Sugar trap

New guidelines have been laid down to redefine the scale of diabetes

Published: Friday 31 October 1997

levels of blood sugar earlier considered normal by physicians all over the world, are actually high and people having such levels may also have diabetes, says a us Committee on the Diagnosis and Classification of Diabetes Mellitus constituted by the American Diabetic Association (ada).

According to the new guidelines recommended by the Committee, a person is considered diabetic if two readings taken on different days show that the level of glucose in the blood is 126 mg per decilitre or more. At present, the cut-off point is 140 mg. The ada recommends that more expensive, time-consuming and cumbersome test called oral glucose tolerance test, which requires patients to undergo two tests -- one while fasting and next two hours after consumption of food -- should be replaced by a simple fasting plasma glucose test. Healthy people of age 45 and older, should undergo medical checkups once in every three years.

Figures show that nearly 10 per cent of India's urban population and two per cent of rural population above age 15 are suffering from diabetes. The expected 35 million cases in the country may put a tremendous pressure on the already overburdened health care system.

In the us, the Centres of Disease Control and Prevention, Atlanta and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, have already endorsed the guidelines. Physicians have been told to follow the guidelines during diagnosis and treatment of diabetes. The World Health Organisation (who) is also expected to endorse the recommendations that would pave the way for worldwide acceptance of these guidelines.

S K Wanganoo, senior consultant, department of endocrinology and diabetes, Apollo hospital, New Delhi says, "Many people with glucose levels less than those recommended by the who, develop the complications of diabetes that damage blood vessels. Such damages may lead to cardiovascular problems such as heart disease and strokes, kidney damage, nerve damage and changes akin to retinopathy."

If the who endorses these guidelines, most of the patients in India could be diagnosed and treated at early stages. Treatment in terms of dietary control, exercise and regular drugs would help optimise a patients' body weight and prevent further complications. A basic problem of overweight is insulin resistance that is responsible for coronary artery disease, hypertension and lipid abnormality, he says.

The ada estimates that in the us, nearly 178,000 people die of complications due to diabetes every year, whereas nearly 54,000 need amputations and about 24,000 become blind. Research has shown that high levels of blood sugar produce no symptoms initially and many adults have diabetes for seven years or more before it is actually diagnosed. By the time, the disease is diagnosed, irreversible damage to circulatory system and organs may already have occurred.

After the introduction of new guidelines, most patients would fall under type i diabetes that affects nearly 95 per cent of all diabetic patients. The disease occurs mainly in people over age 40. On the contrary, type ii diabetes or juvenile diabetes is a more severe form of the disease that develops in childhood or adolescence due to severe deficiency of insulin. Type ii patients are more likely to be overweight, have blood pressure and other risk factors associated with heart diseases than type i patients.

In type i diabetes, people have high levels of blood sugar because their bodies cannot use insulin properly and in some cases cannot make enough of the hormone to metabolise sugar. An immediate goal of the treatment is to control blood sugar in people and bring it to normal levels.

According to Richard C Eastman of the National Institute of Diabetes and Digestive and Kidney Diseases, a majority of people who are diagnosed at early stages would not require any specific therapy because their levels of blood sugar would not be very high. But it increases with time, and the health of patients would need to be followed closely, he says.

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