Michael.Massing + diagnosis + standards + care   22

Relation between blood glucose and coronary mo... [Diabetes Care. 2006] - PubMed - NCBI
All-cause, cardiovascular, and respiratory mortality were elevated among participants with glucose intolerance. The hazard of coronary mortality rose from 2hBG = 4.6 mmol/l (83 mg/dl [95% CI 4.2-5.3]). The dose-response relation was best fitted by a single slope above this level, with no evidence of nonlinearity, compared with Cox models using other threshold levels, and those containing log 2hBG terms. There was no evidence for a dose-response relationship below 2hBG = 4.6 mmol/l. Between this level and 11.1 mmol/l (200 mg/dl), the age-adjusted hazard ratio was 3.62 (95% CI 2.3-5.6). The graded relationship was attenuated by 45% after adjustment for baseline coronary heart disease (CHD), BMI, systolic blood pressure, blood cholesterol, smoking, physical activity, lung function, and employment grade.
CONCLUSIONS:
A threshold model with linear slope [rising from 83mg/dL] best described the dose-response relationship between postload blood glucose and CHD mortality risk.
glucose  risk  dysglycemia  threshold  mortality  morbidity  cardiovascular  normal  respiratory  all-cause  medical  research  peer-reviewed  diabetes  prediabetes  standards  self  care  management  diagnosis 
january 2012 by Michael.Massing
Diabetic Retinopathy
There is evidence that retinopathy begins to develop at least 7 years before the clinical diagnosis of type 2 diabetes....
At present, the most effective medical treatment to slow the progression of diabetic retinopathy is glycemic control. The relationship between hyperglycemia and retinopathy has been reported in well-conducted observational studies (70). The Diabetes Control and Complications Trial (DCCT) and the U.K. Prospective Diabetes Study (UKPDS) are two randomized clinical trials that conclusively showed the efficacy of glycemic control in preventing diabetic retinopathy (71–73).
intervention  treatment  medical  research  peer-reviewed  hyperglycemia  dysglycemia  risk  retinopathy  eye  blindness  diabetes  blood  glucose  self  care  morbidity  correlation  standards  normal  prediabetes  diagnosis 
january 2012 by Michael.Massing
IRIS - Publications - Coronary-heart-disease risk and impaired glucose tolerance. The Whitehall study.
In the Whitehall Study of 18,403 male civil servants aged 40--64 years, 7 1/2 year coronary-heart-disease (CHD) mortality has been examined in relation to blood-sugar concentration 2 h after a 50 g oral glucose load. CHD mortality was approximately doubled for subjects with inpaired glucose tolerance (IGT), defined as a blood-sugar above the 95th centile (greater than or equal to 96 mg/dl). There was no trend of CHD mortality with blood-sugar below the 95th centile. Within the IGT group, age, systolic blood-pressure, and ECG abnormality (Whitehall criteria) were significantly predictive of subsequent CHD mortality. These findings are relevant to discussions on the criteria for diabetes which include the definition of an IGT category with increased risk of large-vessel disease, but without the high risk of small-vessel disease as occurs in diabetes mellitus.
diabetes  risk  mortality  CHD  CVD  heart  vascular  disease  coronary  normal  standards  blood  glucose  impaired  tolerance  challenge  post-challenge  prediabetes  self  care  management  correlation  diagnosis 
january 2012 by Michael.Massing
“Normal” Blood Sugar Levels May Still Mean You Have Prediabetes « Diabetes Dialectics
[Under 1% of those starting with fasting blood sugar levels between 51 and 82 mg/dl wound up diabetic;] more than 3% did so if they had values between 91 and 99. After controlling for other [risk factors], that corresponded to a two-fold difference in risk of developing the disease.
[With prediabetes, the long-term damage of diabetes—especially to the] heart and circulatory system—may already be starting. If your blood sugar tests over 100 mg/dl fasting more than once, your fasting blood sugar is likely to go over the 125 mg/dl level used to diagnose full diabetes within 3 years.
More importantly, if your blood sugar is at 100 mg/dl fasting, it is very likely that your post-meal blood sugar is heading towards the diabetic range, which is over 200 mg/dl which is why your fasting blood sugar is deteriorating. High post-meal blood sugars kill beta cells. If you can bring down those post-meal highs, you may be able to prevent the beta cell death that is destroying your fasting control!
diabetes  prediabetes  criteria  risk  progression  prevention  normal  blood  sugar  glucose  standards  threshold  number  to  harm  intervention  medical  research  fasting  beta  cell  death  point  comorbidities  symptoms  late-stage  complications  morbidity  postprandial  tipping  self  care  management  correlation  peer-reviewed  late  end-stage  diagnosis  from delicious
june 2011 by Michael.Massing
Guidance for Industry - Powered by Google Docs
The treatment goals for patients with diabetes have evolved significantly over the last 80 years, from preventing imminent mortality, to alleviating symptoms, to the now recognized objective of normalization or near normalization of glucose levels with the intent of forestalling diabetic complications....
remission  normal  treatment  blood  glucose  sugar  progression  benefit  risk  cardiovascular  medical  research  drug  effects  regulation  via:FDA.gov  references  consensus  mortality  morbidity  diabetes  standards  normoglycemia  links  what.I'm.reading  prediabetes  self  care  management  T2D  diagnosis  from delicious
april 2011 by Michael.Massing
What should your A1C be?
There are several answers to this question and the experts do not seem to agree.

According to Dr. Richard Bernstein a normal, healthy, thin, non-diabetic A1C will be within the range of 4.2-4.6. He also believes every diabetic can and should target, attain and sustain these normal levels.

The American Diabetes Association (ADA) states an A1C of less than 6.0 is normal and recommends an A1C less than 7.0 in diabetics.

The American College of Endocrinology (ACE) and the American Association of Clinical Endocrinologists (AACE) adopted a target A1C of less than 6.5 percent at their diabetes treatment consensus conference in 2001.

What do the experts agree on?

Although the diabetes experts disagree on the definition of a normal A1C and a target A1C for diabetics, they do agree that lowering A1C has been associated with a reduction in microvascular and neuropathic complications of diabetes and possibly macrovascular disease.

The ADA states "More stringent goals (i.e., a normal A1C less than 6 percent) should be considered in individual patients based on epidemiological analyses suggesting that there is no lower limit of A1C at which further lowering does not reduce the risk of complications…(particularly in those with type 1 diabetes)."
diabetes  Richard  Bernstein  normal  risk  blood  glucose  cutoff  threshold  standards  conversion  mg/dL  A1c  prediabetes  self  care  management  diagnosis  from delicious
april 2011 by Michael.Massing
Normal Fasting Plasma Glucose and Risk of Type 2 Diabetes Diagnosis
Subjects developed diabetes at a rate of less than 1% per year during a mean follow-up of 81.0 months. Each mg/dL of fasting plasma glucose increased diabetes risk by 6% (hazard ratio [HR] 1.06, 95% confidence interval [CI], 1.05-1.07...) after controlling for other risk factors. Compared with those with fasting plasma glucose levels less than 85 mg/dL, subjects with glucose levels of 95 to 99 mg/dL were 2.33 times more likely to develop diabetes (HR 2.33; 95% CI, 1.95-2.79...). Subjects in the 90 to 94 mg/dL group were 49% more likely to progress to diabetes (HR 1.49; 95% CI, 1.23-1.79...). [P <.0001 in all caes] All other risk factors except sex were significantly associated with a diabetes diagnosis.
The strong independent association between the level of normal fasting plasma glucose and the incidence of diabetes after controlling for other risk factors suggests that diabetes risk increases as fasting plasma glucose levels increase, even within the currently accepted normal range.
normal  FPG  blood  glucose  standards  risk  high  threshold  cutoff  diabetes  medical  research  comorbidities  symptoms  late-stage  complications  morbidity  prediabetes  self  care  management  correlation  late  end-stage  diagnosis  from delicious
april 2011 by Michael.Massing
Diabetes Testing Among Poor, Minority and Inner-City Adults Plummets
The proportion of poor [adult diabetics] age 40 and over who had their blood sugar, eyes and feet examined at least once a year dropped from 39% to 23% between 2002 and 2007, according to the latest News and Numbers from the Agency for Healthcare Research and Quality. <br />
For middle-income adults the drop in these three tests to prevent complications [such as blindness, kidney failure, and amputation] was 41% to 33%.... <br />
Blacks experienced an 11 percentage point plunge, from 43% to 32%, while the proportion of Hispanics who had all three exams tumbled from 34& to 27%...<br />
Regardless of race or ethnicity, complications monitoring among adult residents of large inner cities dropped from 45% to just under 33%. <br />
Also regardless of race, the percentage of adults with high school education who had the three tests fell 11 points (from 43% to 32%) and for those who did not finish high school, the drop was 34% to 29%. The reduction was only 4% (51 to 47%) for adults with at least some college...
class  education  risk  health  literacy  diabetes  healthcare  socioeconomic  status  poor  poverty  research  social  science  self  care  disparities  socioeconomics  screening  testing  public  race  ethnicity  geography  demographics  provider  caregiver  standards  diagnosis  disparity  mortality  morbidity  from delicious
april 2011 by Michael.Massing
Diabetes Risk Extends Into "Normal" FPG Range - American Diabetes Association
Although the overall risk of developing diabetes was low in people with normal FPG levels, the risk increased as FPG increased, after taking other factors into account. For every 1 milligram per deciliter increase in FPG, the risk of developing diabetes increased by 6 percent. Patients with an FPG of 95 to 99 were more than twice as likely to develop diabetes as those with an FPG less than 85, and patients with an FPG of 90 to 94 were 49 percent more likely to develop diabetes than those with an FPG less than 85. Other risk factors for diabetes, such as obesity, high blood pressure, cholesterol problems, and smoking, made development of the disease more likely.
FPG  normal  risk  blood  glucose  research  medical  peer-reviewed  diabetes  comorbidities  symptoms  late-stage  complications  standards  morbidity  prediabetes  self  care  management  threshold  late  end-stage  diagnosis  from delicious
april 2011 by Michael.Massing
Diabetes Dateline Summer 2010
The A1C test can be misleading in people with less common forms of red blood cell hemoglobin, or hemoglobinopathies, such as sickle cell trait. The NGSP provides a list of A1C assays that are accurate in people with hemoglobinopathies. The A1C test should not be used to diagnose diabetes in people with conditions that shorten red blood cell survival, including certain types of anemia and pregnancy. More information about the A1C test and factors that interfere with test results is available at www.ngsp.org....
The ADA noted in diagnosing pre-diabetes, risk extends below the lower limit of the range and is disproportionately greater at the higher end of the range for all three tests. Thus, a person with an A1C above 6.0 percent should be considered at very high risk, and a person with an A1C of below 5.7 percent may still be at risk depending on individual factors.
A1c  diabetes  racial  disparity  accuracy  pregnancy  gestational  prediabetes  risk  normal  blood  glucose  continuum  race  standards  self  care  management  via:NIDDK.NIH.gov  demographics  epidemiology  health  disparities  Black  African-American  racism  ethnicity  socioeconomic  diagnosis  from delicious
march 2011 by Michael.Massing
Insulin Resistance and Pre-diabetes
Metabolic syndrome is defined as the presence of any three of the following conditions:
* waist measurement of 40 inches or more for men and 35 inches or more for women
* triglyceride levels of 150 milligrams per deciliter (mg/dL) or above, or taking medication for elevated triglyceride levels
* HDL, or “good,” cholesterol level below 40 mg/dL for men and below 50 mg/dL for women, or taking medication for low HDL levels
* blood pressure levels of 130/85 or above, or taking medication for elevated blood pressure levels
* fasting blood glucose levels of 100 mg/dL or above, or taking medication for elevated blood glucose levels....
[M]ost people with pre-diabetes develop type 2 diabetes within 10 years, unless they lose 5 to 7 percent of their body weight—about 10 to 15 pounds for someone who weighs 200 pounds—by making changes in their diet and level of physical activity. People with pre-diabetes also are at increased risk of developing cardiovascular disease.
insulin  resistance  prediabetes  diabetes  metrics  metabolic  syndrome  risk  factor  prevention  body  fat  via:NIDDK.NIH.gov  self  care  correlation  diet  T2D  type  2  research  peer-reviewed  waist  size  triglyceride  HDL  cholesterol  symptoms  blood  pressure  glucose  sugar  etiology  standards  diagnosis  hypertension  high  from delicious
march 2011 by Michael.Massing
New Guidelines Issued on Optimal Hemoglobin A1C Targets for Type 2 Diabetes
Below 7%, below 6.5% OR NORMAL?
When do we [tell the public the honest truth]? To reduce your risks as if you did not have diabetes, then you need an A1c that represents a healthy individual without diabetes. [A] normal A1c for a healthy person without diabetes should be 4.3 to 4.6%. In the Epic-Norfolk study they showed that an A1c of 5% compared to an individual with an A1c of 6% had an increased risk of cardiovascular death of 28% higher.
In all of the recommendations they say that the A1c should be as low as possible without hypoglycemia. The ADA sticks with 7% or below, AACE stays with 6.5% or below, what does below mean? When we say it should be 7 or below then that is usually where most medical professionals stop being aggressive. We hear 7% we hear 6.5 % we even sometimes hear 6%.
If your child had diabetes, would you be satisfied at 6.5% or would you want it Normal, as if they did not have diabetes? Or would you like to wait 15 years and see what the studies tell us?
blood  glucose  target  management  normal  Richard  Bernstein  remission  diabetes  tight  control  A1c  medical  research  risk  comorbidities  symptoms  late-stage  complications  standards  morbidity  prediabetes  self  care  benefit  threshold  self-monitored  monitoring  SMBG  late  end-stage  diagnosis  treatment  from delicious
march 2011 by Michael.Massing
High-Normal HbA1c Is a Strong Predictor of Type 2 Diabetes in the General Population - American Diabetes Association
The American Diabetes Association has recently recommended HbA1c for the diagnosis of diabetes‚ but its value for predicting type 2 diabetes is not well understood.
For their study‚ researchers measured HbA1c in more than 900 subjects‚ ages 40 to 79 years‚ and recorded new cases of type 2 diabetes in 15 years of follow-up‚ using diagnosis by HbA1c. The authors concluded that HbA1c is an independent risk factor for type 2 diabetes‚ and that individuals with high–normal HbA1c levels have a strong risk of developing the disease.
A1c  screening  normal  research  peer-reviewed  blood  glucose  prediabetes  via:nih.gov  risk  prognostic  via:diabetes.org  diabetes  standards  self  care  management  diagnosis  from delicious
march 2011 by Michael.Massing
How Do We Define Cure of Diabetes? — Buse JB et al. Diabetes Care. 2009;32:2133-2135.
[Our definitions] are the same for type 1 and type 2 diabetes: Remission is defined as achieving glycemia below the diabetic range in the absence of active pharmacologic (anti-hyperglycemic medications, immunosuppressive medications) or surgical (ongoing procedures such as repeated replacements of endoluminal devices) therapy. A remission can be characterized as partial or complete. <br />
Partial remission is sub-diabetic hyperglycemia (A1C not diagnostic of diabetes [<6.5%], fasting glucose 100–125 mg/dl [5.6–6.9 mmol/l]) [for at least a year] in the absence of active pharmacologic therapy or ongoing procedures. <br />
Complete remission is a return to “normal” measures of glucose metabolism (A1C in the normal range, fasting glucose <100 mg/dl [5.6 mmol/l]) [for at least a year] in the absence of active pharmacologic therapy or ongoing procedures. <br />
Remission of type 2 diabetes could be attained...after bariatric/metabolic surgery or with lifestyle efforts such as weight loss and exercise.
diabetes  remission  treatment  cure  language  diet  exercise  diagnosis  prognosis  self  care  hyperglycemia  dysglycemia  morbidity  risk  medical  research  correlation  activity  standards  threshold  from delicious
february 2011 by Michael.Massing
Analysis Shows Minorities Less Likely to Receive “Cornerstone” Diabetes Test | Neumiller, J, Sclar, D et al. Diabetes Educator 2020-02
'Ethnic and racial minorities bear a disproportionate share of America’s diabetes epidemic but are significantly less likely than whites to receive a commonly used test to monitor control of blood glucose....[B]lack and Hispanic patients diagnosed with diabetes are 2 to 3 times less likely than white patients to receive the A1C test during physician office visits. The A1C test is a “monitoring cornerstone,” providing a retrospective snapshot of a patient’s blood-glucose level,,,.
'[Washington State University] researchers note that diabetes has become a global epidemic projected to affect 48 million Americans by 2050. Hispanics and blacks are more than twice as likely to develop diabetes and suffer the consequences of insufficient monitoring, say the WSU researchers.
'Earlier this year, the American Diabetes Association announced guidelines encouraging use of the A1C test in both the monitoring and diagnosis of Type 2 diabetes, the most common form of the disease.'
healthcare  racism  equity  justice  A1c  diabetes  blood  glucose  self  care  health  disparities  socioeconomics  socioeconomic  status  testing  screening  public  race  ethnicity  racial  ethnic  minorities  Hispanic  Latino  Black  African-American  standards  diagnosis 
february 2010 by Michael.Massing
New Online Test Estimates 10-Year Risk for Diabetes | Hippisley-Cox, J. BMJ (online) 2009/03/18
Predictive variables were self-assigned ethnicity, age, sex, [BMI, smoking, family history,] Townsend deprivation score, treated hypertension, cardiovascular disease, and current use of corticosteroids. The primary endpoint of the study was incident diabetes...The validation cohort was used to determine measures of calibration and discrimination.
Different ethnic groups had 4-fold to 5-fold variation in the risk for Type 2 diabetes. The algorithm explained 51.53% of the variation in women and 48.16% of that in men...The model was well calibrated, and the risk score showed good discrimination. D statistic was 2.11 in women and 1.97 in men.
"The QDScore is the first risk prediction algorithm to estimate the 10 year risk of diabetes on the basis of a prospective cohort study and including both social deprivation and ethnicity...The algorithm does not need laboratory tests and can be used in clinical settings and also by the public through a simple web calculator.”
risk  healthcare  healthware  diabetes  self  care  health  disparities  standards  diagnosis 
april 2009 by Michael.Massing
The Top 10 [sic] Anti-Inflammatory Foods: wild salmon, grass-fed meat, olive oil, salads, crucifers, cherries, blueberries, turmeric, ginger, garlic, green tea
Chronic, low-grade inflammation[, usually imperceptible,] significantly increases the risk of coronary heart disease, the leading cause of death among [diabetics....A] doctor can measure it with the “high-sensitivity C-reactive protein,” or CRP, test.
inflammation  autoimmune  diet  cancer  Alzheimer's  risk  self  care  food  wild  salmon  grass-fed  meat  olive  oil  salads  crucifers  cherries  blueberries  turmeric  ginger  garlic  green  tea  C-reactive  protein  brain  cognition  dementia  diabetes  insulin  neuroendocrine  correlation  resistance  neurotransmitter  type  2  3  blood  glucose  sugar  fats  lipids  T2D  research  peer-reviewed  standards  diagnosis 
july 2008 by Michael.Massing

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