Millions of diabetics at high risk, doctors say

WASHINGTON — A dismal two-thirds of the nation's 18 million type 2 diabetics don't have their blood sugar under control, putting them at high risk of the disease's nastiest complications, even death. Yet most are unaware they're doing so poorly, diabetes specialists said yesterday.

"The report, I think, is sobering," said Dr. Lawrence Blonde of the American Association of Clinical Endocrinologists (AACE), which released the latest statistics at its annual meeting.

Dr. Paul Jellinger, president of the American College of Endocrinology, was more blunt: "It's horrible."

Type 2 diabetes is the most common form of the illness, and experts estimate a third of the people who have it don't know. An additional 41 million have "pre-diabetes," an impaired sugar tolerance that can lead to the full-blown disease.

Type 2 diabetes sneaks up on you, as the body gradually loses its ability to use insulin, a hormone crucial to converting blood sugar into energy. High glucose levels damage blood vessels and nerves, eventually leading to blindness, kidney failure, amputations of feet and legs and heart disease. Diabetes is the nation's sixth-leading killer.

Tight control of blood sugar, either through diet and exercise or with a variety of medications, can prevent that damage. The best measure of control: the A1C test, a way of tracking average blood-sugar levels over two or three months.

The endocrinologists' group defines glucose control as an A1C level below 6.5. But 67 percent of type 2 diabetics aren't meeting that goal, a new analysis concludes.

The analysis is based on the A1C measurements, reported by a laboratory database, of 157,000 people in 39 states during 2003 and 2004.

An AACE-commissioned survey of type 2 diabetics found that 84 percent believed they were doing a good job controlling their blood sugar, even though 61 percent went on to say they didn't know what the A1C test is.

Endocrinologists said patients should ask their doctor about their A1C level at every visit, and if they're not making progress, ask what they can do to lower their level.