American Diabetes Alert Day

Diabetes affects about 9.4 percent of the U.S. population. A population of 7.2 million Americans which is almost 1 in 4 adults living with diabetes are unaware that they have the disease. Another 84 million Americans have prediabetes, where blood glucose levels are higher than normal, but not high enough to be diagnosed as diabetes. One in three Americans is at risk for developing type 2 diabetes, which can lead to serious complications of kidney, eyes etc. The good news is type 2 diabetes is not permanent and can be prevented or delayed with healthy lifestyle modifications.

American Diabetes Alert Day which is sponsored by the American Diabetes Association is observed in March. The awareness color for Diabetes is Gray. On this day adults are alarmed about the prevalence of diabetes. This year wake-up call for American Diabetes Association Diabetes is on March 26, 2019, observed annually on the fourth Tuesday in March. This wake-up call focuses on the seriousness of diabetes and the importance of understanding the risk.

Diabetes is a disease that occurs when blood glucose/blood sugar, is too high. Blood glucose is the main source of energy which is generated from the food. Insulin which is a hormone made by the pancreas helps glucose from food to get into the cells and then to be used for energy. Sometimes body makes less/no insulin and then glucose stays in the blood and doesn’t reach cells. Too much glucose in the blood can cause health problems. Although diabetes has no cure, with medication and exercise it can be managed.

The most common types of diabetes are type 1, type 2, and gestational diabetes. In type 1 diabetes, the body does not make insulin and insulin-producing cells get damaged (1). In Type 1 diabetes the body’s system attacks and destroys the insulin-producing beta cells of the pancreas. Type 1 diabetics need to take insulin every day to stay alive. According to scientists, type 1 diabetes is caused by genes and environmental factors, such as viruses, that might trigger the disease. Research studies are ongoing to nail down the causes and possible ways to prevent or slow down the disease. It can develop at any age, even during childhood but most often observed in middle-aged and older people. Type 2 is the most common type of diabetes and lifestyle is also one of the causes. Physically less active and overweight/obese are more likely to develop type 2 diabetes. This condition usually begins with insulin resistance, a condition in which muscle, liver, and fat cells do not use insulin well (2). As a result, the body needs more insulin to help glucose enter cells. In the beginning, the pancreas makes more insulin to keep up with the added demand but over time, the pancreas can’t make enough insulin, and blood glucose levels rise. Like type 1 diabetes, certain genes may make it more likely to develop type 2 diabetes and also, the disease tends to run in families. The third type of diabetes is Gestational diabetes which develops in some women when they are pregnant and goes away after the baby is born. However, with gestational diabetes the chances of developing type 2 diabetes later in life increases. Gestational diabetes is responsible for the increased risk for macrosomia (birth weight ≥ 4.5 kg), preeclampsia, preterm birth and cesarean delivery due to large babies (3). Sometimes diabetes diagnosed during pregnancy is actually type 2 diabetes. Other less common types of diabetes include monogenic diabetes, which is an inherited form of diabetes, and cystic fibrosis-related diabetes. For gestational diabetes, the glucose challenge test along with oral glucose tolerance test (OGTT) is performed if needed. In this glucose screening test blood is withdrawn 1 hour after intake of sweet liquid containing glucose. For high blood glucose i.e. 135 or more, an oral glucose tolerance test is performed while fasting. The OGTT measures blood glucose after fasting for at least 8 hours. First point collection is after fasting which is followed by the consumption of glucose-containing liquid. For diagnosing gestational diabetes, blood is drawn every hour for 2 to 3 hours. High blood glucose levels at any two or more blood test times during the OGTT—fasting, 1 hour, 2 hours, or 3 hours confirm gestational diabetes. Health care professionals also use the OGTT test which is better than the FPG test for diagnosis of type 2 diabetes and prediabetes. However, the OGTT is a more expensive test and is not as easy to give.

Both fasting glucose (FPG) and hemoglobin A1C (A1C) levels are used to derive estimates for undiagnosed diabetes and prediabetes. In some cases, random plasma glucose (RPG) test is also performed. The FPG blood test measures blood glucose level at a single point in time and performed after at least 8 hours of fasting where nothing should be allowed to eat or drink except water. Another test is the HbA1C test also known as glycated hemoglobin, and glycosylated hemoglobin test, which provides average levels of blood glucose over the past 3 months. This test doesn’t require fasting and one can eat and drink before the test. Few factors considered for this test are age and anemia or another problem with the blood. The HbA1C test is not accurate in people with anemia.

With the passage of time, high blood glucose leads to other problems. To name a few heart disease, stroke, kidney disease, eye problems, dental disease, nerve damage, foot problems etc. The good news is that type 2 diabetes can be delayed or even prevented. Delaying diabetes by even a few years benefits as the longer is diabetes, the chances are more to develop health problems.

Type II diabetes can be prevented or delayed by losing a modest amount of weight by following a reduced-calorie eating plan and being physically active most days of the week. Research such as the Diabetes Prevention Program shows that a lot can be done to reduce the chances of developing type 2 diabetes. At least 30 minutes of physical activity 5 days a week, healthy foods eating habit most of the time and smaller portions to reduce the number of calories. Choosing foods with less fat and water instead of sweetened beverages is another way to reduce calories.

References

1. Daneman D. Type 1 diabetes. Lancet. 2006 Mar 11; 367(9513):847-58.
2. Halban PA, Polonsky KS, Bowden DW, Hawkins MA, Ling C, Mather KJ, Powers AC, Rhodes CJ, Sussel L, Weir GC. β-cell failure in type 2 diabetes: postulated mechanisms and prospects for prevention and treatment. Diabetes Care. 2014 Jun; 37(6):1751-8.
3. HAPO Study Cooperative Research Group., Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, Hadden DR, McCance DR, Hod M, McIntyre HD, Oats JJ, Persson B, Rogers MS, Sacks DA. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008 May 8; 358(19):1991-2002.