Thursday, May 19, 2005
Two-thirds of diabetics in the United States fail to adequately control their blood sugar levels, raising their risk for painful complications and early death, according to the first national survey of this key measure of their health.
The report was released at an endocrinology conference, so it's impossible to scrutinize, but the news story provides these details:
The study collected data from 157,000 diabetics in 39 states and Washington D.C during 2003 and 2004 by using A1C tests, which can gauge patients' average blood sugar levels for the previous two to three months. Blood sugar binds to hemoglobin in the blood and stays there for up to four months. The A1C test measures the percentage of sugar-bound hemoglobin, giving a longer-term average than the daily blood testing most diabetics perform at home, which only reveals blood sugar levels in the moments before the test.
Nationally, two in three patients had A1C levels exceeding 6.5 percent, which the American Association of Clinical Endocrinologists considers unhealthy. The study broke the data down by states. Mississippi fared the worst, with nearly 73 percent of patients exceeding the threshold. Montana did the best, but still just over half its diabetics were in unhealthy territory.
A HbA1C of 6.5 is a pretty stringent goal, and somewhat difficult for many diabetics to obtain without frequent episodes of hypoglycemia - episodes which people often find frightening because the symptoms are so bad - lightheadedness, nausea, sweating. On the other hand, mildly elevated blood sugars have no symptoms whatsoever. Few people are willing to adhere to a strict regimen that makes them feel sick.
On the other hand, the report says that diabetics - at least in New England - aren't doing much better with less strict goals:
For logistical reasons, not enough data could be collected on New England states and five others, though the report indicated that the two-thirds figure for diabetics with unhealthy blood sugar levels could be considered a national average. Instead, for the 11 states lacking data, the researchers relied on another data set that indicated how many patients scored 9 percent or higher on the A1C test, considered a dangerously high level.
Rhode Island, Massachusetts, Connecticut, Maine, and Vermont all had nearly 30 percent of patients above this level, while New Hampshire had 20 percent.
There's no easy answer to this. No one can stand over an adult and control the food they put in their mouth or the amount of exercise they get.
UPDATE: A diabetic's perspective:
I read your diabetic article with some interest because its the first time ever that I could read something like that and not get the sinking feeling of yeah, I really should be doing something about that. . You talk about out of control -- I did an A1C in late January which was over 12 ! In contrast, the one I just did about a month ago was 6.9 -- which is the best it has ever been. The turnaround was induced by moving to a long-lasting insuilin last November which, after a lot of tweaking, started to have positive effects by the end of January. I knew it'd be better -- I've been testing the morning and evening numbers religiously (you want to see all the little calluses on my fingertips from doing it 2-4 times a day?) -- but that was better than I'd hoped.
I suspect that there are a goodly number whose estimate of a good BSG number is triple what a good one actually is. I was like that, and on days when I'm having difficulity (where the hell did THAT reading come from?), I can be that way again. But I get over it. Knowing that things are generally working gives me the confidence to think that I can fix problems when they appear. In a way, its like being an alcoholic. I just take one day at a time. I even have a reminder posted in the bathroom -- 'Every Day is Another Chance To Get It Right'.
posted by Sydney on 5/19/2005 09:23:00 AM 0 comments