.

In the study, Dr. Andrew Farmer, a lecturer in the Department of Primary Health Care at the University of Oxford, and his team randomly assigned 453 patients with type 2 diabetes to one of three groups.

One group had blood sugar levels checked three times a month. The second group was given a meter to test their blood sugar at home and told to have their doctor interpret the results. The third group received blood glucose meters and were taught how to interpret the findings.

At one year, Dr. Farmer's group found no difference in blood sugar levels between the groups. In addition, there was no evidence that monitoring blood sugar improved control.

Moreover, half of the people who had been given glucose monitors stopped using them before the end of the study, Dr. Farmer says.

Given these findings, Dr. Farmer believes that the current guidelines for monitoring blood sugar may need to be revised. The value of home monitoring remains necessary and worthwhile for persons with type 1 diabetes and for those with type 2 diabetes who are taking insulin, he says.

These findings are preliminary and should not be adopted without first consulting a physician.

A Little Body Fat May be Helpful in Type 1 Diabetes

Another team of researchers at the sessions presented evidence that a little extra weight may be associated with better coronary health for persons with type 1 diabetes.

According to a team at the University of Pittsburgh Schools of the Health Sciences, people with diabetes tend to develop cardiovascular disease at a much younger age than people who do not have the disease. Cardiovascular complications, including heart disease, are a leading cause of death among people with diabetes.

However, for people with the type 1, inherited form of diabetes, "Gaining weight may reflect good or better treatment with insulin therapy, which may partly explain why participants who gained weight over time [in the study] had lower mortality rates," says Dr. Trevor Orchard, professor of epidemiology at the University of Pittsburgh Graduate School of Public Health.

He and his colleagues studied 315 patients with type 1 diabetes who took part in the 18-year Pittsburgh Epidemiology of Diabetes Complications Study, which began in 1986. CT scans were used to assess coronary artery calcification in patients, who were also evaluated for body mass index (BMI), waist circumference, abdominal fat, and fat underneath the skin.

Coronary artery buildup of calcium is a known marker for heart disease.

Overall, the more fat a person had, the more likely he or she was to have coronary artery calcification. But among the two-thirds of patients with calcification, people with more fat had less severe calcification.

"This is not a firm recommendation to people with type 1 diabetes to put on weight, but it does raise the possibility that weight recommendations in type 1 diabetes may be somewhat different than those for the general population, and emphasizes the complex relationship between body fat and cardiovascular risk in diabetes," Dr. Orchard says.

Always consult your physician for more information.

Facts About Diabetes

Diabetes is a metabolic disorder characterized by a failure to secrete enough insulin, or, in some cases, the cells do not respond appropriately to the insulin that is produced. Because insulin is needed by the body to convert glucose into energy, these failures result in abnormally high levels of glucose accumulating in the blood.

Diabetes may be a result of genetic syndromes, chemicals, medications, malnutrition, infections, viruses, or other illnesses.

The three main types of diabetes - type 1, type 2, and gestational - are all defined as metabolic disorders that affect the way the body metabolizes, or uses, digested food to make glucose, the main source of fuel for the body.

Diabetes affects an estimated 20.8 million people in the US (90 percent to 95 percent of those affected have type 2 diabetes) - 6.2 million are unaware they have the disease. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the American Diabetes Association, those affected include:

• 9.7 million US women (8.8 percent of all women)

• 10.9 million US men (10.5 percent of all men)

• 176,500 people under age 20

• 10.3 million adults over age 60

• 3.2 million African Americans (13.3 percent of all African Americans)

• 2.5 million Hispanic/Latino Americans (9.5 percent of all Hispanic/Latino Americans)

• 13.1 million Caucasian Americans (8.7 percent of all Caucasian Americans)

According to the most recent statistics, diabetes was the sixth leading cause of death.

How do the three main types of diabetes differ?

Although the three main types of diabetes are similar regarding elevated blood glucose levels, there are differences in cause and treatment:

• type 1 diabetes
  Type 1 diabetes is an autoimmune disease in which the body's immune system destroys the cells in the pancreas that produce insulin, resulting in no or a low amount of insulin. People with type 1 diabetes must take insulin daily in order to live.

• type 2 diabetes
  Type 2 diabetes is a result of the body's inability to make enough, or to properly use, insulin. Type 2 diabetes may be controlled with diet, exercise, and weight loss, or may require oral medications and/or insulin injections.

• gestational diabetes
  Gestational diabetes occurs in pregnant women who have not been diagnosed with diabetes in the past. It results in the inability to use insulin but usually resolves after delivery. Gestational diabetes may be controlled with diet, exercise, and attention to weight gain. Women with gestational diabetes may be at higher risk for type 2 diabetes later in life.

Always consult your physician for more information.