Prevention is the key
Monitoring patients at risk of developing diabetes
with Dr. Jeffrey Katt, FACP, Internal Medicine, Advanced Healthcare
In his internal medicine practice with Advanced Healthcare, Dr. Jeffrey Katt sees many people with diabetes and, increasingly, many bordering on development of this disease.
Recent studies have spurred recommendations from the Department of Health and Human Services (HHS) to closely monitor those people who may be considered at high risk for diabetes. But just who is considered high risk and why?
The HHS reports that nearly 16 million Americans have a "pre-diabetic" condition that could lead to type 2 diabetes (the type found most commonly in adults) within a decade, if lifestyle changes are not made.
"The good news is, if you have pre-diabetes, you can do something about it," says HHS Secretary Tommy Thompson, noting that even modest changes in diet and exercise can reverse the condition. The bad news, however, is that our fast-food, TV and computer-driven lifestyles are working against those changes.
To counter the dramatically increasing incidence of diabetes, new guidelines recommend that physicians start screening overweight patients at age 45 for elevated blood sugar. If there are additional risk factors present, screening should start even earlier, says the panel from the National Institute of Diabetes and Digestive and Kidney Diseases and other experts.
Risk factors
A number of factors put a person at risk for diabetes.
"Along with family history, obesity is the major indicator of risk for diabetes," says Dr. Katt. Even the type of obesity can send up a red flag. "The risk is even higher with 'central obesity,' where the patient's waist circumference is greater than that of the hips."
By examining a number of factors, physicians such as Dr. Katt can pinpoint those at the highest level of risk for type 2 diabetes.
"'Syndrome X' or the 'metabolic syndrome' is what we call a combination of factors that put patients at a very high risk," explains Dr. Katt. "This means that at least three of the following factors are present: waist size more than 40 inches in men or 35 inches in women, triglyceride levels in the blood of 150 or greater, HDL or 'good cholesterol' less than 40 in men or less than 50 in women, blood pressure of 130/85 or greater, and fasting blood sugar over 99."
When a patient is diagnosed with metabolic syndrome, Dr. Katt suggests a regular exercise and weight loss program. As the HHS study indicated, sometimes even modest weight changes can make a big difference.
"If a patient is 50 pounds overweight, losing even 10 to 15 pounds may reduce blood sugar and triglyceride levels significantly," says Dr. Katt.
Screening
Dr. Katt will also recommend the patient be screened for diabetes with a fasting blood sugar test at least annually. Diabetes is defined by a fasting blood sugar level of more than 126 or any blood sugar value of over 200. A normal level is less than 110. Those found in the range of 110 to 126 are considered to be "glucose intolerant" and are at extremely high risk of developing diabetes in the near future, therefore warranting close monitoring and follow-up.
Dr. Katt estimates that he currently treats about 300 patients with diabetes and sees approximately five new cases a month. Not only are more and more people developing diabetes, but there is an alarming trend toward younger patients.
"Early in my 12 years of practice, most of the patients I saw with diabetes were in their 60s and 70s," he says. "Now it is more common to see patients developing the disease in their 40s and 50s, or even in their 30s."
Read about the latest diabetes treatments discussed by Dr. Rajeev Jain, an endocrinologist with Advanced Healthcare and one of four medical directors at Columbia St. Mary's Diabetes Treatment Center.
