Primary care physicians should screen all adults over age 45 for diabetes, according to new recommendations proposed Monday by a government-sponsored panel of experts. The US Preventive Services Task Force, composed of primary care providers, base their new advice on evidence suggesting that diagnosing elevated blood sugar levels before people develop full-blown diabetes can reduce their risk of getting the condition and also developing heart disease.
Evidence from several recent large clinical trials suggest that those who have moderately elevated blood sugar, a condition called prediabetes, detected on a routine blood test and treated through a diet and exercise program have a 47 percent reduced risk of developing diabetes over the next several years.
The Task Force’s previous recommendations from 2008 only recommended diabetes screening in those at increased heart disease risk due to high blood pressure because studies were lacking to show benefits for screening the general population. “More evidence has emerged since then on the benefits of lifestyle interventions,” said Task Force member Dr. Michael Pignone, a professor of medicine at the University of North Carolina at Chapel Hill School of Medicine. “Our feeling is that you need to have an effective intervention available for people that you screen.”
People who are overweight, have a family history of diabetes, or are African-American, Asian, or Latino, likely need to be screened earlier than 45, the Task Force recommended, because they’re at higher diabetes risk. Women who have polycystic ovarian syndrome or who developed gestational diabetes during pregnancy also fall into the high-risk category.
“We didn’t specify an age for screening those high-risk groups,” Pignone said. “That’s something patients should discuss with their doctors.” The group also didn’t advise how frequently adults should be screened.
Diabetes experts supported the new recommendations, which agree with the latest advice from other medical organizations.
Both the American Diabetes Association and the Centers for Disease Control and Prevention urge doctors to consider performing screening every three years in adults age 45 and older, especially for those who are overweight. Screening tests include a blood glucose test which requires fasting for eight hours beforehand, a glucose tolerance test which checks blood sugar both before and after drinking a sweetened beverage, or a blood test to measure the marker hemoglobin A1C, which measures average blood glucose for the past 2 to 3 months.
About 86 million American adults have elevated blood sugar levels, and an additional 29 million have diabetes, which is up from 26 million in 2010. But more than one-quarter of those with diabetes are unaware that they have the condition because they don’t recognize the symptoms, like frequent urination, weight loss, and fatigue, and aren’t getting screened, according to a 2014 CDC report.
Dr. Osama Hamdy, medical director of the obesity clinical program at Joslin Diabetes Center, said the Task Force’s guidelines, aimed at primary care physicians, will likely lead not just to earlier diabetes diagnoses but to a greater detection of high blood sugar levels at a point when diabetes can still be prevented.
“We need to focus on prevention rather than just treating a problem,” Hamdy said.
Doctors, however, need to do more in terms of prevention than simply telling patients to quit junk food and soda and increase their physical activity, Pignone said. “The type of prevention program found to be effective in studies we reviewed typically involved 16 educational sessions, access to a health coach, and achievement of 150 minutes of activity each week,” he said. “Primary care practices don’t usually have the resources” to get patients to make drastic lifestyle changes.
Most of the lifestyle intervention programs offered at Joslin, Hamdy said, are only covered by insurance companies once a patient has been diagnosed with diabetes -- not for prevention.
“I hope this new recommendation will set the stage for reimbursements at an earlier stage when diabetes can be prevented,” he added.
In the meantime, the CDC offers a National Diabetes Prevention program that teaches nutrition and exercise classes at more than a dozen health centers and YMCA’s in Massachusetts at little or no cost to participants.
It’s the sweetest time of year: apple season! You know that apples are good for you, but why does an apple a day keep the doctor away? There has been all kinds of research into the various nutrients and phytochemicals found in apples, and the benefits they have. Here are 10 ways that apples prevent illness, slim you down and protect your health.
1. Apples’ pectin lowers your cholesterol.
Eating apples significantly lowers you blood cholesterol. The fruit’s soluble fibre, known as pectin, has been proven to lower both LDL and overall cholesterol. But pectin alone won’t do the trick; a study showed that the whole apple’s phytonutrients work with the fibre to create more of a cholesterol-lowering impact than just pectin alone.
2. The peel prevents weight gain.
A substance called ursolic acid, which is found in the peels of apples, has been found to protect against obesity by increasing muscle and brown fat, which are both associated with weight loss. While muscle has long been known as a calorie burner, scientists have recently been learning more about brown fat, which, unlike the fat associated with obesity, is associated with healthy weight and blood sugar.
3. The fibre keeps you full.
Another way apples protect against weight gain is by filling you up. A single apple is just 100 calories, but it’s dose of fibre and more than 80 percent water content help keep you satiated. Plus, the pectin is a natural appetite suppressant, telling your brain you’re full, which makes it a great snack to hold you over till your next meal.
4. Eating apples helps clean your teeth.
The crisp fruit acts as a tool for physically cleaning your teeth of any residual food left from a meal, so eating an apple is a great way to protect your mouth when you don’t have a toothbrush handy. Since there is some acidity to apples, it’s a good idea to rinse your mouth after eating one for an even healthier mouth.
5. Apples could prevent diabetes.
According to a study that looked at nearly 200,000 people for 24 years, eating whole apples—and other fruits—was associated with a lower risk of type 2 diabetes. Of course, the same is not true for fruit juices, which can spike your blood sugar. For those who already have diabetes, apples are a safe sweet treat.
6. Their fibre boosts your immunity.
A study from the University of Illinois found that apples’ soluble fibre strengthens the immune system. Researchers discovered that the fibre increases production of an anti-inflammatory protein that protects the body from illness. In the study on mice, those fed soluble fibre got much less sick and recovered faster than those who were given insoluble fibre.
7. Apples could reduce your cancer risk.
Numerous studies have linked apple consumption with lowered risk of various types of cancer, including breast cancer, colon cancer and lung cancer. The combination of phytonutrients, vitamin C and fibre make this a super cancer fighter. In fact, apples were added to the American Institute for Cancer Research’s list of Foods That Fight Cancer.
8. They naturally boost your good gut bacteria.
Recent research is finding that eating a diet high in apples (and their fibre, pectin) can increase the healthy bacteria in the gut. So think of apples as kind of a natural probiotic, promoting healthy digestion.
9. They’re associated with better breathing.
Numerous studies have shown a link between apple consumption and a lower risk for asthma. There are a whole host of phytonutrients found in apples, many of them with antioxidant and anti-inflammatory properties, that researchers think could improve respiratory function. One flavonoid, quercetin, found in apple skin, has been researched for its respiratory benefit when it comes to colds, allergies and even more serious lung diseases.
10. They’re key to protecting your heart.
In the conclusion of a 2013 study, researchers from the U.K. extrapolated to find that if everyone over age 50 ate an apple a day, up to 11,000 heart-related deaths could be prevented each year. Now there’s a reason to eat an apple today.