Diabetes Disconnect

Sometimes I have to wonder how some experts in the diabetes community can sleep at night.

From an outsider perspective (that would be me) it seems many held as "expert" in the diagnosis and management of diabetes, who say they believe in the goal of improving the lives of those with diabetes, remain apathetic to their own findings, and the conclusions of numerous studies, that find alarming numbers of people are walking around with undiagnosed diabetes who are experiencing major complications because they are unaware they have diabetes!

Case in point - the recent publication of Evidence of Nephropathy and Peripheral Neuropathy in US Adults With Undiagnosed Diabetes in the September/October issue of Annals of Family Medicine. This was a study funded by a grant from the National Institute for Diabetes & Digestive & Kidney Diseases (NIDDK), an agency within the National Institutes of Health (NIH). Your tax dollars at work.

In this study, the researchers "sampled adults 40 years of age and older for this analysis because this population in the NHANES had both monofilament and urine testing. We also used the subsample of participants who had fasting plasma glucose measurements, resulting in an unweighted sample size of 2,571."

The findings in the cohort, "24.9% of adults 40 years and older with undiagnosed diabetes had signs of nephropathy and 21.5% had signs of peripheral neuropathy adds to the accumulating literature which documents undiagnosed diabetes is not a benign condition but represents a serious public health concern."

The researchers continued "These findings, along with estimates of the prevalence of complications at the time of diagnosis, suggest the time before diagnosis of diabetes is neither benign nor quiescent. The time from disease onset to clinical diagnosis has been estimated to be at least 9 to 12 years. Furthermore, onset of type 2 diabetes is often insidious, with a prodrome of subclinical disease that may last more than 10 years and involves insulin resistance and other metabolic abnormalities. Insulin resistance in the absence of diabetes has been shown to be a risk factor for cardiovascular disease, prolonging the period of potential risk for complications. In fact, increased prevalence of microalbuminuria and sensory neuropathy is found in those with impaired glucose tolerance."

Now, their conclusion: "Mass population screening for diabetes is not recommended at this time despite evidence that early treatment can prevent complications."

Now you can see why I wonder why some can sleep at night.

People who have any type of diabetes are subject to long-term complications.

These complications are broken down into two groups: microvascular (small blood vessels) and macrovascular (large blood vessels).

The microvascular complications include

• Diabetic retinopathy: Eye damage that can lead to blindness if untreated.
• Diabetic nephropathy: Kidney damage that can lead to kidney failure if not treated.
• Diabetic neuropathy: Nerve damage resulting in many different symptoms, the most common of which is loss of sensation, tingling, and numbness in the feet and hands.

The macrovascular complications include

• Arteriosclerotic heart disease: The blood vessels that supply blood to heart tissue are blocked. This is the most common cause of death in people with diabetes, just as it is in people who do not have diabetes.
• Arteriosclerotic cerebrovascular disease: The arteries to the brain are blocked, leading to stroke or sometimes loss of intellectual function.
• Arteriosclerotic peripheral vascular disease (PVD): The arteries that carry blood to the legs become narrowed or clogged. If blood flow ceases completely, amputation may be necessary.

Here we have a study pointing to the damage and complications ravaging those who haven't been diagnosed - and the researchers conclude there is no reason to recommend more aggressive screening for diabetes. Basically they're saying it's okay to allow the ticking timebomb within to keep ticking away to the point of no return, "DESPITE THE EVIDENCE THAT EARLY TREATMENT CAN PREVENT COMPLICATIONS!"