New Type 2 Diabetes Guidelines

(AP)  A pair of physicians groups on Wednesday recommended increasingly aggressive treatment for newly diagnosed diabetes patients.

While lifestyle changes such as losing weight, exercising and watching the diet are often recommended for people with Type 2 diabetes, the new recommendations urge physicians to treat the disease aggressively early, often with two or more drugs.

The goal is to quickly get blood sugar levels as close to normal as possible, said Dr. Harold Lebovitz of SUNY Downstate Medical Center in New York.

In addition, people at high risk for developing diabetes should be screened starting at age 30, the American College of Endocrinology and the American Association of ClinicalEndocrinologists said.

"If we don't get them diagnosed early we miss an opportunity to prevent complications later in life," said Dr. Jaime A. Davidson of the University of Texas Southwestern Medical School in Dallas.

Complications from diabetes can include heart and nerve disease, eye damage and amputation of limbs.

The recommendations focus largely on Type 2 diabetes, the more common form of the illness, in which the body either doesn't produce enough insulin, or doesn't use it correctly. Type 1 diabetes, in which the body simply doesn't produce insulin, always requires treatment with drugs.

The groups estimate that more than 20 million Americans are diabetic, though as many as one-third don't know it. In addition, they said 41 million are believed to have pre-diabetes, an impaired sugar tolerance that can lead to diabetes.

"The reason we are here is because we have a lot of work to do," Davidson said in announcing the recommendations.

Pushing for early medical treatment doesn't mean diet and exercise are not important, Lebovitz said, and those lifestyle changes can help maintain correct blood sugar once it is reduced to normal or near normal levels.

"We all enjoy eating, but if you have diabetes controlling what you eat is essential," added Davidson. "Medications and lifestyle changes can help patients with diabetes stay under control for a long period of time."

In addition to early intervention and treatment the groups recommendations said:

Education is critical for patients with diabetes. The more people know about the disease the better their chance of living a longer and healthier life.

Frequent blood glucose monitoring allows the patient and doctor to better control sugar levels in the blood. Good control means keeping blood sugar below 110 before eating and below 140 two hours after eating.

Stick to a daily meal plan and know when and how to make adjustments.

Include daily exercise in the management of diabetes.

The physicians also urged patients to get an A1C test, which measures the amount of sugar in the hemoglobin - the red chemical in blood. That test gives a picture of average blood sugar levels over the previous two to three months.

In people who do not have diabetes, about 5 percent of the hemoglobin is affected by sugar, while levels can range up to 25 percent in the most severe cases of diabetes.

The new recommendations call for efforts to reduce the level to 6.5 percent in diabetics, somewhat less than the 7 percent recommended by the American Diabetes Association.

Dr. Nathaniel Clark, national vice president for clinical affairs at the Diabetes Association, said that while there are slight differences between the recommendations of endocrinologists and the ADA, "the basic message we fully support, and that is that patients with diabetes need to be treated aggressively using a variety of treatments."

When a patient is first diagnosed with diabetes, many physicians will prescribe lifestyle changes and then wait several months to see if they have an effect, Clark said. There are clearly some patients for whom that will not be enough and who will need medication from the beginning, he said.

Endocrinologists specialize in the treatment of diseases like diabetes that involve the glands that secrete hormones. Their recommendations came at the end of a consensus conference on diabetes treatment.


By Randolph E. Schmid