Diabetics Said to Lack Control of Blood Sugar

Two-thirds of the nation’s 18 million Type 2 diabetics don’t have their blood sugar under control, putting them at high risk of the disease’s nastiest complications, even death. Yet most are unaware they’re doing so poorly, diabetes specialists said Wednesday.

“The report, I think, is sobering,” said Dr. Lawrence Blonde of the American Assn. of Clinical Endocrinologists, which released the latest statistics at its annual meeting.

Dr. Paul Jellinger, president of the American College of Endocrinology, was more blunt: “It’s horrible.”

Type 2 diabetes is the most common form of the illness, and experts estimate a third of the people who have it don’t know. An additional 41 million have “pre-diabetes,” an impaired sugar tolerance that can lead to the full-blown disease.

Type 2 diabetes sneaks up on people as the body gradually loses its ability to use insulin, a hormone crucial to converting blood sugar into energy. High glucose levels damage blood vessels and nerves -- eventually leading to blindness, kidney failure, amputations of feet and legs and heart disease. Diabetes is the nation’s sixth-leading killer.

Tight control of blood sugar, either through diet and exercise alone or with a variety of medications, can prevent that damage. The best measure of control: the A1C test, a way of tracking average blood-sugar levels over two or three months.

AACE, the endocrinologists’ group, defines glucose control as an A1C level below 6.5. But 67% of Type 2 diabetics aren’t meeting that goal, concludes a new AACE analysis.

The analysis is based on the A1C measurements, reported by a laboratory database, of 157,000 people in 39 states during 2003 and 2004.

The analysis didn’t calculate what the average A1C level was, so there was no way to know how poorly controlled these patients were, said Blonde, head of diabetes research at New Orleans’ Ochsner Clinic Foundation.

But in the remaining states, Blonde checked a different database that showed between a fifth and a third of diabetics had A1C readings above 9 -- not even minimal glucose control.

A normal A1C level is 5.

Yet an AACE-commissioned survey of Type 2 diabetics found that 84% believed they were doing a good job controlling their blood sugar, even though 61% went on to say they didn’t know what the A1C test is.

Why the disconnect?

“The American public largely doesn’t understand” this disease, said Surgeon General Richard H. Carmona, who urged patients “to take their treatment seriously.”

The endocrinologists began a campaign Wednesday for more aggressive diabetes treatment, and advised patients to:

* Ask their doctor about their A1C level at every visit. If the scores show they’re not making progress, they should ask what else can be done to lower A1C levels. Diet and physical activity are crucial to glucose control, but many patients also need medications.

* Strive for good blood-sugar levels during daily at-home glucose monitoring: no more than 110 before meals, and 140 two hours after eating.