The word epidemic is tossed around by the media quite easily…. it’s a scary word that sells news. Unfortunately it doesn’t always sell individual health care. The incidence of diabetes is rising to such an extent that it unfortunately warrants the term “epidemic”. Most concerning is the statistic that up to 40% of people with diabetes are not diagnosed! The principal reason (aside from the fact that they don’t go to a health care facility until they are really sick) is that screening usually requires a fasting blood test. If a visit is postprandial (a fancy medical way of saying after eating) a blood sugar test is often postponed for another don’t eat for 8 hours time, and subsequent noncompliance or busy schedules mean that there is a good chance that it won’t be done at all.
Before I get to the “easier” test I must perform my public health duties and give you the scare the sugar out of us statistics from the American Diabetes Association:
- 20.8 million Americans or 7.0% of the population had diabetes in 2005
- 14.6 million were diagnosed
- 6.2 million were undiagnosed
- 51 million people aged 40 to 74 have impaired glucose tolerance (considered to be a pre-diabetic condition), impaired fasting glucose level ( it was high) or both.
- 5 to 10%, of those with diabetes have type 1 (insulin dependent)
- 90 to 95% have type 2 (not insulin dependent, latter age onset, associated with obesity, heart disease and to sum it up…early onset of death)
- Within the next 3 decades the number of people with diabetes is projected to double (to 366 million people); as the population ages, expands (literally and figuratively), eats more, exercises less and become obese.
Now, for the diagnostic good news: There is a blood test called hemoglobin A1c (HbA1c), also called glycelated hemoglobin, that reflects the status of your blood sugar in the previous 2 to 3 months. As you know hemoglobin carries the oxygen in your blood cells. It also links to excess sugar in a process called glycelation. The more your blood sugar levels rise, the more your hemoglobin becomes glycelated. The HbA1c test has become standard in “telling” whether glucose control has been adequate in individuals treated for diabetes. Now many experts feel that the test can be used in lieu of a fasting blood sugar to screen everyone. It “can see” if diabetes is developing in otherwise undiagnosed adults and children. (Unfortunately we have also seen an increase in Type 2 diabetes in adolescents and children over the last decade). If HbA1c is higher than 6.0%, further testing should be done to check for diabetes. If it is 6.9 or higher, a diabetes diagnosis is highly likely and therapy warranted.
Bottom line…this is a simple blood test that would benefit all those with any risk factors for diabetes including:
- Women who have had gestational diabetes
- Women with a history or diagnosis of polycystic ovarian syndrome ( which may cause irregular periods, fertility problems, obesity, abnormal hair growth, acne and/or elevated blood triglycerides)
- A family history of diabetes, obesity, hypertension and early heart disease
- Elevated lipids
- Coronary heart disease
There are so many common and shared risks for diabetes that most of us might benefit from knowing our HbAIc level.