Diabetes 'Revolution' is Cutting Both Ways

New drug treatments, more accurate methods for monitoring blood sugar levels and assessing control of diabetes, and practical steps that patients can take are more common than ever, she says.

A Disease With No Respect

Buse, president of the American Diabetes Association, says it wasn't so long ago that diabetes treatments weren't much of a priority in the medical community.

"It was the Rodney Dangerfield of human disorders," Buse says. "Ten or 15 years ago at ADA, we were talking about what message we want to convey (to the public), and a decision was made not to convey the message that diabetes was serious," because there was so little doctors could do to prevent complications.

"It would have been like saying: 'Bad news, your house is on fire, and worse, there's no water for miles,' " he says. Until 1993, it wasn't clear that lowering blood sugar prevented or delayed complications, and it's only within the past decade that doctors learned that managing blood pressure and cholesterol reduced complications, he says. "Until 1995, there had been no substantial advance in drug management of diabetes since the 1950s."

Diabetes, like other chronic diseases, is caused by a combination of genetics and environment. It results in a high level of sugar in the blood, which over time clogs vessels the way gummy oil clogs a car engine, leading to poor circulation that affects everything from brain to feet, increasing the risk of heart disease and damage to kidneys, eyes and nerves.

There are two major forms of diabetes: type 1, an autoimmune disease that results in loss of the insulin-producing cells in the pancreas and usually occurs in children or young adults, who need daily insulin shots; and type 2, which accounts for 90 percent of diabetes cases and is associated with obesity and inactivity and reduces the ability to use insulin efficiently.

American Indians, blacks, Asians and Latinos are believed to carry a higher genetic risk for type 2 diabetes. That, along with increasingly fatty diets, has helped to trigger an explosion of diabetes in those communities — even as treatments for complications from diabetes have improved.

Dorothy Becker, chief of the division of pediatric endocrinology and diabetes at Children's Hospital Pittsburgh, treats children, most of whom have type 1 diabetes.

"I used to see major complications in kids," she says. "Now, I can't make my kids understand what complications are. We used to see kidney damage, now we're not. We used to see protein in the urine (an indicator of decline in kidney function), but now we don't see it at all. We're just not seeing what we used to see."

Doctors say these changes are the result of improvements in:

Diagnosis. Greater awareness of diabetes has prompted increased screening and earlier diagnosis of type 2 diabetes. One example: The Blood Bank of Delmarva, which serves Delaware and the Eastern Shore of Maryland and Virginia, last month began offering free, non-fasting blood sugar tests to donors. Donors will have access to a secure site online to see their results and get more information on their diabetes risks. Those whose tests indicate dangerously high blood sugar levels will be contacted by the blood bank.

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