Today’s post comes from Amy Campbell, MS, RD, LDN, CDE. Campbell is a registered dietitian and certified diabetes educator at Joslin Diabetes Center. She is actively involved in education initiatives, both at Joslin and with the American Association of Diabetes Educators, the American Diabetes Association and the Academy of Nutrition and Dietetics. She has authored several books published by the American Diabetes Association and recently received the 2012 Will Solimene Award for Excellence in Medical Communication. Campbell is also a member of the Egg Nutrition Center’s Health Professional Advisor panel.
We’re in the midst of November now and the winter holidays are encroaching upon us. Very likely, your mind is busy focusing on what to cook for Thanksgiving dinner, your son or daughter coming home for break, raking leaves or getting a head start on some holiday shopping. What often doesn’t come to mind is diabetes. A little known fact is that November is known as diabetes awareness month (with World Diabetes Day falling on November 14).
If you’re a healthcare professional, no doubt, your career has been touched in some way by diabetes, whether by counseling patients who have diabetes, writing articles or teaching classes. Diabetes touches all of us in some way or another, either professionally or personally. And the grim reality is that diabetes prevalence keeps growing and growing. Check out the latest statistics about diabetes from the 2011 National Diabetes Fact Sheet which you can find on the American Diabetes Association’s website at www.diabetes.org/diabetes-basics/diabetes-statistics/.
- 26 million Americans have diabetes (about 8% of the population)
- 7 million Americans don’t know that they have diabetes
- 79 million Americans have prediabetes
- 366 million people, worldwide, have diabetes
- $245 billion dollars was spent on diabetes in the U.S. in 2012
You probably know that the rate of diabetes continues to increase, both in the U.S. and across the world. The International Diabetes Federation (IDF, for short) aptly describes diabetes as being a “global burden”, predicting that by the year 2030, 552 million people worldwide will have diabetes (one third of Americans are predicted to have diabetes by 2050). The numbers are staggering. We have enough of a “diabetes burden” in the U.S., let alone worldwide. Being a certified diabetes educator (CDE), what comes to mind when I see these numbers is that there’s no way that there are enough CDE’s in this country to handle the enormous number of people who have diabetes. Everyone has to play a part in helping to combat this disease.
There’s no cure for diabetes at this time. Until there is one, we need to focus on two things: preventing diabetes from occurring in the first place and effectively treating diabetes to lessen the risk of potentially devastating complications, such as retinopathy, kidney disease and nerve damage.
What every healthcare provider can do is spread the message of being “diabetes aware.” Most people know something about diabetes, but many people don’t realize just how serious it is. It’s much more than having a “touch of sugar.” And it doesn’t really matter if a person has type 1 or type 2 diabetes; both are equally serious. Most people with diabetes have type 2 diabetes, with type 1 diabetes accounting for about 5 percent of the cases.
Let’s not forget about those who have prediabetes, either. Prediabetes is defined as having blood glucose (sugar) levels that are higher than normal but not high enough to be diagnosed as diabetes. Remember that almost 80 million Americans have prediabetes. What can we do to help them lower the chance of developing type 2 diabetes?
Know the Risks
One of the ways that healthcare providers can increase diabetes awareness is to assess for risk. Helping patients to know their risk factors is a first step. The list below can help. Explain that risk for type 2 diabetes is increased if the patient:
- Is overweight or obese (with a body mass index of 25 or higher and/or a waist circumference of greater than 35 inches if female or greater than 40 inches if male)
- Has a parent or sibling with diabetes
- Is African American, Hispanic American, Asian American, Native American or Pacific Islander
- Has had gestational diabetes (diabetes that occurs during pregnancy) or has given birth to a baby weighing more than nine pounds
- Is not physically active
- Has a blood pressure of 140/90 mmHg or higher or has been told that he or she has high blood pressure
- Has a HDL (good) cholesterol of less than 35 mg/dl and/or triglycerides (blood fats) higher than 250 mg/dl
- Has been told by their healthcare provider that they have impaired glucose tolerance, impaired fasting glucose or an A1C of 5.7 percent or higher
- Has a history of heart disease
- Has polycystic ovary syndrome (PCOS) – which applies only to women
- Has acanthosis nigricans, which are dark, velvety markings on the neck or under the arms
If the patient has any of the risk factors on the above list, he or she needs to talk with their primary care provider and get checked for prediabetes or diabetes.
Testing for prediabetes or diabetes involves one of the tests below. These tests should be repeated to confirm a diagnosis. It’s important to reiterate with patients that prediabetes or diabetes cannot be diagnosed using a home blood glucose meter or via a fingerstick at, say, a health fair.
- Fasting plasma glucose (FPG): blood glucose is measured in a lab first thing in the morning after not eating or drinking anything (except water) for at least 8 hours.
- Results: a FPG of 100 to 125 mg/dl is pre-diabetes; 126 mg/dl or higher is diabetes.
- Oral glucose tolerance test (OGTT): the patient drinks a beverage containing 75 grams of glucose. The blood glucose is measured before and two hours after drinking the drink.
- Results: a two-hour glucose of 140 and 199 mg/dl means pre-diabetes; 200 mg/dl or higher is diabetes.
- Hemoglobin A1C: this is a blood test that measures the average blood glucose levels over the past 2-3 months.
- Results: an A1C of 5.7 to 6.4 percent is prediabetes; 6.5 percent or higher is diabetes.
If prediabetes or diabetes is confirmed, the next step is to refer the patient to a diabetes educator or education program so that they can learn how to effectively self-manage their condition.
The Message of Hope
Receiving a diagnosis of prediabetes or diabetes is frightening. It’s not uncommon for people recall a family member or friend who had diabetes and suffered from complications as a result. Unfortunately, there is still no cure for diabetes. Fortunately, there are many ways to treat this condition. There are newer and more effective medications. Evidence shows that lifestyle interventions (healthy eating, weight management and physical activity) can help prevent diabetes and make it easier to manage existing diabetes.
People with diabetes need to know that there is hope – and that they can live long, healthy lives with diabetes. We know this thanks to Joslin Diabetes Center’s 50-Year Medalist Study, a program that recognizes individuals who have lived with type 1 diabetes with 50 or more years. Recently, an individual was just recognized for having lived 75 years with diabetes! So, until there’s a cure, there’s hope. Help spread the message of diabetes awareness this (and every)November.