The who, what, where, and why of diabetes testing
Everyone knows that Type 2 diabetes is a serious, long-term health condition that impairs bodily function, threatens quality of life, and can lead to other complications. And almost everyone knows that its incidence and prevalence are on the rise globally.
So why aren’t people routinely being tested for diabetes?
According to the Centers for Disease Control (CDC), through 2014, 21 million people had been diagnosed with diabetes in the U.S. alone. And the American Diabetes Association (ADA) reports 1.4 million Americans are diagnosed each year. These numbers are expected to increase, because
• More of the population is aging;
• More people are eating unhealthy diets; and
• Physical inactivity is on the rise.
The World Health Organization (WHO) has called diabetes a hidden global pandemic because, although it isn’t infectious or communicable, the number of people diagnosed with the condition is growing annually. It can lead to blindness, limb amputation, cardiovascular disease, and stroke. It overburdens health-care systems and reduces quality of life for patients and their families.
Given the increasing diagnoses, and the growing awareness of Type 2, it is imperative everyone knows the risk factors and the who, what, where, and why of getting tested for diabetes. By learning how you can help friends and loved ones determine their risk of diabetes, you could save a life.
Who is at risk?
Common risk factors for developing Type 2 diabetes include
• Being over age 40;
• Having obesity or excess weight;
• Having a waistline larger than 31.5 inches (80 centimeters) in women and 37 inches (94 centimeters) in men;
• Being of South Asian descent or ethnicity;
• Living with a mental health problem, cardiovascular disease, gestational diabetes, or polycystic ovarian syndrome (PCOS); and
• Having immediate family members who have been diagnosed with diabetes.
According to Ben Ng Jen Min, MD, an endocrinologist practicing in Singapore, “A blood glucose test usually is indicated for people who possess the risk factors or clinically present with any of the symptoms.” Indeed, when risk factors are present, testing is recommended, and if you are diagnosed with diabetes or prediabetes, you can be treated to forestall development of any complications.
What tests are available?
According to Mayo Clinic, four tests commonly are used to determine the presence of Type 2 diabetes. Which one your doctor chooses will depend on your age, health, and other factors specific to you.
Glycated hemoglobin (A1C) test. This is the most commonly used blood test for diagnosing diabetes. It shows your average blood sugar level for the past two to three months, measuring the percentage of blood sugar attached to hemoglobin, the oxygen carrying protein in red blood cells. An A1C level of 6.5% or higher on two separate tests indicates diabetes. Results between 5.7% and 6.4% are considered prediabetes.
Random blood sugar test. A blood sample is taken at a random time. A level of 200 mg/dl (milligrams per deciliter) or 11.1 mmol/l (millimoles per liter) or higher suggests diabetes, particularly if other symptoms such as frequent urination and extreme thirst are present.
Fasting blood sugar test. A blood sample is taken after an eight- to 10-hour fast. A fasting blood sugar level of 126 mg/ dl or 7 mmol/l or higher on two separate tests indicates diabetes. A level between 100 and 125 mg/dl, or 5.6 and 6.9 mmol/l, is considered prediabetes.
Oral glucose tolerance test. After fasting for eight to 10 hours, your fasting blood sugar level is measured. After drinking a sugary/glucose liquid, your blood sugar levels are tested periodically over the next two hours. A blood sugar level of 200 mg/dl, or 11.1 mmol/l, or higher after two hours may indicate diabetes. A reading between 140 and 199 mg/dl, or 7.8 mmol/l and 11.0 mmol/l, indicates prediabetes.
Why are people tested only when they clinically present risk factors or symptoms?
“Testing for diabetes can be invasive and time-consuming, especially when fasting time is included,” said Ng Jen Min. “Many people don’t like going for a blood test.” For example, for an oral glucose tolerance test, the patient must go to a lab after fasting for eight to 10 hours. While there, a blood sample is taken to establish a baseline reading. The patient then drinks 75 grams of bottled oral glucose and then must wait two more hours for blood to be drawn again. The patient then needs to wait another two hours for a third blood draw for a diagnosis to be made.
Fortunately, it is possible to have a simple finger prick blood test. It’s not accurate enough to be used for full diagnosis, but it can indicate whether further testing is warranted. You don’t even have to go to your doctor’s office for this test. Many pharmacies offer free screenings that take just a few minutes.
Evidence suggests that even when people realize they are at risk of developing diabetes, they seldom alter their lifestyle accordingly. This indicates that many people don’t take diabetes seriously — until they are diagnosed with Type 2 or prediabetes.
However, some people fail to get tested simply because they are afraid of the result. “When patients are first diagnosed with diabetes, they often become upset, cry, and are distressed or afraid for the future,” said Ng Jen Min. “Some patients diagnosed with Type 2 diabetes feel helpless and unable to envision living a full life when they are insulin-dependent.”
Where can people get tested?
According to the ADA, as of 2012, 8.1 million Americans had undiagnosed diabetes, and 86 million had prediabetes. In response, many large retail pharmacies now offer free diabetes screening services, including a risk-assessment questionnaire, finger prick test, and consultation. Depending on the results, further testing may be recommended.
Find out about free diabetes screenings in your area and share the information with friends and relatives. It’s much easier to say, “Wow! I wish I’d known about this! Why don’t you give it a try?,” than to list risk factors and tell loved ones you think they should be tested. Trained personnel will be able to better inform and counsel those at risk of developing diabetes without offending them. They also will be able to refer them for further testing if needed.
Online screening is another option. The ADA has an online diabetes screening self-assessment consisting of seven quick questions. Another way to raise awareness among friends and loved ones is to send an e-mail reminding them of the dangers and prevalence of diabetes and asking them to be tested. Tell them you are there to help if they have any questions or concerns. After that, it’s up to them to take action.
How can those with diabetes help?
As someone with diabetes, you have a heightened awareness of the inconveniences and risks associated with the condition. You might be able to identify people with diabetes risk factors. But it’s difficult to tell people their unhealthy diet, excess weight, and lack of activity may be placing them at risk. They could easily take this well-meant advice as personal criticism. Prediabetes often is symptom-free — and yet at this stage, steps can be taken to prevent development of full-blown Type 2 diabetes.
Testing can ensure people with diabetes and prediabetes get treatment but, ultimately, the choice is up to them. Other strategies you could implement to promote the health of friends and family members include:
• Starting a healthy eating challenge and make it fun to participate. For example, challenge your friends to report how much sugar and junk food they consume — the person who eats the most junk food has to cook a healthy dinner for the group.
• Getting a group of friends to commit to taking regular walks or runs together.
• Finding a place where your colleagues can buy healthy lunches and snacks instead of junk food. Encourage them to commit to a no-junk-food policy.
The sooner people are tested and made aware of diabetes or prediabetes, the sooner they can take action. However, since many health-care providers don’t routinely recommend diabetes testing, it is up to individuals to request it. One way to motivate another to request a diabetes test is to share your personal story and what your risk factors were. This can make the person realize he or she might be at risk without directly making the suggestion.
It is far better to know if you have prediabetes or have developed Type 2 diabetes so you can take action. It often is a lifestyle condition, although it can be hereditary, and with careful monitoring, you can lead a much healthier life through weight control, exercise and maintaining blood sugar levels. There is no reason to put off diabetes testing.
So what are you waiting for?