What's more, both patients and physicians contribute to the lag in diagnosis, said Timothy Lyons, MD, who is presently Director of Research of the Harold Hamm Diabetes Center in Oklahoma City, and who has served in numerous capacities at the American Diabetes Association.
Dr. Lyons explained:
"Patients with type 2 diabetes tend to run into problems that are often attributed to other things. Diabetes may have no symptoms for years or decades, yet silently damages blood vessels throughout the body. Patients may present with a heart attack, a stroke, a gangrenous leg, kidney failure, or they go blind - but diabetes is viewed as something in the background, rather than the actual cause of the problem - one that could have been treated if detected earlier."
Primary care physicians, as well, are faced with an immense task. "They're overwhelmed," he said. "There's so much of it [diabetes], and so much of it is asymptomatic until it causes a problem. I think it is human nature to be more focused on acute problems rather than on slowly evolving, long-term problems."
Routine screening should occur after 45 years of ageDr. Lyons recommends that screening for diabetes should be undertaken in anyone 45 years of age or older, and in younger people who are at high risk: including those who are overweight, or have a family history of diabetes, or who are not Caucasians.
"I personally think that everyone by age 30 should know what their fasting glucose is," he added.
Regrettably, even when diabetes is diagnosed, the typical primary care practitioner may not have time to examine patients adequately.
Dr. Lyons said:
"The primary care physician faces a long-haul challenge with diabetes. Optimal care requires multiple examinations and assessments spread over months and years to ensure control of glucose, blood pressure, and cholesterol, and also to assess cardiac status, renal status, eyes, nerve function, cognitive function, lower limb circulation, and so on.
It's very labor-intensive to do it properly, and it can only be accomplished through a coordinated, team approach - but it is important, because it can prevent disastrous complications."
Dr. Lyons acknowledged the many advances in diabetes care that have taken place in recent years. While this progress is very encouraging, he said, it also increases the complexity of managing the condition. Teams of knowledgeable physicians, nurses, dietitians, and other health providers are essential to provide coordinated care. This is especially the case during acute illness, for example, infection, or during admission to hospital for surgery.
He emphasized that prevention, early detection, and good long-term management are key to defeating the diabetes epidemic.
By Jill Stein
Jill Stein is a Paris-based freelance medical writer.