Diabetes Requires Aggressive Management

Oct 19, 2004
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Live report from the AAFP annual meeting in Orlando, FL Diabetes kills one American every 3 minutes according to Dr. Jeffrey Unger of the Chino Medical Diabetes Intervention Center, in Chino, CA. That’s more than AIDS and breast cancer combined. There are over 150 million diabetes patients worldwide and that number is expected to double in 20 years.

We, as family physicians, need to aggressively treat our patients. Aggressive treatment reduces microvascular and macrovascular complications and decreases endothelial cell inflammation.

Dr. Unger recommends screening patients over 45 years old every three years and if their fasting is between 110 and 126mg/dl then a 2 hour glucose challenge test is warranted.

If a patient has a multiple risk factors they should be screened yearly starting at age 30(table 1)

Table 1
Pre-Diabetes: Fasting reading of 100 to 120mg/dl or Postprandial Reading of 141 to 189mg/dl
Risk Factors for Pre-Diabetes:
Overweight (body mass index of 25 or more).
Family history of diabetes.
Low HDL cholesterol

Family physicians should also be aware of Insulin Resistance Syndrome. This metabolic defect leads to diabetes in 15% of all patients.

Lifestyle interventions during the pre-diabetes phase can help prevent the onset of diabetes according to Dr. Unger. “Behavioral modification is the key to successful intervention.” “Be sure to set reasonable goals for weight loss and exercise for your patients. Start small and build on the successes. Even a 4% weight loss is beneficial and a good starting goal.”

Medical intervention should be aggressive also. Dr. Unger recommends statins and aspirin for all diabetic patients at risk for cardiovascular disease. Strive for A1c’s below 7% and think insulin early.

He recommends that FP’s should consider insulin when they are symptomatic or are unable to achieve the desired A1c within 3 months of starting triple oral therapy or have triglyceride levels higher than 700 mg/dl.

In closing Dr. Unger reminded us that primary care physicians see 90% of all diabetes patients but on had 4 hours of diabetes training while in school.

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FACT:
After an amputation, the chance of another amputation within 3 to 5 years is as high as 50 percent. The 5 year mortality rate after amputation ranges from 39 to 68 percent.
National Diabetes Fact Sheet, 2002 ADA