Diabetes is a condition that affects the way the body uses glucose
(sugar from foods) for energy. When we eat, glucose is absorbed into the
bloodstream. The pancreas releases a hormone, insulin, that unlocks
cell walls and enables the glucose to get inside to be used as fuel.
Excess glucose is stored in fat cells.
In people with type 1 diabetes, the body doesn't make insulin. This causes high levels of glucose to circulate in the blood. In type 2 diabetes,
the pancreas makes some insulin, but often not enough. In addition, the
body is unable to effectively use the insulin. For both types of
diabetes, the cells are unable to take in glucose and are starved for
The American Diabetes Association reports 25.8 million Americans
have diabetes. About 1.9 million new cases are diagnosed annually. Type 2
is the most common form, accounting for about 95 percent of cases. Over
time, elevated and fluctuating levels of glucose can increase the risk
for a number of serious health complications, like heart disease,
stroke, diabetic retinopathy (a eye disease that can lead to blindness),
kidney disease, neuropathy (nerve disease), poor wound healing and
Prediabetes: Making the Diagnosis
Prediabetes is a state in which blood glucose levels are above
normal, but not high enough to be classified as having diabetes.
Researchers estimate about 57 million Americans have prediabetes. These
patients are at a higher risk than those with normal glucose levels of
eventually developing diabetes.
The American Diabetes Association reports, annually, about 11
percent of those with prediabetes develop diabetes. However, there are
steps that can be taken to reduce that risk. Prediabetics who eat a
healthy diet, exercise at least 30 minutes a day and lower their body
weight by 5 to 10 percent can reduce the risk for diabetes by up to 58
Traditionally, doctors use one of two tests to measure glucose (blood sugar) levels. The fasting plasma glucose
measures glucose levels after an 8-10 hour fast. Normal fasting blood
glucose levels are below 100 mg/dL. Prediabetes levels are between 100
and 125 mg/dL.
The oral glucose tolerance test also requires an overnight
fast. The next morning blood glucose levels are measured. Then the
patient is given a glucose-laced drink. Blood samples are drawn every 30
to 60 minutes after drinking the solution for up to three hours. The
test measures how the body responds to and processes a high load of
glucose. Two hours after the drink, normal blood glucose levels are
below 140 mg/dL. People with prediabetes have a two-hour blood glucose
level of between 140 and 199 mg/dL.
A1C is another type of blood glucose measurement. Red blood cells
contain a protein, called hemoglobin, which carries oxygen from the
lungs to the tissues of the body. Hemoglobin combines with glucose,
forming hemoglobin A1C. The more glucose circulating in the blood, the
higher the levels of hemoglobin A1C. Red blood cells live for about 120
days. Thus, by measuring the amount of A1C in the blood, doctors can
determine how well blood sugar has been controlled over the past three
Ronald Ackermann, M.D., Associate Professor of Medicine at Indiana
University School of Medicine in Indianapolis, says the A1C test is
commonly used to monitor patients with diabetes. The test is very
accurate and doesn't require patients to fast overnight. And since it
looks at glucose control over time, rather than the past day or so, it
helps doctors determine how well patients are managing their diabetes.
Now the American Diabetes Association has recommended the use of the A1C to screen patients for both diabetes and
prediabetes. Early detection is important. Research shows some of the
damage from diabetes has often already occurred long before the disease
is diagnosed. Patients who receive an early diagnosis can take steps to
manage their blood sugar levels and reduce their risk for heart attacks,
strokes, and other complications.
Some investigators question the reliance on just the A1C test for
prediabetes and diabetes. One study found the current "normal" A1C
levels are less likely than the other screening tests to detect elevated
risk among non-Hispanic whites. In addition, about one percent of those
who are currently identified as having diabetes (through the other
testing methods) would fall into the "normal" glucose levels with the
Research compiled and edited by Barbara J. Fister
AUDIENCE INQUIRYFor general information on the A1C test or prediabetes:
American Diabetes Association, http://www.diabetes.org
Centers for Disease Control and Prevention, http://www.cdc.gov/diabetes
National Institute of Diabetes and Digestive and Kidney Diseases, http://www.niddk.nih.gov
BIBLIOGRAPHYIf you need a list of the research titles supporting this story, please contact Barbara Fister at (610) 395-1300 ext. 238.
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