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Diabetics often not aware of problems

WASHINGTON - A dismal two-thirds of the nation's 18-million Type 2 diabetics don't have their blood sugar under control, putting them at high risk of the disease's nastiest complications, even death. Yet most are unaware they're doing so poorly, frustrated diabetes specialists said Wednesday.

"The report, I think, is sobering," said Dr. Lawrence Blonde of the American Association of Clinical Endocrinologists, which released the statistics.

Dr. Paul Jellinger, president of the American College of Endocrinology, was more blunt: "It's horrible."

Type 2 diabetes is the most common form, and experts estimate a third of the people who have it don't know. An additional 41-million have "prediabetes," an impaired sugar tolerance.

Type 2 diabetes sneaks up on you, as the body gradually loses its ability to use insulin, a hormone crucial to converting blood sugar into energy. High glucose levels damage blood vessels and nerves - eventually leading to blindness, kidney failure, amputations of feet and legs and heart disease. Diabetes is the nation's sixth-leading killer.

Tight control of blood sugar, through diet and exercise alone or with medications, can prevent that damage. The best measure of control: the A1C test, a way of tracking average blood-sugar levels over two or three months.

AACE defines glucose control as an A1C level below 6.5. But 67 percent of Type 2 diabetics aren't meeting that goal, concludes an AACE analysis.

The analysis is based on the A1C measurements, reported by a laboratory database, of 157,000 people in 39 states during 2003 and 2004.

The analysis didn't calculate what the average A1C level is, so there's no way to know just poorly controlled these patients are, acknowledged Blonde, head of diabetes research at the Ochsner Clinic Foundation in New Orleans.

But in the remaining states, Blonde checked a different database that showed between a fifth and a third of diabetics had A1C readings above 9 - not even minimal glucose control.

A normal A1C level is 5. Every point represents a 25 percent to 40 percent change in the risk of serious complications.

Yet an AACE-commissioned survey of Type 2 diabetics found that 84 percent believed they were doing a good job controlling their blood sugar, even though 61 percent went on to say they didn't know what the A1C test is.

"The American public largely doesn't understand" this disease, said Surgeon General Richard Carmona.

The endocrinologists began a campaign Wednesday for more aggressive diabetes treatment, and advised patients to do the following:

Ask your doctor about your A1C level at every visit. Ask what else you can do to lower A1C levels. Diet and physical activity are crucial to glucose control, but many patients also need combinations of medications.

Strive for good blood sugar levels during daily at-home glucose monitoring: no more than 110 before meals, and 140 two hours after eating.

[Last modified May 19, 2005, 00:44:07]