People With Diabetes Not Getting Needed Flu Shots

Flu season is on its way. Everyone with diabetes especially needs to be ready since flu and pneumonia can lead to deadly complications. Unfortunately, if a 1997 study holds true, about half of the 15.7 million people with diabetes in the United States will not get their flu or pneumonia vaccinations. 

In spite of the recommendation that every one with diabetes receive these vaccinations, a 1997 telephone survey of over 7,000 adults with diabetes found that only 51.2 percent said that they had received a flu vaccination the previous year, and only one third had ever been vaccinated against pneumonia. 

The study found that older people with diabetes do better than the young in preventing problems. Among those 75 or older, almost 70 percent had flu shots and 53.4 percent had pneumonia vaccines, compared to only 27.7 percent for flu and 11.2 percent for pneumonia among people 18 to 44. 

How serious is the risk? Between 10,000 and 30,000 people with diabetes die each year from complications of flu and pneumonia. And already, the CDC reports cases of the flu in 17 states last week. Call your doctor's office to get your yearly flu vaccine. We highly recommend getting a pneumococcal vaccine which prevents most cases of pneumonia and needs to be given only once every ten years.

HMOs Not Any Better At Preventing Diabetes Complications

In spite of the words "health maintenance" in their name, health maintenance organizations (HMOs) are not doing what they can to prevent the problems that come with diabetes. Specifically, they perform the tests that screen people with diabetes for complications only as often as traditional fee-for-service medicine. 

These are the findings of the Centers for Disease Control and Prevention (CDC) published in the October 29th issue of their journal Morbidity and Mortality Weekly Report. The CDC research studied the frequency of three screening tests--eye exams, foot exams and a blood test called glycosylated hemoglobin (HbA1c)--doctors can use to spot early warning signs of vision loss, kidney disease, and numbness or pain in the extremities which arise from poorly controlled diabetes. Previous surveys suggested that these tests are not consistently used. 

CDC researchers examined the 1995 and 1996 testing rates for 350 people with diabetes who are members of Rhode Island HMOs or PPOs (preferred provider organizations). They found that the eye exam was done most often. Annual dilated eye exams of the blood vessels of the eye to spot diabetes-related retinopathy were given to 87% of patients, a rate of testing that is higher than before. 

However, patients were less fortunate when it came to receiving either foot exams or HbA1c testing. Semi-annual foot exams were done for 58% of the patients and HbA1c was done 54% of the time. 

The CDC and the Rhode Island Diabetes Control Program are currently working with various healthcare organizations to ensure that state HMOs adhere to ``standards of diabetes care.'' They are attempting to improve testing rates by educating patients, healthcare providers, and HMOs as to the necessity of these procedures.

FDA To Review GlucoWatch Monitor

Cygnus Inc. reports that its GlucoWatch monitor that allows people with diabetes to semi-invasively and continuously read their blood sugar will be reviewed by a U.S. Food and Drug Administration (FDA) advisory committee on Dec. 6. 

The watch-like device is strapped on the wrist so that the wearer can read his blood sugar level. Following a three-hour warm-up period, a finger stick blood glucose measurement is input into the GlucoWatch monitor for calibration. Then the device will provide a reading every 20 minutes for 12 hours.

The monitor uses reverse iontophoresis. The monitor generates a small current which enlarges the pores in the skin. Then the monitor collects glucose samples in the fluid that seeps out of the pores. The glucose molecules are collected in gel collection discs that contain the enzyme glucose oxidase. As glucose enters the discs, it reacts with the glucose oxidase in the gel to form hydrogen peroxide. A biosensor detects the hydrogen peroxide, generating an electronic signal. 

The monitor uses the calibration value previously entered by the patient to produce a glucose measurement. The glucose measurement is then displayed on the monitor where the patient can read it and also it's stored in memory. 

The GlucoWatch also has an alarm that will sound when glucose levels are too high or too low. The level at which the alarm will sound can be individually set. 

This device is generally considered an improvement over the current finger-stick blood tests because of the frequency of information given and the less invasive process. The greater amount of information provided potentially helps the person manage his diabetes better. 

In July, the FDA granted expedited review to Cygnus for its device, which may indicate that the approval process will be quicker than usual. See also Less Invasive Technology.

Epidemic Of Killer Obesity In US

The numbers are stark. Half of all Americans are overweight. One in five adults in the US is obese. Obesity kills 300,000 Americans a year. 

Several new studies, published October 27 in the Journal of the American Medical Association (JAMA) and announced at the AMA's Science Reporters Convention, are the latest to warn that a national epidemic has Americans getting fatter and dying from fat.

The prevalence of obesity, defined as being more than 30 percent above ideal body weight, increased to 17.9 percent of the population in 1998 from 12 percent in 1991, as reported from a study by the U.S. Centers for Disease Control and Prevention in Atlanta. The data, based on telephone surveys of more than 100,000 randomized participants each year between 1991-98, probably under reports the problem since people often underestimate their weight. 

``Rarely do chronic conditions such as obesity spread with the speed and dispersion characteristic of a communicable disease epidemic,'' the study notes. 

Who is getting fatter? Everybody. ``A steady increase was observed in all states; in both sexes; across age groups, races, educational levels; and occurred regardless of smoking status,'' the study found. Younger adults, people with some college education and Hispanics showed the most drastic increases. 

Why is being overweight so deadly? Being overweight carries with it a greater risk of heart disease, high cholesterol and blood pressure, diabetes, stroke and some cancers, to name only the most deadly diseases. A recent study of more than 1 million Americans in the New England Journal of Medicine reported that obese people run a higher risk of dying early, even if they don't smoke and are otherwise healthy. 

What is causing this epidemic? An editorial accompanying this issue of JAMA concludes that growth in the marketing of fast food and snack food, as well as lack of exercise, are among the reasons Americans are taking in more calories than they burn. ``Children watch more television daily, physical education has been markedly reduced in our schools, many neighborhoods lack sidewalks for safe walking, the workplace has become increasingly automated, household chores are assisted by labor-saving machinery, and walking or bicycling has been replaced by automobile travel,'' the editorial said. 

The editorial calls for developing a comprehensive national strategy to prevent obesity. ``Our data suggest that the development of strategies and programs for weight maintenance as well as weight reduction must become a higher priority,'' the editorial said. ``Public health messages should focus increasingly on balancing energy intake with physical activity.''

Tuna Once A Day Helps Weight Loss

Eating tuna, salmon, or other fish rich in omega-3's once a day as part of a weight loss program helps you lose weight and be healthier, Australian researcher Trevor A. Mori and colleagues of the University of Western Australia report in the November issue of the American Journal of Clinical Nutrition. 

In a 4-month study of 69 overweight men and women with high blood pressure, participants who ate a daily serving of fish rich in 3.65 grams of omega-3 fatty acid as part of a weight-loss regimen lost weight, lowered their cholesterol levels and reduced their risk for diabetes.

The results of the omega-3 regimen were better that participants who either just ate fish once a week, only participated in a weight loss plan, or those in a 'control' group who maintained their usual eating habits. 

Why does eating fish once a day help in weight loss? The reason is uncertain but it is assumed that the more fish is eaten, the less meat with its higher saturated fat content is eaten. 

Why does eating fish rich in omega-3's improve health? Research suggests that omega-3's lower blood pressure and cholesterol levels, thus protecting against heart disease. Participants who ate fish daily had the greatest drop in blood fats that increase the risk of heart disease, and the greatest rise in HDL cholesterol, the "good" cholesterol. The weight loss realized by the fish-once-a-day diet also improved all around health. 

The authors also suggest that fish oil supplements sold in most health food stores can be taken instead of eating fish if people who don't like fish.

Type 2's Should Know Their GlucoseAverage

Just as knowing your average cholesterol and blood pressure helps you determine your heart attack risk, now there is a new number to know if you have Type 2 diabetes or insulin resistance. Every person with this disease or this condition needs to know and control their GlucoseAverage, their average blood sugar reading, because this is an early warning sign of developing diabetes or, if you already have diabetes, developing serious complications.

About 15 million Americans currently have Type 2 diabetes. More than 60 million Americans, most of them overweight, are resistant to insulin, and a fourth of them will likely develop Type 2 diabetes.

The American Association of Clinical Endocrinologists (AACE), the nation's diabetes physicians group, is introducing during November, Diabetes Awareness Month, the new standard of the GlucoseAverage to fight the growing Type 2 diabetes epidemic. In an article to be published in ``Endocrine Practice, The Journal of the American Association of Clinical Endocrinologists'' (Jan.-Feb. 2000), AACE will recommend that people with Type 2 diabetes be taught intensive diabetes self-management and get their GlucoseAverage to a level of 7 or below. The new guidelines emphasize proper nutrition, physical activity and the use of new drugs and medical devices. 

What is GlucoseAverage? 
GlucoseAverage is currently called the glycosolated hemoglobin (HbA1c) test. It measures the average blood glucose level over the last two to three months so it is a more accurate indicator of control than one glucose reading which measures only current blood glucose level. A standard of keeping the GlucoseAverage 7 or below is more effective than the more commonly known diabetes threshold of an individual test while fasting should be 126 mg/dL or lower. The current GlucoseAverage of 9.2 for the more than nine million Americans currently being treated for Type 2 diabetes is too high and represents the typical casual care that produces poor control.

New Type 2 Guidelines 
AACE urges that patients and their physicians practice intensive diabetes self-management, which is a system in which the patient achieves near normalization of blood glucose levels through proper nutrition, physical activity, glucose self-monitoring, and medication. AACE recommends a daily diet of 55-60 percent carbohydrate, 10-20 percent protein, and no more than 30 percent fat. An exercise program of 20 to 40 minutes of physical activity every 48 hours is also recommended. 

AACE also advises doctors and patients how to use the new drugs for diabetes care developed in the past few years. The standard is set by 90 percent of endocrinologists using three or more blood glucose-lowering drugs in combination to better manage glucose control. 

Copies of the new guidelines may be downloaded by physicians, patients, and the public after Nov. 1 at www.aace.com. Information on intensive diabetes self-management also may be obtained by calling an AACE toll-free hotline at 1-888-50-SUGAR.

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