More than 10 million Americans are diabetic. It’s the leading cause of amputations and blindness in working adults in the U.S., costing $98 billion annually in health care fees. Greg Doelle, MD, endocrinologist at University of Iowa Hospitals and Clinics, talks about diabetes and its treatment:
How is diabetes diagnosed?
Diabetes is diagnosed by the measurement of blood sugar concentration, demonstrating an abnormally elevated blood sugar concentration. I think it’s important for people to recognize that diabetes is actually a group of different disorders, all of which are characterized by a high blood sugar concentration.
What is prediabetes, and why is it important?
Prediabetes is receiving a lot of attention because it’s now recognized as a fairly well defined risk factor for developing type 2 diabetes. A recent estimate suggests that 57 million Americans may have prediabetes and, hence, be at risk for developing type 2 diabetes and the complications related to that disorder.
How can people with diabetes go about their lives undiagnosed?
The elevations in blood sugar are very often asymptomatic. Like many diseases, people can have elevations in blood sugar or other disorders (for example, high blood pressure), without symptoms and can have those problems for many years. They can develop complications related to elevations in blood sugar, but never really know that they have diabetes. And so the diagnosis requires measurement of blood glucose concentration for diagnosis.
Are all treatment plans for diabetes basically the same, regardless of the patient?
No, I think not. I think that therapy is individualized. We certainly recognize, as I mentioned earlier, that diabetes is a lot of different disorders, and so recognizing the particular disorder and how that individual developed elevated blood glucose concentrations is important, so we can tailor therapy toward the underlying disease process.
For example, are there disorders of insulin action in which case certain medicines may be appropriate? Or, is the process really one of insulin deficiency where insulin replacement therapy might be the most important aspect of therapy? Very often there are combinations of both of those defects leading to the elevated blood sugar. So I think the treatment of individuals with diabetes is very much based on what we think the underlying problem is, and we try to correct your elevated blood sugars by dealing with those underlying defects.
What are the goals of treatment?
I think that the primary goal is normalization of blood sugar concentrations, and in doing so, reducing the risk of long-term complications of diabetes. So I think that’s the immediate goal. I think that the other important goal is trying to allow patients to manage their disease, rather than the other way around—the disease managing them and controlling their lives. We allow people to control blood sugar concentrations while continuing in their job, continuing in school, continuing in other situations—to really be in control of their disease and in control of their blood sugars.
Is diabetes a life-long disease, or can it be cured?
I think diabetes should be considered a life-long disease. Recently, there’s been some attention given to reversal of diabetes in people undergoing bariatric surgery, for example. And I certainly think that that does occur. But I think that the underlying disorder or predisposition to glucose disorders still exists in those individuals. So, for the majority of people, this is a life-long disease that requires life-long and, oft times, changing treatments to accommodate changes in the disease process itself.
Does a patient need to be referred by a physician, or can they make their own appointment to diabetes clinic?
People do not need to be referred to diabetes clinics, and we certainly welcome self-referrals to the clinics at The University of Iowa. We generally suggest to individuals that if they have concerns that they may have diabetes, that they see their primary care provider first. But if the diagnosis is confirmed, we’re happy to see patients and there’s no referral requirement. |
