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Testing for Diabetes in Asymptomatic Patients

Testing for Diabetes in Asymptomatic Patients

In the United States, about 7 million people have undiagnosed diabetes, representing nearly one-fourth of all diabetes cases. Approximately 35% of adults aged 20 and older—or 79 million Americans—have prediabetes, a condition in which patients have blood glucose levels higher than normal but not high enough to be classi­fied as diabetes. These people are at increased risk of developing type 2 diabetes, heart disease, and stroke. “Clinicians should have a high index of suspicion for undiagnosed diabetes in people who are older, obese, physically inactive, or have a history of abnormal glucose tolerance, including gestational diabetes,” explains Robert E. Ratner, MD. Those with hypertension, dyslipidemia, and a family history of diabetes are also at high risk. Furthermore, racial and ethnic minorities have been shown to be at greater risk for diabetes. In people with these risk factors, periodic glucose testing should be performed to evaluate their dia­betes status. “We need to identify people with prediabetes so that preventive measures can be undertaken.” “The movement toward screening for diabetes in people without symptoms has become increas­ingly important because of the growing number of cases of undiagnosed diabetes and prediabetes,” explains Dr. Ratner. “To decrease the burden of the diabetes and obesity epidemics, clinicians need to diagnose patients as early as possible so that treatments can be administered early and so that diabetes-related complications can be man­aged and perhaps avoided. We need to identify people with prediabetes so that preventive mea­sures can be undertaken. The greatest opportunity for case-finding is in the clinical setting.” Type 2 Diabetes & Future Disease According to the American Diabetes Association’s Standards of Medical Care in...

Public Awareness of Specialized Stroke Hospitals

When managing stroke, time is brain. Every minute that stroke therapy is delayed can make a major difference in outcomes for patients. Appropriate treatment of stroke requires a well-organized, protocol-driven, evidence-based approach to meet treatment goals. Goals include seeing patients with stroke symptoms within 15 minutes, performing a CAT scan and having it read within 25 minutes, and treating patients with tPA within an hour of their arrival. The challenge for physicians is that all of these goals must be accomplished within a limited amount of time. Primary Stroke Center Certification In an effort to improve stroke outcomes and eliminate disparities in access to acute stroke centers, the Joint Commission developed a primary stroke center certification program in collaboration with the American Stroke Association (ASA). The program encourages hospitals and medical centers to apply for a Certificate of Distinction for Primary Stroke Centers in order to be recognized as a center that makes exceptional efforts to improve performance measures in the treatment of stroke. Achievement of certification signifies that the services provided have the critical elements to achieve long-term success in improving outcomes. In order to receive certification, centers must have the appropriate infrastructure in place—including personnel and protocols—to deal with acute stroke and collect different data points so that performance can be tracked. Centers must also offer public education about stroke and medical education for members on the stroke service team. “Every minute that stroke therapy is delayed can make a major difference in outcome.” The Joint Commission monitors certified centers longitudinally, using numerous performance indicators, to validate that the center is meeting certification parameters. Previous studies have...

Effective Approaches to Managing Newly Diagnosed Diabetes Patients

This Physician’s Weekly feature covering effective approaches to managing newly diagnosed diabetes patients was completed in cooperation with the experts at the American Diabetes Association. According to the American Diabetes Association, 23.6 million children and adults in the United States have diabetes, 25% of whom are undiagnosed. Approximately 1.6 million new cases of diabetes are diagnosed in people aged 20 and older each year. In addition, another 57 million people have pre-diabetes, a condition in which blood glucose levels are higher than normal but not yet high enough to be diagnosed as diabetes. People with pre-diabetes are at an increased risk of developing diabetes and cardiovascular disease. “Identifying diabetes and pre-diabetes early is critical because the earlier clinicians take measures to help patients with lifestyle changes and appropriate medication choices the most initial success they will have and the more successful they will likely be in the long run in controlling their disease and preventing diabetes complications,” says Richard M. Bergenstal, MD. Making the Diagnosis Historically, clinicians have used tests that are based on the measurement of plasma glucose to detect diabetes in people without symptoms. These tests include a fasting plasma glucose (FPG) test or an oral glucose tolerance test (OGTT). Recently, the American Diabetes Association suggested adding the A1C test as another diagnostic tool for identifying diabetes and pre-diabetes (Figure 1). The A1C test reflects the average amount of glucose in the blood over the last 2 to 3 months, and is not affected by short-term physical and emotional stresses that can temporarily affect a blood glucose test. “A1C tests are accurate and precise, and offer several advantages...
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