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November 2008: Identifying and Managing Diabetes Mellitus

01 Nov 2008

Dr. Renee Schickler is a board-certified endocrinologist at Lakefront Medical Associates, located at Weiss Memorial Hospital. Her interests lie in diabetes mellitus and thyroid disease.

Identifying and Managing Diabetes Mellitus

Dr. Renee Schickler
Endocrinologist
Lakefront Medical Associates
Weiss Memorial Hospital
(773) 564-5344

The impact of diabetes
Diabetes mellitus is a worldwide health problem. The incidence of diabetes continues to rise in most countries. In 2007, approximately 7.8 percent of Americans were diagnosed with diabetes mellitus. In people over the age of 60, the prevalence of diabetes is greater than 23 percent. This amounts to at least 23.6 million people and 1.5 million new cases of diabetes diagnosed each year.

Additionally, the Centers for Disease Control estimates that at least 56 million people in the United States have prediabetes. By definition, prediabetes results in blood glucose levels that are above normal, but not yet in the diabetes range (see table below). Those with prediabetes are at an increased risk for developing full-blown diabetes mellitus and diabetic complications. The annual direct and indirect costs of diabetes amounted to 174 billion dollars in 2007.

Complications
Diabetes mellitus is a major contributor to blindness, renal failure, limb amputation, poor would healing, stroke and heart disease. Part of the problem in attempting to avoid these complications, is that many people are unaware that they have diabetes. Despite the fact that their blood glucose levels are abnormal, that may feel well and have no symptoms. Many people are initially diagnosed with diabetes when they present with one of the complications mentioned above. At this point, diabetes may have been present for many years.

Diagnosis
The goal for many medical organizations, including the American Diabetes Association (ADA), is to diagnose diabetes as early as possible. The ADA recommends that all adults 45 years and older without symptoms be screened every three years. Those with symptoms such as excessive thirst and urination, blurred vision, frequent urinary tract or vaginal infections, fatigue and weight loss, should have their blood glucose checked immediately. Patients who are at increased risk for diabetes include a strong family history of diabetes, obesity, gestational diabetes, members of certain ethnic groups (Hispanic, Asian, African American, Native American), hypertension, lipid (cholesterol and triglyceride) abnormalities and cardiovascular disease. High-risk patients should be screened as early as possible and continue to be monitored yearly even if diabetes has not been diagnosed.

The criteria for the diagnosis of diabetes and prediabetes are as follows:

  • Diagnosis
    • No diabetes
    • Prediabetes
    • Diabetes
    • Fasting Plasma Glucose
      • <100 mg/dl
      • 100-125 mg/dl
      • >126 mg/dl
      • Two-Hour Oral Glucose Tolerance Test
        • <140 mg/dl
        • 140-199 mg/dl
        • >200 mg/dl
        Managing diabetes
        Once diabetes mellitus is diagnosed, it is important to assess all associated risk factors and decide on a therapeutic regimen. The physician may include a dietitian and a diabetes educator to aid the patient in understanding how to manage the diabetic therapeutic regimen. This includes weight loss and diet. Since most newly diagnosed diabetics are overweight, a modest initial weight loss of 7–10 percent can greatly improve blood glucose. The diet should include fresh fruits, vegetables, increased fiber, decreased saturated fats and carbohydrates. An exercise regimen that involves 30 to 45 minutes of moderate activity at least three times a week can also improve blood glucose and weight. Clearly, diet and exercise plans need to be individualized and involve the family whenever possible. Medications, including a variety of oral tablets or insulin, may be required at initial diagnosis to control blood glucose.

        The most common way to assess glucose control is to measure hemoglobin A1C. HgA1C measures a portion of the hemoglobin molecule in the blood that is bound to glucose. The rate of formation of HgA1C is proportional to the blood glucose levels for the previous two or three months. The higher the HgA1C, the higher the risk for diabetes complications. The ADA recommends that an HgA1C goal of < 7 percent should be attempted in most patients, but this needs to be individualized. HgA1C should be checked at least twice a year for stable patients and every three months for patients whose blood glucose is not controlled and treatment changes are being made.

        Disease management tools
        Technological advances in diabetes management include: glucose meters that enable patients to easily self-monitor their blood glucose, insulin pens, continuous glucose monitors and insulin pumps. All of these tools can greatly aid the control of blood glucose. Despite all of the advancements in diabetes care, it is crucial to remember that a healthy lifestyle that includes appropriate diet and exercise is essential to control diabetes and prevent the onset of diabetes.

        For more information
        If you would like more information about diabetes prevention and care or would like to schedule an appointment, call Lakefront Medical Associates at (773) 564-5344.