WHAT YOU DON'T KNOW...
JUNE 24, 1997
Eight million Americans have been diagnosed with diabetes, but another eight million have no idea that they suffer from the disease. An international panel gives its reccomendations on how to keep people informed about how to catch the signs of diabetes.
JIM LEHRER: The diabetes story and to Elizabeth Farnsworth.
ELIZABETH FARNSWORTH: About 8 million Americans have been diagnosed with diabetes. Another 8 million are believed to have the disease but not know it. Yesterday, an international panel of experts announced some recommendations for remedy that situation. All adults aged 45 years and above should be tested for diabetes every three years, the experts said. High risk individuals should be tested at a younger age and more often. The panel also recommended lowering the levels of blood sugar considered to signal diabetes. The new guidelines, which were announced at a medical meeting in Boston, were the results of 15 years of research. Dr. James Gavin chairs the panel of experts that reviewed the research. He is with us now. Thanks for being with us, Doctor.
DR. JAMES GAVIN, Howard Hughes Medical Institute: Thanks for having me.
ELIZABETH FARNSWORTH: What have you learned about diabetes that made you recommend these changes?
DR. JAMES GAVIN: Well, it's been a full 18 years since there was a serious discussion about diagnosing diabetes and on what basis we should do that. And in that period of time we learned an awful lot about this disease. And one of the main things was that the damaging effects of high blood sugar are occurring earlier than we thought; that a lower level of blood sugar is actually driving the complications of this disease like eye disease and kidney disease, such that we now have the basis for lowering the level of blood sugar that we call diabetes from 140 to 126. And that's a very important finding.
ELIZABETH FARNSWORTH: Explain what diabetes is and what does this--the blood sugar level that's abnormal--why does it make these--why does it cause these problems?
DR. JAMES GAVIN: Well, diabetes is a disease of high blood sugar, and it's the result of the body either not making enough insulin or not responding normally to that hormone insulin. And it doesn't matter which of those two problems you have. Your blood sugar goes up above a certain level and that high blood sugar level causes damage to the blood vessels. It leads to eye disease, which causes blindness; leads to kidney disease, amputations, impotence, heart attacks, and strokes. This is a very, very serious chronic disease.
ELIZABETH FARNSWORTH: So when you talk about people that have this--the blood sugar levels that before were not considered diabetes, you're talking about people walking around out here who may not even know they have it, but this damage is being done in their body right now?
DR. JAMES GAVIN: That's been one of the things that has concerned us most. We have learned that while there are 16 million people in this country who suffer from diabetes, only 8 million of them know they have it. The average time from the beginning of the disease to the time when the disease is actually diagnosed in the majority form of diabetes, which is what we call Type II diabetes, the average time--
ELIZABETH FARNSWORTH: These are people that get it as an adult, as opposed to as children, when they have to take shots?
DR. JAMES GAVIN: That's right. Usually older people, usually obese people. The average time from beginning of the disease to when the diagnosis is made can be as much as seven to ten years. People walk around without symptoms, but their bodies are suffering, the damaging effects of that undetected high blood sugar, and we really need to break into that and to avoid it. And we can.
ELIZABETH FARNSWORTH: And what do you want people to do? Do you want people to call their doctors tomorrow and say I think I ought to get a test?
DR. JAMES GAVIN: No.
ELIZABETH FARNSWORTH: People over age 45?
DR. JAMES GAVIN: What we've learned is that in this country there's an explosive increase in the number of cases of diabetes, and there are a number of things happening in this country that are driving that explosion. Diabetes risk increases in all of us as we get older. Once we pass the age of 45 there's a very sharp increase in diabetes. But in addition, diabetes risks increase as you become more obese, as you become more sedentary, and as you develop things like hypertension and high blood fat levels. All of those things are increasing in this country. And we have a 35 percent incidence of obesity; we are now spending over $130 billion in total costs related to diabetes complications. And so it is clear that we need to do something to stem this tide. And so we're asking that people who are over the age of 45, in that highest risk group, be screened with a very simple test to see whether they have this disease.
ELIZABETH FARNSWORTH: And tell us a little about that test, because that's another change you're recommending, right?
DR. JAMES GAVIN: That is a change, and it's a major change, because the gold standard for diagnosing diabetes in the past has been a test called the oral glucose tolerance test. It's a very difficult test to perform. Not many people were using it. It requires drinking a glucose or sugar solution and then having multiple tubes of blood drawn over several hours' time. The test that we're now recommending is called the fasting plasma glucose. It's a simple blood test, one tube of blood that's drawn when a person has had nothing to eat for a period of eight hours or more. And that is now what we're recommending as a gold standard. And that makes it easier to do.
ELIZABETH FARNSWORTH: Okay. Let's say that somebody goes in, gets that test, and their level is still fairly low, but above this number that you've set that's new. What should they do? What kind of treatment is available to them?
DR. JAMES GAVIN: Well, what we've recommended all along and what will not be changed by lowering the level of blood sugar for diagnosis is that there be aggressive treatment of diabetes and the earlier that aggressive treatment takes place, the more likely it is we're going to be able to avoid some of those complications. Now, the thing that we're trying to avoid is that people think that once they get the diagnosis of diabetes that they're going to go on insulin shots or they're going to have to start taking some drugs. That's not true. In fact, the treatment recommendations that we now use recommend that we start with diet and exercise and lifestyle changes. That's the kind of treatment that's most effective early in this disease. So the sooner we make the diagnosis the more likely it is that non-drug-related kinds of treatment will really be able to help us control this disease.
ELIZABETH FARNSWORTH: So you're saying that somebody could go in and be diagnosed with what is known as diabetes, but they--they just are told to lose weight and exercise, and they're not put on any medication necessarily.
DR. JAMES GAVIN: That's right. We want to get away from the notion that treatment means drugs. Treatment can mean changing your lifestyle, and that's a very important message for the American public, because we need to detect these problems earlier; we need to move in the direction of prevention strategies, and early aggressive treatment, because we now know beyond a shadow of a doubt that all of the complications of diabetes that we are afraid of, all of the ones that are costing us so much money, we now have the evidence that we can prevent them.
ELIZABETH FARNSWORTH: What are the symptoms of diabetes? What might a person have that makes them think that they should get tested?
DR. JAMES GAVIN: Well, the people who are at highest risk for developing diabetes are, first, people who are age 45 and older, but if you have a positive family history. If you have a mother or father or sister or a brother with this disease, then you are at high genetic risk--if you are obese--and that means if you are more than 20 percent over what we consider your ideal body weight--and that doesn't take a lot of additional weight.
ELIZABETH FARNSWORTH: And then there are symptoms, aren't there, for example, thirst, I've always read--unusual thirst?
DR. JAMES GAVIN: Well, the people who develop those symptoms are people who already have full-blown diabetes.
ELIZABETH FARNSWORTH: I see.
DR. JAMES GAVIN: These are people whose blood sugar levels are so high that their body--their bodies are trying to get rid of some of that blood sugar. That's what causes the extra thirst. That's what causes all of the excessive urination. That's what causes them to lose weight. Those people are very easy to diagnose. The people that we are concerned about are those 8 million people who have absolutely no symptoms; that show up to get an eye exam and they're found by the ophthalmologist or the optometrist to already have diabetic eye disease, and they didn't even know they had diabetes. Those are the people we worry about.
ELIZABETH FARNSWORTH: Okay. Dr. Gavin, thanks for being with us.
DR. JAMES GAVIN: Thank you.