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Item
#3
Afternoon
Office Visits May Miss ˝ of Diabetes Diagnosis
Doing
a random blood glucose test in the afternoon can miss 50% of those
with undiagnosed diabetes.
Application
of current diabetes diagnostic criteria to patients seen during
afternoon office visits may miss half of the patients who have
undiagnosed diabetes, according to a report published in the
December 27th issue of The Journal of the American Medical
Association. This occurs as a result of the diurnal
variation in fasting glucose, where levels are higher in the
morning than in the afternoon.
Dr.
Maureen I. Harris, from the National Institute of Diabetes and
Digestive and Kidney Diseases, in Bethesda, Maryland,
randomized 12,882 subjects, age 20 years or older, with no
previously diagnosed diabetes to undergo a morning or afternoon
fasting glucose evaluation.
Fasting plasma glucose levels
from morning-examined subjects were significantly higher than
levels from afternoon-examined subjects, the authors note. As a
result, only half as many afternoon-examined subjects had glucose
levels greater than 126 mg/dL compared with morning-examined
subjects.
The fasting glucose level
diagnostic of diabetes would have to be reduced to 114 mg/dL or
greater in afternoon-examined patients, Dr. Harris' team
calculated, in order to achieve a prevalence comparable to that in
morning-examined subjects when the standard level of 126 mg/dL or
greater was employed.
The
researchers pointed out that many patients in the ambulatory care
setting are seen in the afternoon, and these patients can be asked
to fast for at least 4 hours before testing for diabetes.
Therefore regardless of the time of day that patients are
tested, physicians need to confirm the diagnosis by repeat testing
on a different day.
Early
morning rises in fasting glucose levels and insulin requirements
(the 'dawn phenomenon') have been observed in patients with
diabetes and in some, but not all, studies of nondiabetic persons.
The data showing higher fasting levels of plasma glucose, serum
insulin, and serum C peptide.
The Journal of the American Medical Association, Dec
27, 2001
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FACT:
Diabetes
mortality rates vary considerably across the U.S. with the highest
rates in the Ohio Valley and New England and in parts of the
southeast, and lowest in Alaska and the Rocky Mountain region.
Source Diabetes 2001: vital Stats Pg. 78
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