What is Diabetes Mellitus Type II?
To understand what Diabetes Mellitus Type II (DM) is, we first need a quick explanation of insulin, and what happens when you eat. When you eat, your body absorbs all of the carbs, fats, proteins and other particles from the food. It then attempts to first of all use the available sugars (carbs) as energy, and stores the rest. The way that these sugars enter the cells of your body, are triggered by a hormone called insulin, which is secreted from the pancreas when you eat. Diabetes occurs when there is a problem with the insulin secretion, or when the insulin does not function properly in the body. It creates a problem where there is too much sugar in your bloodstream.
Why is it dangerous?
Excess sugar in the bloodstream may lead to a variety of problems. It can be damaging to the small vessels in your eyes, causing problem of sight that may be irreversible. It causes your kidneys to work overtime excreting the sugar, which can easily lead to dehydration. However perhaps the most dangerous of the problems is when the excess sugar in the blood vessels leads to a narrowing of the vessels themselves. This can cause peripheral neuropathy, heart attacks, stroke, and kidney failure. This is why it is absolutely imperative to control your blood sugar levels if you have been diagnosed with diabetes.
Who should be screen tested?
The good news about diabetes is that it can be detected easily through blood tests even before the disease has progressed enough to cause symptoms. However, it is always important to be skeptical of the evidence. For a large portion of the population, there has been no evidence pointing to the direct benefit of screen testing for DM. However, patients over the age of 40 who have been diagnosed with hypertension (high blood pressure) can reduce the chances of having a cardiovascular event by around 50% over 5 years if they catch their diabetes at the asymptomatic stage. That is currently the only population that has a concrete recommendation to get their blood tested for A1C levels, or plasma glucose every 3 years.
What can we do about it?
The benefits of lifestyle changes cannot be recommended enough for the impact they have on individuals diagnosed with DM. A healthy diet, regular exercise have been shown to have significant benefit on the outcome of patients with DM, as well as preventing it. Furthermore, patients who have balanced glucose and A1C levels in their blood have better outcomes than patients who are untreated. However it is important to note that the evidence for starting medical treatment (medication) early in patients diagnosed with DM has not been proven to show major improvements in outcome. This is a point that should be taken into consideration when discussing the treatment options with your physician. That being said, it is important to once again reiterate the importance of lifestyle changes (diet and exercise) which evidence is quickly mounting up to support the positive impact that this has on individuals diagnosed with DM.
Are these the only recommendations?
Of course not. There are many different bodies providing different recommendations. The American College of Obstetricians and Gynecologists for example recommends all women after the age of 45 to test their fasting glucose levels every 3 years. The American Diabetes Association also recommends people to be screened after the age of 45, though they put an emphasis on people who are overweight, or have been diagnosed with hypertension. It’s important to look at the evidence for the healthy individuals over the age 45, which doesn’t provide much support to screen the general population if they don’t have additional risk factors.
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Here are a few studies which prove the efficacy of screening and early treatment for DM Type II. Feel free to contact us for more information about the matter, we would be happy to provide it to you.
Lauritzen T, Griffin S, Borch-Johnsen K, Wareham NJ, Wolffenbuttel BH, Rutten G. Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen Detected Diabetes in Primary Care. The ADDITION study: proposed trial of the cost-effectiveness of an intensive multifactorial intervention on morbidity and mortality among people with type 2 diabetes detected by screening. Int J Obes Relat Metab Disord. 2000;24 Suppl 3:S6-11. [PMID: 11063279]
Coutinho M, Gerstein HC, Wang Y, Yusuf S. The relationship between glucose and incident cardiovascular events. A metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years. Diabetes Care. 1999;22:233-40. [PMID: 10333939]
Norris SL, Kansagara D, Bougatsos C, Fu R. Screening adults for type 2 diabetes: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2008;148:855-68.
Norberg M, Eriksson JW, Lindahl B, Andersson C, Rolandsson O, Stenlund H, et al. A combination of HbA1c, fasting glucose and BMI is effective in screening for individuals at risk of future type 2 diabetes: OGTT is not needed. J Intern Med. 2006;260:263-71. [PMID: 16918824]