7/31/0 12:35 PM Inches: 19.9 REGULAR BC-Diabetes Bjt 07-31 0842

HEALTHBEAT: Experts urge more aggressive testing diabetes


AP Medical Writer

WASHINGTON (AP) - The statistic is dismal: Americans too often have the most common form of diabetes silently festering for up to 12 years before they're diagnosed.

That's 12 years that diabetes quietly eats away your vision, injures your kidneys and nerves and sets you up for heart disease - damage that's preventable if only people learned sooner that they have Type 2 diabetes.

Worse, half of diagnosed patients don't have their diabetes controlled well enough to stop that early damage from worsening. And experts estimate hundreds of thousands skip a test they're supposed to take every few months that's crucial for improving therapy.

Shouldn't your doctor know if you're at risk for diabetes and test you? If you've got it, shouldn't the doctor automatically provide the proper exams, including that often-skipped ''A1C'' test, to adjust your therapy? Ideally, yes.

But doctors aren't doing a good enough job, says a new government call for more aggressive diabetes screening and care - a call that urges at-risk Americans to demand their physicians check them.

''We're trying to get the word out so people who are at risk will ask their doctors,'' says Dr. Judith Fradkin of the National Diabetes Education Program, a federal initiative to improve the alarming state of diabetes care and diagnosis. ''There's so much we can do for you'' if the illness is discovered early.

The NDEP's new call to action, published recently in the Journal of the American Medical Association, is important because too many people don't realize how serious diabetes is, says Dr. Robert Sherwin, president of the American Diabetes Association.

''A 'touch of diabetes' is what you constantly hear, the implication being that's not a serious problem,'' when in fact even borderline diabetes is dangerous, Sherwin says.

Diabetics' bodies cannot regulate blood sugar, or glucose.

Some 16 million Americans have the disease, and experts say at least a third don't know it. It's a leading cause of blindness, kidney failure, limb amputations. It dramatically increases the risk of heart attacks, and kills 180,000 Americans each year.

Type 1 diabetes, also called ''juvenile'' diabetes, typically strikes in childhood. Patients' bodies cannot make insulin, a hormone crucial to converting glucose into energy. Regular insulin injections keep them alive.

But the vast majority of diabetics have the Type 2 form - the diabetes that sneaks up on you.

These patients' bodies gradually lose the ability to use insulin properly. Over time, high glucose levels damage their blood vessels, leading to heart, eye, kidney and nerve injury. Indeed, at diagnosis some 20 percent of patients have enough eye damage to calculate they've actually had diabetes for up to 12 years, Fradkin said.

Type 2 diabetes is most common after age 40; risk rises with increasing age. Unfortunately, however, overweight children increasingly are getting Type 2 diabetes, too. Some patients require insulin injections, but most are prescribed other medications, diet and exercise.

So who should seek a diabetes test?

Sherwin recommends routine screening at age 45, but says people with more than one risk factor need testing earlier. Risks include:

-Being overweight.

-Having a close relative who had diabetes.

-For women, having a baby who weighed more than 9 pounds at birth.

-Being black, Hispanic, American Indian or Asian.

In addition, Sherwin urges anyone with high cholesterol or high blood pressure to seek a diabetes test - saying even borderline-high blood sugar can make your cholesterol problem twice as bad.

Tightly controlling fluctuating blood sugar protects diabetics from the disease's deadly complications. Patients check daily glucose levels with finger-prick blood tests. But about every three months, they also need an ''A1C'' or ''hemoglobin A1C'' test. This more intricate blood test measures how well you're doing over time, so doctors know if you need a medication change.

It's a cheap test, usually $15 to $30. Yet ''people aren't getting it,'' Fradkin laments. No one knows why; maybe because so many diabetics get care from doctors who aren't diabetes specialists.

Among those who do get A1C testing, half discover they're not adequately treated, prompting the federal diabetes program to urge more aggressive therapy.

Sherwin urges Americans to take an active role. Ask your doctor about screening if you're at risk, and if you have diabetes: ''Ask about A1C testing every time you walk into the doctor's office'' to ensure you get that test on time.

To learn more, call the National Diabetes Education Program at 1-800-438-5383 or visit its Internet site at http://ndep.nih.gov - or check the ADA at http://www.diabetes.org.


EDITOR'S NOTE - Lauran Neergaard covers health and medical issues for The Associated Press in Washington.


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