Monday, April 4, 2016

Doctors May Be Missing Chances to Treat Prediabetes

More than one-third of U.S. adults have prediabetes, which means their blood sugar levels are higher than normal, but not high enough to be diagnosed with diabetes. People with prediabetes are at risk for circulatory problems, kidney disease, and nerve and retinal damage, the study authors said.

“We know that prediabetes is considered one of the biggest risk factors for the development of diabetes, with estimates ranging from 15-30% of people with prediabetes developing diabetes within five years,” said lead investigator Arch Mainous III. Mainous is chair of the department of health services research, management and policy in the College of Public Health and Health Professions at the University of Florida.

“We also know that 90% of people who have prediabetes don’t know they have it. So the question becomes, where is the doctor in all this? Is the doctor identifying people with prediabetes, telling them about it and providing treatment? That’s what we wanted to find out,” he said in a university news release.

Mainous and his colleagues analyzed 2012 federal government survey data on people aged 45 and older who had doctor-ordered blood tests within the past 90 days. About 34% of them had blood sugar levels that indicated prediabetes.

However, very few of those patients were told they had prediabetes and only 23% of them began treatment for the condition, such as lifestyle changes or drug therapy, according to the study. The findings were published March 8 in the Journal of the American Board of Family Medicine.

“Even with blood test results in front of them, physicians weren’t detecting prediabetes in their patients in terms of making a diagnosis or providing some sort of management or treatment,” Mainous said.

“Identifying people with prediabetes and getting them some sort of treatment has been shown to be effective for slowing the progression to diabetes or stopping it altogether, and that is the goal of prevention,” he explained. “We don’t want to manage half the population with diabetes. What we want to do is keep them from getting diabetes.”

Mainous said he is now conducting a survey of thousands of family doctors to learn why so many patients with prediabetes aren’t receiving treatment.

My Take:
Why no treatment? Because the average PCP (primary care physician) has no concept of prevention. Just the fact that the study mentions drug therapy for the condition makes me wonder if the researchers have any understanding either.

This study used high fasting glucose levels as the indicator of prediabetes which was the gold standard in 2012. Now the gold standard is the hemoglobin A1c which is much more accurate and sensitive to chronic elevation of blood glucose. Using the A1c, the number of U.S. adults with prediabetes (metabolic syndrome) jumps from one-third to one-half. Within ten years half the population will have diabetes.

It is all about lifestyle changes rather than drug therapy but where is the profit in a healthier lifestyle? The cost of treating diabetes in the U.S. in 2012 was $245 billion dollars, including $169 billion dollars in direct medical costs. That’s big money for Big Pharm. But diet and exercise don’t produce a profit. In fact lifestyle changes dramatically reduce medical costs.

This study looked at patients aged 45 and older. I routinely diagnose prediabetes in patients from their late 20’s upward. My first indicator is inflammation (often musculoskeletal) in the prostaglandin pathway that tests favorably for sesame seed oil. That tells me that some aspect(s) of metabolic syndrome are underlying the inflammation. That could be hypothyroidism but more often it is insulin resistance or maybe both. The A1c is the confirmatory test. Clinically, it correlates with the need for sesame seed oil in more than 90% of cases seen in my office.

The Bottom Line:
Have your hemoglobin A1c run on a yearly basis. The medical norms are 4.6 to 5.6%. Anything above 5.6% needs to be addressed now.

Source: March 9, 2016 National Institutes of Health

1 comment:

Comments Await Approval Before Posting