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The McLean County in the State of Illinois has about 9,500 people or 7% of its population with diabetes. Of those, about 120 die each year from the disease. Blue Cross and Blue Shield of Illinois collaborated with McLean County employers and health care providers to develop and implement a diabetes intervention program called Diabetes Checks and Balances.

The first program of its kind in Illinois, Diabetes Checks and Balances encouraged people with diabetes to contact their physician to obtain four tests – a HbA1c, a LDL, and eye exam and screening for kidney disease. More than 600 area participants met the criteria for the exam and 29% completed all four of the tests, twice as many people as in 2006 when it first started.

It is well known that diabetes is under-diagnosed. Approximately one-third of the individuals with diabetes do not know they have it and it generally takes about 7 years to determine the diagnosis. By that time, irreparable damage may already have occurred. This report offers a reconsideration of the diagnostic criteria for diabetes.

This study demonstrated that derangements of blood glucose control occur in patients with and without diabetes who undergo cardiac surgery. The study analyzed 8,727 adults placing them in a variety of blood glucose control categories (good= < 200 mg/dl), (moderate = 200-250 mg/dl)or (poor = >250 mg/dl). They determined that the percentage that fell in the inadequate blood glucose control categories were more likely to have heart failure, hypertension, renal dysfunction and ejection fraction < 50%. The study found that 52% of patients had poor control, 31% had moderate control and 8% with good control had diabetes as a diagnosis. Inadequate blood glucose control, but not diabetes, was associated with in-hospital mortality and morbidity. Inadequate control was also associated with post-operative heart attacks, and with pulmonary and renal complications in people without the diagnosis of diabetes.

A study that looked at birth records of 13,000 births from ten different states found that birth defects were three to four times more likely to develop in women who had a form of diabetes termed “gestational” diabetes. The study provides detailed information on the types of deformities diabetic mothers are likely to incur with their infants which includes heart defects, missing kidneys and spine deformities.

This study demonstrated that derangements of blood glucose control occur in patients with and without diabetes who undergo cardiac surgery. The study analyzed 8,727 adults placing them in a variety of blood glucose control categories (good= < 200 mg/dl), (moderate = 200-250 mg/dl)or (poor = >250 mg/dl). They determined that the percentage that fell in the inadequate blood glucose control categories were more likely to have heart failure, hypertension, renal dysfunction and ejection fraction < 50%. The study found that 52% of patients had poor control, 31% had moderate control and 8% with good control had diabetes as a diagnosis. Inadequate blood glucose control, but not diabetes, was associated with in-hospital mortality and morbidity. Inadequate control was also associated with post-operative heart attacks, and with pulmonary and renal complications in people without the diagnosis of diabetes.

Should diabetes drugs face tougher standards? With nearly 24 million Americans with Type II Diabetes who are already at risk for heart disease, should we be medicating them with drugs that aggravate or increase the risk for heart disease?

In a Fox News report it was brought to our attention that advisors to the Food Drug Administration (FDA) had voted 14-2 on tougher studies to assure that diabetes drugs don’t increase the risk of heart disease. This comes on the heels of the news release that the FDA will be adding new information on heart disease risk to the existing boxed warning about the potential for increased risk for heart attacks with the use of Avandia, a popular anti-Diabetes drug.

The FDA stated that at this time there isn’t enough evidence to indicate that the risks of heart attacks or death are different between Avandia and some other type 2 diabetes treatments. Therefore, the FDA has requested the Glaxo—Smith Kline (GSK) conduct a new long-term study to evaluate these proposed cardiovascular risks with Avandia. GSK, who currently manufactures Advandia, has agreed to the study with FDA oversight authority.

In a study published in the June, 2008 issue of The American Journal of Medicine the cut-off level for determining diabetes was again challenged. After looking at 46, 578 members of Kaiser Permanente it was found that subjects developed diabetes at a rate of 1% per year. Subjects were assigned to 1 of 4 categories of blood sugar levels (<85, 85-89, 90-94, or 95-99 mg/dl). They were followed for 81 months.

The strong independent association between the level of normal fasting plasma glucose and the incidence of diabetes after controlling for other risk factors (i.e. body mass index, blood pressure, lipids, smoking, cardiovascular disease and hypertension) suggests that diabetes risk increases as fasting plasma glucose increases, even within the currently accepted normal range. For example, for each mg. per deciliter of fasting plasma glucose diabetes risk was increased by 6%. Subjects with glucose levels of 95-99 were 2.33 times more likely to develop diabetes. Subjects in the 90-94 mg/dl group were 49% more likely to progress to diabetes.

Age, by itself, is not an indicator for limiting tight glucose control according to a recent study. What limits the control parameters for older adults with type 2 diabetes is functional impairment and their list of co-morbidities. Chronological age, the study states, is not an indicator for abandoning tight control.

Intensive control of type 2 diabetes has met with mixed results according to recent studies such as the ACCORD and ADVANCE trials (http://www.reuters.com/articlePrint?articleId=USN0640739920080606). Both trials failed to show any reduction in cardiovascular events over 3.5-5 years in high risk patients with type 2 diabetes treated with intensive blood glucose lowering strategies, compared with standard treatment.

A study done at Joslin Medical Center has shown that following a prescribed diet is associated with better glycemic control in Type I diabetes. The researcher stated that in recent years treatment had shifted focus from diet to medications and technologies. In this study the importance of diet was evaluated.

The study followed 119 children aged 9-14 and surveyed the parents on how closely their children followed prescribed dietary intake like carbohydrate counting, balancing insulin dose to carbohydrates consumed, and the quality of the diet itself including sweets and fats.