WASHINGTON, Mar 27 (Reuters Health) - Federal health officials issued new recommendations Wednesday designed to help identify as many as 16 million Americans who are at risk for type 2 diabetes but do not know it.
The guidelines create an entirely new medical diagnosis called "pre-diabetes," a term coined to describe the millions of overweight and obese people who have blood sugar levels suggesting an elevated risk of full-blown diabetes.
Doctors have long tested obese patients over 45 years old for diabetes using a fasting blood glucose test or an oral glucose challenge test. Until now, a glucose score above 126 milligrams per deciliter of blood (mg/dL) on the first test or 200 mg/dL on the second meant a patient had diabetes.
Experts are now calling on physicians to diagnose pre-diabetes in patients showing test results below these levels but above normal. Obese patients younger than age 45 should also be tested if they also have other diabetes risk factors, including a family history of the disease, minority ethnicity, or a history of diabetes during pregnancy.
The treatment prescription is familiar to most Americans, though few choose to follow it: lose weight by exercising regularly and cutting calories and fat from the diet.
New federal figures show that 17 million Americans currently have diagnosable type 2 diabetes. The 16 million 40- to 74-year-olds estimated to have obesity and elevated glucose levels could double the total burden of diabetes in the US healthcare system, said US Health and Human Services Secretary Tommy G. Thompson.
Government and private health care payers spent close to $100 billion on direct and indirect costs related to diabetes, Thompson said.
"You can see what it will cost the American tax payer, what it will cost the health care system" if pre-diabetics go on to develop full diabetes, he said.
Experts estimate that the actual number of at-risk Americans is substantially higher, since obesity, the number-one risk factor for diabetes, remains rampant in young adults, adolescents and children.
Type 2 diabetes, also called non-insulin dependent diabetes, is the name given to the disease caused mostly in adulthood by obesity and some genetic factors. It is different than type 1 diabetes, which is an autoimmune disorder in which the insulin-producing cells in the body are destroyed.
Both disorders are a major risk factor for heart disease, kidney failure, blindness and limb amputations. Many experts have abandoned the term "adult onset" to describe type 2 diabetes since the disease has begun to show up in obese adolescents and children.
A 3-year study completed last year showed that at-risk adult patients who lost 5% to 7% of their body weight with moderate diet and exercise were able to cut their risk of full diabetes by nearly 60%.
Researchers conducting the study used counseling and education to help patients lose weight. Experts conceded that most public health programs and private insurance plans do not offer the kind of support to patients that the study participants received.
"It's true that we don't have the resources to do the counseling, but at least some people will do [the diet and exercise] on their own," said Dr. Judith Fradkin a researcher at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Medicare, the nation's public health insurance program for 39 million elderly and disabled persons, also does not pay for the screening officials are recommending.
"At the present time we don't have a benefit to pay for pre-diabetes screening," said Dr. Steven Phurrough, director of medical and surgical services at the federal Centers for Medicare and Medicaid Services.
Thompson urged the nation to lower their overall diabetes risk by becoming more active and losing weight, pleading with parents to get their children "off the PlayStations and onto the playgrounds."
He also announced that he had shed 8 of the 15 pounds he pledged to lose as a way to set an example for the rest of the country.
Public health experts, however, have generally failed in their decades-long efforts to get Americans to lose weight. Recent federal figures indicate that 60% of US adults are either overweight or obese. The total diabetes rate has tripled over the past 30 years.
Researchers blame an increasingly sedentary lifestyle and the popular high-fat, high-calorie American fast-food diet for the out-of-control rates. Many experts also believe that the large portions that have become a mainstay of the US restaurant industry are contributing to the diabetes epidemic.
"We have to make people realize that they're not getting a good deal when they super-size it," Fradkin said in an interview.