INSIDE
Health Matters

By Virginia Lester,
RN, MSN, ARNP

The classification of Diabetes Mellitus (DM) has changed along with the increased knowledge and understanding of the disease process.
A committee of experts has recommended the adoption of a more accurate diagnostic criterion, type 1 and type 2. I will focus on type 2 DM which accounts for 90 – 95 percent of all cases of DM. More than 80 percent of diabetics over the age of 55 are overweight or obese.

Research has demonstrated that obesity is a major risk factor for type 2 DM because insulin resistance is a result of obesity. Recommendation from the committee is to add a new category of impaired glucose metabolism known as “Pre-diabetes.” In years past this term has been suggested, however it was feared that insurance companies might not cover patients with this diagnosis. Now it is clear that it is a legitimate diagnosis and perhaps beneficial in preventing further progression to type 2 DM.

The term “Pre-diabetes” is an attempt to identify those patients who may be at increased risk of developing type 2 DM and initiate early intervention. The criterion for diagnosis of pre-diabetes is that gray area between normal blood sugar levels and abnormal levels.

Following is the criteria for fasting glucose levels:
• Less than 100 is normal
• 100-125 is pre-diabetes
• Over 126 is provisional, requiring confirmation of DM
Following is the criteria for glucose levels two hours after eating or after a measured glucose drink:
• Less than 140 is normal
•140-199 is pre-diabetes
•Over 200 is provisional, requiring confirmation of DM
Insulin resistance is defined as a decreased cell response to insulin, resulting in increased circulating glucose in the blood and a resulting increased blood glucose level. Most patients with type 2 DM are overweight and have increased abdominal fat stores. It has been determined that obesity itself causes some degree of insulin resistance. In the past decade the prevalence of type 2 DM in children and adolescents has paralleled the obesity epidemic. Children are at an increased risk of developing disabling complications seen in adults.
To review: The most common risk factors, but not all inclusive, for the development of DM are physical inactivity, family history, ethnic minority, delivering a baby weighing greater than nine pounds, high blood pressure, abnormal cholesterol or triglyceride results, polycystic ovarian syndrome, impaired glucose test, and history of vascular disease.

Several studies have shown the benefit of early intervention with combination therapy. A five – 10 percent weight reduction, regular exercise and medication may be able to prevent or certainly delay the development of confirmed DM.

The expert committee recommends screening for DM in asymptomatic individuals over age 45, every three years. Screening should be done more often in those who are overweight and have additional risk factors.
The number of Americans with DM is now over 20 million; of which about six million are undiagnosed. Approximately 800,000 – 900,000 new cases of DM are diagnosed yearly. DM and complications from DM is the seventh leading cause of death in this country. This results in an annual cost in disability and premature death of at least $135 billion.
Maintaining good health is our own responsibility. Screening tests are available at the clinic as well as management of all stages of DM.