Do I Have Diabetes?

Recent research published in September found that the prevalence of diabetes in the U.S. has increased significantly in past decades -- from nearly 10 percent to more than 12 percent of American adults between 1988 and 2012. And most adults in the U.S. who haven't been diagnosed with the chronic condition have one or more risk factors for the disease, from being overweight or obese to having a family history of diabetes.

Greater screening and awareness of the problem has increased detection rates of Type 2 diabetes -- the most common form of the disease -- in which the body doesn't make enough insulin or properly use it to help control blood sugar. The proportion of people with undiagnosed Type 2 diabetes decreased 23 percent during the study period, according to researchers from the National Institutes of Health and the Centers for Disease Control and Prevention, whose results were published in the Journal of the American Medical Association.

That was the silver lining.

But the dark forecast coming out of research, experts say, is that a very large proportion of the growing number of people with diabetes -- into the millions -- have no idea they have the disease. The longer a person has diabetes and the higher his or her blood sugar rises as a result of the disease, the more likely an individual is to suffer devastating and even deadly consequences.

"Diabetes is the biggest cause of blindness, biggest cause of kidney failure, biggest cause of amputations; it leads to erectile dysfunction in men ... and it increases your risk for heart disease by anywhere from two- to fivefold," says Dr. David Nathan, director of the Diabetes Center at Massachusetts General Hospital in Boston and a professor of medicine at Harvard Medical School.

Doctors often refer to Type 2 as a "silent" condition, like high blood pressure, because it frequently goes undetected in the early stages. The fact that significant portions of the population with the disease continue to go undiagnosed -- including 51 percent of Asian-Americans and 49 percent of Hispanic-American with diabetes -- has led to a renewed call for testing and education about prevention, early diagnosis and treatment of the disease that affects more than 29 million Americans.

Proper disease management saves lives and can dramatically improve a person's quality of life. "If you treat people and manage their blood sugar and their blood pressure and their cholesterol, they have a much better likelihood of avoiding those complications," Nathan says. "By catching the diabetes early, you can treat it effectively and reduce the risk of people becoming ill with it over time."

Often Type 2 diabetes is asymptomatic until it has progressed to a point in which significant complications have occurred. The American Diabetes Association recommends testing, which measures blood sugar levels, for a large swath of people to detect diabetes and prediabetes. People with prediabetes have a blood sugar level that's higher than normal and may develop diabetes if they don't take steps to reduce their risk, such as increasing exercise, losing weight and improving diet.

The ADA advises testing for diabetes and prediabetes in all adults who are overweight or obese and who have one or more additional risk factors for diabetes. A body mass index of 25 to 30 is considered overweight; 31 and up is considered obese. In addition, the research published in JAMA in September found that Asian-Americans often develop diabetes at a lower BMI than the general population, and the ADA recommends Asian-Americans be tested for diabetes at a BMI of 23 or higher.

Based on BMI, more than two-thirds of adults in the U.S. are overweight and experts say many, if not most, have at least one or more of a long list of risk factors for the disease. These include a family history of diabetes, habitual physical inactivity or being in certain racial or ethnic groups, such as African-American, Hispanic-American, Native-American or Asian-American, says Dr. Amisha Wallia, an endocrinologist at Northwestern Memorial Hospital and assistant professor of medicine-endocrinology at the Northwestern University Feinberg School of Medicine in Chicago. "If you have been previously diagnosed with high blood pressure or high cholesterol, if you're a female and have had a history of gestational diabetes or a baby weighing greater than 9 pounds or if you had polycystic ovarian syndrome, those are additional risk factors for Type 2 diabetes," Wallia says.

In addition, ADA guidelines say that testing for all patients, particularly those who are overweight or obese, should begin at age 45, and the association recommends routine testing at least every three years after that. Although doctors may recommend this during checkups, patients are encouraged to take initiative and request to be tested for diabetes.

The guidelines also say testing should be considered for children or adolescents who are overweight or obese, and who have two or more risk factors for Type 2 diabetes, which is on the rise in the younger set, placing them at increased risk for experiencing complications at younger ages than typical.

As it stands, doctors say, many people are diagnosed with diabetes by happenstance -- such as during a routine medical visit or when patients are being assessed for a surgical procedure unrelated to the disease -- says Dr. Solomon Rosenblatt, an endocrinologist and assistant professor of medicine at Oakland University William Beaumont School of Medicine in Rochester, Michigan. "It's not unusual for them to be first diagnosed when they first come in for surgery or come in for an infection or come in for some type of heart problem," he says. "In retrospect, they may have had symptoms for weeks or months before that. So, of course, we take care of the problem that they came in for, but you always hope that they'll come in earlier."

That's why major U.S. health agencies would like to see a more proactive approach to detection. "If we can identify an individual with diabetes earlier," Rosenblatt says, "we are more likely to be successful with our treatment in preventing complications."

Recent research published in September found that the prevalence of diabetes in the U.S. has increased significantly in past decades -- from nearly 10 percent to more than 12 percent of American adults between 1988 and 2012. And most adults in the U.S. who haven't been diagnosed with the chronic condition have one or more risk factors for the disease, from being overweight or obese to a family history of diabetes, which can cause blood sugar levels to rise dangerously.

Greater screening and awareness of the problem has increased rates of detection for Type 2 diabetes -- the focus of the latest research, and the most common form of the disease, in which the body doesn't use insulin properly. The proportion of people with undiagnosed diabetes decreased 23 percent during the study period, according to researchers from the National Institutes of Health and the Centers for Disease Control and Prevention, whose results were published in the Journal of the American Medical Association.

That was the silver lining.

But the dark forecast coming out of research, in addition to the increased number of people with diabetes in the U.S., experts say, remains that a very large proportion of people with diabetes -- into the millions -- have no idea that they have the disease. The longer a person has diabetes and the higher their blood sugar rises as a result of the disease, the more likely an individual is to suffer devastating and even deadly consequences.

"Diabetes is the biggest cause of blindness, biggest cause of kidney failure, biggest cause of amputations, leads to erectile dysfunction in men ... and it increases your risk for heart disease by anywhere from two- to five-fold," says Dr. David Nathan, director of the Diabetes Center and Clinical Research Center at Massachusetts General Hospital in Boston and professor of medicine at Harvard Medical School.

Doctors often refer to Type 2 diabetes, like high blood pressure, as a "silent" condition, since it frequently goes undetected in the early going. That significant portions of the population with the disease continue to go undiagnosed -- including 51 percent of Asian-Americans and 49 percent of Hispanic-American with diabetes -- has led to a renewed call for testing and education about early diagnosis, treatment and proper management of the disease that affects more than 29 million Americans.

Proper disease management saves lives and can dramatically improve a person's quality of life. "If you treat people and manage their blood sugar and their blood pressure and their cholesterol, they have a much better likelihood of avoiding those complications," Nathan says. "By catching the diabetes early, you can treat it effectively and reduce the risk of people becoming ill with it over time."



Often the disease is asymptomatic until it has progressed to a point that significant complications have occurred. So, the American Diabetes Association recommends testing, including to measure blood sugar levels, for a large swath of people to detect diabetes and prediabetes. A person with prediabetes has a blood sugar level that's higher than normal and may develop diabetes, if they don't take steps to reduce risk, such as exercising more, losing weight and improving diet, to consume less sugar and more healthy proteins and vegetables.

The ADA recommends testing to assess for diabetes and prediabetes in adults of any age who are overweight or obese and who have one or more additional risk factors for diabetes. A body mass index of 25 to 30 is considered overweight, and 31 and up is considered obese. In addition, the research published in JAMA in September found Asian-Americans often develop diabetes at a lower BMI than the general population, and the ADA recommends Asian-Americans be tested for diabetes at a BMI of 23 or higher.

Experts say that along with more than two-thirds being overweight, many -- if not most -- adults in the U.S. have at least one of a long list of risk factors for diabetes: Included: "A family history of diabetes; if they have habitual physical inactivity; or are from racial or ethnic groups, such as African-American, Hispanic-American, Native-American and Asian-American -- [these] are all risk factors for diabetes," says Dr. Amisha Wallia, an endocrinologist at Northwestern Memorial Hospital and assistant professor of medicine-endocrinology at the Northwestern University Feinberg School of Medicine. "If you have been previously diagnosed with high blood pressure or high cholesterol, if you're a female and have had a history of gestational diabetes or baby weighing greater than 9 pounds or if you had polycystic ovarian syndrome, those are additional risk factors for Type 2 diabetes."

In addition, ADA guidelines say testing for all patients, particularly those who are overweight or obese, should begin at age 45. If tests come back normal, the association recommends following up to repeat testing at least every 3 years after that. The guidelines also say testing should be considered for children or adolescents who are overweight or obese with two or more risk factors for diabetes.

As it stands, many people are diagnosed with diabetes incidentally -- such as during a routine doctor's visit or when patients are being assessed for surgical procedure unrelated to the disease -- says Dr. Solomon Rosenblatt, M.D., endocrinologist, assistant professor of medicine at Oakland University William Beaumont School of Medicine in Rochester, Michigan. "It's not unusual for them to be first diagnosed when they first come in for surgery or come in for an infection or come in for some type of heart problem," he says. "In retrospect, may have had symptoms for weeks or months before that. So, of course, we take care of the problem that they came in for, but you always hope that they'll come in earlier."

Reiterating the emphasis on early detection, he notes that when the disease progresses, without intervention, it can result in any number of life-altering -- or life-ending -- health issues: from blindness to stroke. "If we can identify an individual with diabetes earlier," Rosenblatt echoes other medical providers and researchers, "we are more likely to be successful with our treatment in preventing complications."