Diagnosing Diabetes: It's In The Blood
ABBOTT PARK, Ill. (Ivanhoe Newswire) - Heart disease, stroke, blindness, and kidney failure are just some of the devastating complications of diabetes. Nearly 26 million people have the disease in the U.S. and three times that amount are pre-diabetic and don't know it. Now, a new test could help them before it's too late.
Diabetes is a disease Dr. Steve Edelman knows all too well.
"I got diabetes when I was 15. I was super tired. I would fall asleep in class," Dr. Edelman told Ivanhoe.
However, not everyone with diabetes gets diagnosed so early. That's where a new diabetes test already in use in Europe and under development here could help.
Unlike some tests that require you to fast overnight and give you a short-term result, Dr. Beth McQuiston said the A1c blood test gives patients a picture of their blood sugar over the last three months without fasting.
"You can test patients that just showed up at your hospital, weren't fasting, and figure out what their blood sugar looked like over time," Beth McQuiston, MD, RD, Medical Director, Diagnostics Products, Abbott, told Ivanhoe.
It would allow physicians to help manage patients with diabetes.
"The biggest, most important issue is that 79 million people are pre-diabetic, walking around right now with abnormal blood sugars, and they have no idea," Dr. McQuiston said.
It's a simple test that could save your health.
"If you're heading towards an iceberg, shouldn't you know that it's coming so you can change your direction? Of course," Dr. McQuiston said.
Doctors say tests like the hemoglobin A1c are so important because they can help patients better monitor and manage their diabetes. Research shows that for every one percent reduction in results of hemoglobin A1c blood tests, the risk of developing eye, kidney, and nerve disease is reduced by 40 percent.
BACKGROUND: Type 1 diabetes typically occurs in children and young adults. This condition does not allow the body to produce insulin, which is the hormone that is needed to transfer food into energy. Patients with type 1 diabetes rely on insulin treatments and therapy to survive. Type 2 diabetes is a condition in which the body causes blood sugar levels to rise higher than normal. Also referred to as hyperglycemia, type 2 diabetes is the most common form of diabetes and can also be the most dangerous. (Source: http://www.diabetes.org/diabetes-basics/?loc=GlobalNavDB)
SYMPTOMS: Symptoms of diabetes depend on the patient and type of diabetes. Some patients may not experience any symptoms, while others may suffer from severe symptoms. Common signs and symptoms are:
- Extreme hunger
- Excessive urination
- High blood pressure
- Blurred vision
- Weight loss
- Ketones in urine
- Slow-healing sores (Source:http://www.mayoclinic.com/health/diabetes/DS01121/DSECTION=symptoms)
TREATMENT: Although, there is not a cure for diabetes, there are ways to prevent symptoms from interfering with everyday life. A few treatment options include eating healthy, becoming physically active, monitoring blood sugar levels, and medication. Following these basic treatment options will enhance your physical performance and increase your ability to live a normal functioning life. (Source:http://www.mayoclinic.com/health/diabetes/DS01121/DSECTION=treatments-and-drugs)
HBA1C: Glycated hemoglobin, also known as HbA1c, is a form of hemoglobin used primarily to monitor long-term diabetes control. This helps doctors understand how well the patient's diabetes is being managed from a treatment or dosing perspective. The HbA1c test differs from a patient-administered blood glucose test, which takes a snapshot of a patient's blood sugar level at a moment in time. Laboratories are seeing an increase of HbA1c testing due to the rise in patients with diabetes. More than 346 million people worldwide are living with diabetes, and the World Diabetes Foundation estimates that number will increase by nearly 27 percent by 2030. The blood test provides a result to the physician in just 36 minutes. "We are pleased to offer an important tool to address the need for a fully automated glycated hemoglobin assay, which can meet the demands of increased testing volumes. With this test, health care providers can now confidently measure their patients' management of diabetes and use this information to potentially improve treatment decisions," Brian Blaser, executive vice president, Diagnostics Products, Abbott, was quoted as saying.
Beth McQuiston, MD and registered dietitian, Medical Director, Diagnostics Products, Abbott, talks about a new test for diabetes.
Can you talk about what the A1c test does?
Dr. McQuiston: With diabetes testing, there are two tests that are typically used. The first is blood glucose which is a measure of blood sugar. That is a one-time measurement or a snapshot in time of what someone's blood sugar looks like. Hemoglobin A1c is more like a video over time for the past 3 months of what your blood sugar looks like.
What differentiates this new test?
Dr. McQuiston: Hemoglobin A1c tests have 3 fabulous attributes; one is that you can do them without fasting, the second is that it captures information for approximately 3 months over time and the third is that you can do it at any time of day.
Can anyone that thinks they might have a problem be diagnosed with the test?
Dr. McQuiston: Outside the United States, Abbott has the new hemoglobin A1c test. In the United States, that test is currently under development.
Can you talk about the great benefit by having this test?
Dr. McQuiston: In 2009 the American Diabetes Association and a consensus panel determined that an FDA-approved hemoglobin A1c test could be used for diagnosis of diabetes. Traditionally in the past, what you would use is fasting blood glucose. The benefit with a Hemoglobin A1c test is that you can test patients that just showed up at your hospital, weren't fasting, and figure out what their blood sugar looked like over time.
It could actually look back in time?
Dr. McQuiston: Yes. Instead of it giving you a one-time measurement of what happened in that particular moment. For example, patients come in because they are not feeling well. They don't usually show up after having a leisurely dinner. They don't feel well, they are not eating--so if they come in and they have a normal blood sugar, what does that mean? You are not sure. If you want to evaluate them for diabetes, if you have an FDA approved hemoglobin A1c test that can tell you because it provides a 3-month retrospective summary of what their blood sugar has looked like 24 hours a day 7 days a week.
And in addition to that, that same test can be used by the individual once they are diagnosed with diabetes?
Dr. McQuiston: You have to talk to your doctor or healthcare provider. There are a variety of different tests that are out there and you use each test in a specific manner.
Can some of these A1C tests monitor your blood sugar?
Dr. McQuiston: Right. That's correct. So, currently Abbott has a hemoglobin A1c test approved in the United States that can be used for monitoring that would be for diabetics who are already diagnosed and you can see how they are doing with their diet and with their medication, their exercise plan.
So the new test though is purely for diagnosis, not for monitoring?
Dr. McQuiston: The current hemoglobin A1c test being used in Europe is for diagnosis and could also be used for monitoring.
What do you see for the future of managing diabetes?
Dr. McQuiston: The most important issue is that 79 million people are pre-diabetic; walking around right now with abnormal blood sugars and have no idea. And we know that in 5 years' time, one out of every three of those will develop diabetes. When patients come in and are diagnosed with diabetes, 10% of them will already have some sort of kidney injury, and 20% will have some sort of eye problems from their diabetes. As a physician, as a registered dietitian, and as someone who worked in a dialysis center, I have seen what the long term effects of diabetes have done to people and it's absolutely essential to catch it early so that you can intervene.
What are some of the effects? Can you talk about some of the complications? e He He said itw as He said itw as
Dr. McQuiston: Yes, what happens is when your blood sugar is high, that sugar is floating around in your bloodstream and it is attaching to different things that it's not supposed to attach to. So it can attach to your blood vessels in your eye. It can attach to things in your heart, your kidneys, your nerves, and it causes damage.
What do you recommend for their diet?
Dr. McQuiston: Well first of all, I am a very strong advocate of registered dietitians. You can find one online at eatright.org and what is really important here is that you find someone that is a good fit for you; that will work with you as a partner. Traditionally what I would do is listen to their diet. I would say how do you normally eat? Tell me everything. If you eat a bag of Oreos, tell me that. If you are drinking a carton of juice, tell me. Whatever it is, tell me. We would sort through the whole day and you would scoop up the easy stuff first, have them take that out of their diet, and then work in things they could actually do. There is no one size fits all. You have to work with each patient so that they can have the best, most practical diet. If I am working with say a bachelor that doesn't know how to cook, I am certainly not going to start off with telling him how to make every meal home cooked. . You are going to work with him to find perhaps restaurants that he can choose, or how to easily prepare foods that are delicious. That is very important. You listen to your patients; you come up with a diet that is spectacular for them. It is very important.
Do you have any other recommendations?
Dr. McQuiston: Now, when you were talking about diabetes or prediabetes, or weight gain—you don't gain that overnight and you are not going to lose that overnight. And it is not because most people go home and eat 2 extra cakes every night. It's the small things that add up over time. Limit eating out, limit processed foods, and instead do things with having healthy foods on hand, having them cut up and ready to goso that when you are hungry you reach for the cut watermelon slices instead of reaching for the bag of cookies. The other thing you can do--and its shocking how fast this adds up-- is, for example at work, I recommend to people that they park the farthest away from the door. The best parking spot isn't by the door; it's the farthest away from the door at work. Where we work, if you park in that far away spot, you get an extra mile of walking per week. That's 50 miles a year. For me, I calculated that is a pound and a half of fat per year I lose or ward off from just walking a farther distance from the parking lot. And over 10 years that is 15 pounds. It's the small changes that add up over time that are absolutely essential.
Is it the compound effect?
Dr. McQuiston: Yeah, absolutely. Or another thing would be when you get an email and you want to respond to somebody, instead of picking up the phone, go walk to their office. If they are in the same building with you, there is no reason to call them. Get up, get moving, and start losing some weight. When I am sitting at my desk traditionally for about an hour or two, I get up and I actually do a lap around the building. I will go down the stairs; I will walk back up all the stairs and it really gets you revving. And those little things per day make such a big difference.
Can you reverse it if you catch it early enough?
Dr. McQuiston: Here is another example: so working as a clinical dietitian, I remember one woman in particular that was referred to me. She was overweight. She hadn't been feeling well. She had been up all night using the bathroom, and that was why she felt like she was tired. Her vision was a little bit blurred. She went into see her physician. She got the diagnosis of diabetes. She was understandably very upset. So, she comes to see me, and says, "I suppose you are going to tell me I can eat nothing. I am not going to be able to eat anything." She said "I feel like my life is over." So, you go through her diet. She tells me everything she eats. We went through it together and. Found some things she really liked that were super easy. She ended up losing weight, she felt great. Her blood pressure went down. She was sleeping through the night. So wouldn't that be amazing if we could empower other people, that other 79 million that have prediabetes or the 7 million that have diabetes and don't know it to have that same success.
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