With Diabetes on the Rise, Doctors Urge Tests at Age 30
    By Lauran Neergaard
    September 4, 2001

Commentary: if you have HIV or Hepatitis C diagnosing yourself for diabetes is all the more important. Certain HIV treatments may increase risk for developing diabetes. Identifying if you have diabetes or a predisposition for diabetes may influence your HIV treatment choices and may help you manage your sugar better. If a person has diabetes, sugar levels in blood can increase on HCV therapy. Several studies have found negative associations between diabetes and HCV.

IS AGE 30 too young to get a diabetes test? Unfortunately for millions of young Americans who may not realize they are at risk, it is not.

New health guidelines reflect an increasingly dismal reality: Cases of the most common form of diabetes, once only a bane of aging, are up 70 percent among 30-somethings in the past decade.

Because the disease can quietly fester for years, half of Type 2 diabetics have suffered serious damage to their eyes, kidneys, nerves and arteries by the time they learn they are sick.

So if you thought you do not need to be checked for diabetes until age 45, the American Association of Clinical Endocrinologists -doctors who specialize in diabetes care - wants you to think again.

People with any one of the following diabetes risks should get tested at age 30, according to the group's new guidelines:

Why check so early? Patients then may control their blood sugar enough to stay healthier longer, explains association president Dr. Rhoda Cobin of New York's Mount Sinai School of Medicine.

The American Diabetes Association long has urged that everyone be considered for a diabetes test of blood and urine at age 45 and that high-risk people be checked earlier. But it never said how early.

The government and the ADA may issue their own updated guidelines later this year, but age 30 seems reasonable, says Dr. Charles M. Clark Jr., chairman of the National Diabetes Education Program.

Still, for many primary-care physicians, that threshold may come as a surprise. If your doctor hesitates to test so young, new research might tip the scales. Kaiser Permanente researchers studied 2,437 recently diagnosed diabetics in Oregon and Washington and found the fatter you are, the more likely Type 2 diabetes is to strike before age 45 - as young as 18. Obesity not only was key to early diabetes, but the risk rose 6 percent for every 5 pounds to 8 pounds of extra weight.

At least 16 million Americans have diabetes; the number is expected to rise to 22 million within 25 years. At least a third do not know they have it. Diabetes is a leading cause of blindness, kidney failure and amputations, and dramatically raises the risk of heart attacks. It kills 180,000 Americans each year.

With Type 1 or "juvenile" diabetes, patients' bodies cannot make insulin, a hormone crucial to converting blood sugar into energy. Regular insulin injections keep them alive.

But the vast majority of diabetics have the Type 2 form - the diabetes that sneaks up. Over time, the body loses the ability to use insulin properly. High blood sugar damages the blood vessels.

Half of these diabetics already have a complication such as vision loss or kidney damage by the time they are diagnosed.

Type 2 diabetes once hardly ever struck before middle age, and risk increased with age. Now it is striking younger people.

Consider the toll found by the Kaiser Permanente study, unique because it tracked the newly diagnosed. Half of the young diabetics already had high blood pressure, and 80 percent had abnormal cholesterol, heart disease risks that accompany diabetes. That means young diabetics are likely to get heart disease much earlier than people who can fend off diabetes until they are at least in middle age.

The good news: A diabetes test is empowering. Find out you have it and good treatment that tightly controls blood sugar can stave off the disease's damage.

Better, if you find out your blood sugar is borderline high, a condition called impaired glucose tolerance, with a little work you could actually prevent diabetes, Clark notes. A recent study found walking 30 minutes a day and losing just 15 pounds cut the risk of developing diabetes in half.

What Tests to Get

IF YOU'RE diagnosed with diabetes, what next? Tightly controlling fluctuating blood sugar protects diabetics from deadly complications. Patients check daily glucose levels with finger-prick blood tests. But about every three months, they also need an "A1C" test, a more intricate blood test that measures how well they are doing over time so doctors can reassess treatment.

The test usually costs $15 to $30.

Not enough diabetics get this test regularly, so demand it from your doctor, learn your A1C number, and try to lower it, the endocrinologist advise. The American Diabetes Association advises getting it below 7 percent; the endocrinologists' group advises 6.5 percent.

Studies suggest that each 1 percent drop in A1C lowers patients' risk of diabetes complications about 25 percent.