Friday, Mar. 14, 2008; 4:18 PM
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FRIDAY, March 14 (HealthDay News) — Minority and low-income Americans with insulin-treated diabetes are less likely to monitor their blood glucose than other diabetics, a new study shows.

The researchers examined data on 16,630 Hispanic, black and white adults aged 19 and older with insulin-treated diabetes to come to this conclusion.

At every income level, fewer Hispanics and blacks reported daily self-monitoring of blood glucose than whites. The study was to be presented Friday at the American Heart Association’s Annual Conference on Cardiovascular Disease Epidemiology and Prevention, in Colorado Springs, Colo.

“Minority and financially vulnerable adults with insulin-treated diabetes appear to have lower reported rates of self-monitoring of blood glucose [SMBG] — a vital disease management component,” study author Dr. Deborah A. Levine, an assistant professor in general internal medicine at the Ohio State University College of Medicine, said in a prepared statement.

“Efforts to improve diabetes control, including the collection and use of SMBG data in Hispanic and black populations with diabetes [particularly those on insulin], are warranted given that Hispanics and blacks have a higher frequency of diabetes-related complications compared to whites. We need to better understand income’s role in racial and ethnic disparities in SMBG to offer effective programs and policies to improve SMBG by minorities,” Levine said.

The study found that among those with annual household incomes of $20,000 and higher, SMBG rates were 85 percent for whites, 78 percent for Hispanics, and 77 percent for blacks. Among those with household incomes of less than $20,000, SMBG rates were 85 percent for whites, 79 percent for blacks, and 65 percent for Hispanics.

The researchers also found that among those with household incomes of less than $20,000, 49 percent of Hispanics received diabetes education, compared with 62 percent of whites and 64 percent of blacks.

“Receipt of diabetes education varied significantly by race-ethnicity only in the less-than-$20,000 income group,” Levine said. “At incomes of $20,000 or more, both Hispanics and blacks had 40 percent lower odds of daily SMBG compared to whites. At incomes of less than $20,000, however, the odds of daily SMBG decreased by 70 percent for Hispanics compared to whites, but did not change for blacks.”

These racial and ethnic disparities in self-monitoring of blood glucose were not fully explained by demographic characteristics such as health insurance, health status, or diabetes-related measures such as diabetes education, disease duration or end-organ damage, Levine said.

The findings suggest that poverty significantly worsens self-monitoring of blood glucose and receipt of diabetes education among Hispanics. This means that income must be “explicitly considered when assessing SMBG performance and designing SMBG interventions for Hispanics with insulin-treated diabetes,” Levine said.

In 2005, 15.1 million U.S. adults (7.3 percent of the adult population) had diagnosed diabetes, according to the American Heart Association. Of those, 13.2 percent were non-Hispanic black females and 10.7 percent were non-Hispanic black males; 11 percent were Mexican-American males and 10.9 percent were Mexican-American females; and 6.7 percent were white males and 5.6 percent were white females.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about diabetes control.

FRIDAY, Feb. 29 (HealthDay News) — Fasting blood sugar levels are typically used to diagnose diabetes, however, a common complication of the disease that can lead to blindness begins at blood sugar levels below what is considered diabetic, Australian researchers report.

Retinopathy is a vascular condition where the small blood vessels in the eye become damaged; other complications of diabetes include heart, kidney and circulatory problems.

“Retinopathy, which is one of the complications traditionally associated with diabetes, occurs at fasting glucose levels below the threshold that is used to define diabetes,” said lead researcher Dr. Tien Y. Wong, chairman of the Department of Ophthalmology at the University of Melbourne.

In the study, Wong’s team analyzed three studies that looked at retinopathy among 11,405 people. The report was published in the March 1 issue of The Lancet.

The researchers found that the overall prevalence of retinopathy ranged from 9.6 percent to 15.8 percent in the general population. In addition, they didn’t find evidence of a particular blood glucose level that would indicate the presence of retinopathy. In fact, 60 percent of retinopathy cases were missed by the current threshold for diabetes diagnosis, which is 7.0 mmol/L.

The finding suggests that eye damage happens much earlier and at lower blood sugar levels than what is currently used to pinpoint the presence of diabetes, Wong said. “This suggests that diagnostic threshold may have to be revised, so that we can pick up more people who are at risk of eye and other complications,” he noted.

In addition to retinopathy, signs of cardiovascular disease also appear to develop at glucose levels below those defined as diabetes, Wong said.

One expert agrees that fasting blood sugar levels may not be the best way of diagnosing diabetes and those at risk for diabetes.

“It is becoming more common that studies are showing that a fasting blood sugar value is not necessarily the best way to judge diabetes or diabetes control,” said Dr. Stuart Weiss, an endocrinologist at New York University Medical Center.

Weiss noted that right now there is no other marker for diabetes. However, many new studies point to the use of blood sugar levels after eating as being better markers for risk, he said.

“Fasting blood sugar is not all that helpful,” Weiss said. “The problem is that a lot of our thinking is based on fasting. That’s an issue we need to focus in on,” he said.

Kidney Disease (Nephropathy)/Kidney Transplantation
Diabetes can damage the kidneys, which not only can cause them to fail, but can also make them lose their ability to filter out waste products. This is called nephropathy.

Eye Complications
Diabetes can cause eye problems and may lead to blindness. People with diabetes do have a higher risk of blindness than people without diabetes. Early detection and treatment of eye problems can save your sight.

Diabetic Neuropathy and Nerve Damage
One of the most common complications of diabetes is diabetic neuropathy. Neuropathy means damage to the nerves that run throughout the body, connecting the spinal cord to muscles, skin, blood vessels, and other organs.

Foot Complications
People with diabetes can develop many different foot problems. Foot problems most often happen when there is nerve damage in the feet or when blood flow is poor. Learn how to protect your feet by following some basic guidelines.

Skin Complications
As many as one-third of people with diabetes will have a skin disorder caused or affected by diabetes at some time in their lives. In fact, such problems are sometimes the first sign that a person has diabetes. Luckily, most skin conditions can be prevented or easily treated if caught early.

Gastroparesis and Diabetes
Gastroparesis is a disorder that affects people with both type 1 and type 2 diabetes.

Depression
Feeling down once in a while is normal. But some people feel a sadness that just won’t go away. Life seems hopeless. Feeling this way most of the day for two weeks or more is a sign of serious depression.

Studies have shown that taking a low-dose aspirin every day significantly lowers the risk of heart attacks. Aspirin can benefit people at high risk of a heart attack, such as those with diabetes and other risk factors such as high blood pressure. It can also help people with diabetes who have had a heart attack or a stroke, or who have heart disease. However, aspirin’s effects have not been studied in people under age 30.

How does aspirin lower my risk for a heart attack?

Exactly why aspirin works is not completely understood, but it may be because it helps keep red blood cells from clumping together. These cells seem to clump together more readily in people with diabetes. When blood cells clump, a blood clot can form and narrow or block a blood vessel. This can lead to a heart attack or stroke.

Is aspirin safe for everyone?

Taking a daily low-dose aspirin is not safe for everyone — it’s best to ask your health care provider whether you should take aspirin. In some people, aspirin can irritate the lining of the stomach, resulting in pain, nausea, vomiting, or bleeding. You should avoid taking aspirin if:

• you’re allergic to it
• you have a tendency to bleed
• you’ve recently had bleeding from your digestive tract
• you have liver disease that’s currently active
• you’re under 21 years of age

Check with your health care provider to see if aspirin therapy is right for you.

How much aspirin should I take every day?

Your health care provider can suggest the lowest possible dosage for you. Most people take a pill containing a dosage between 75 and 162 milligrams. The low-dose version may be labeled “baby aspirin.”

What form of aspirin is recommended?

Some health care providers recommend the enteric-coated form of aspirin. This form of aspirin is coated with a substance that allows it to pass through the stomach without dissolving. Instead, the aspirin is absorbed in the intestine, decreasing the risk of side effects.

The good news is that you can take steps to prevent heart disease or reduce your chances of having another heart attack. Lifestyle changes, such as choosing foods wisely and being physically active, as well as taking medication can help.

What is coronary artery disease?

Coronary artery disease is caused by a narrowing or blocking of the blood vessels that go to your heart. It’s the most common form of heart disease. Your blood carries oxygen and other needed materials to your heart. Blood vessels to your heart can become partially or totally blocked by fatty deposits. A heart attack occurs when the blood supply to your heart is reduced or cut off.

What steps can I take to prevent coronary artery disease?

You can lower your risk by keeping your ABCs of diabetes on target with wise food choices, physical activity, and medication. Losing weight can also help you manage your ABCs and prevent heart disease. Every step you take will help. The closer your numbers are to your targets, the better your chances of preventing heart disease or cutting your risk for another heart attack. If you smoke, get help to quit.

A is for A-1-C

An A-1-C is the blood glucose (sugar) check “with a memory.” It tells you your average blood glucose for the past 2 to 3 months. The American Diabetes Association (ADA) recommends that people aim for an A-1-C below 7.

B is for blood pressure

Your blood pressure numbers tell you the force of blood inside your blood vessels. When your blood pressure is high, your heart has to work harder than it should. The ADA recommends that you keep your blood pressure below 130/80 (said as “130 over 80”) mmHg.

C is for cholesterol

Your cholesterol numbers tell you the amount of fat in your blood. Some kinds, like HDL cholesterol, help protect your heart. Other kinds, like LDL cholesterol, can clog your blood vessels and lead to heart disease. Triglycerides are another kind of blood fat that raises your risk for heart disease.

What can I do to reach my ABC targets?

Making wise food choices, being physically active, and taking medications can help you reach your targets.

Make wise food choices

Many people find that changing what they eat can make a big difference in their blood glucose, blood pressure, and cholesterol levels. Below are several strategies for making wise food choices. Determine which ones you would be willing to try. For more information about how to make these changes, talk with your health care team.

· I’ll eat less fat, especially saturated fat (found in fatty meats, poultry skin, butter, 2% or whole milk, ice cream, cheese, palm oil, coconut oil, trans fats, hydrogenated oils, lard, and shortening).

· I’ll choose lean meats and meat substitutes.

· I’ll switch to low-fat or fat-free dairy products.

· I’ll eat at least 5 servings of fruits and vegetables each day.

· I’ll cut back on foods that are high in cholesterol (such as egg yolks, high-fat meat and poultry, and high-fat dairy products).

· I’ll choose the kinds of fat that can help lower my cholesterol, such as olive oil or canola oil. Nuts also have a healthy type of fat.

· I’ll eat fish two or three times a week, choosing kinds that are high in heart-protective fat (such as albacore tuna, herring, mackerel, rainbow trout, sardines, and salmon).

· I’ll cook using low-fat methods (such as baking, roasting, or grilling foods or by using nonstick pans and cooking sprays).

· I’ll eat more foods that are high in fiber (such as oatmeal, oat bran, dried beans and peas like kidney beans, fruits, and vegetables).

· I’ll eat less salt and sodium.

Lose weight or take steps to prevent weight gain

· I’ll cut down on calories and fat.

· I’ll try to be more physically active than I am now.

Be physically active

Before you start a new routine, check with your health care team to find out which activities will be safe for you. Then think about how you can add more activity to your routine. If you’re just starting out, begin with 5 minutes a day and gradually add more time. Then work up to doing a total of about 30 minutes of aerobic exercise, such as brisk walking, most days of the week.

Take medications

Medications are available to help you reach your ABC targets and lower your risk of another heart attack. You may need several medications to stay on track.

Some types of blood pressure and cholesterol-lowering medications can protect your heart. Your health care provider can provide information about which medications are best for you.

Aspirin can also help lower your risk of heart disease. Ask your provider whether taking a low-dose aspirin every day would be wise.

What can help me quit smoking?

If you’re ready to quit, talk with your health care team. They can help you find ways to quit. Joining a support group or smoking-cessation program can also help.