Blind Men and The Diabetes Elephant

You remember that fable, don’t you? The one where six blindfolded men each describe an elephant – or at least the part he could reach. One said the elephant was a fan (the ear), another said it was a giant snake (the trunk), another said it was a tree trunk (the leg), and so on and so on. Well, the diabetes news this week has been similar – lots of people describing one piece of the puzzle from different corners of the research world. Here at Doc Gurley, we think it’s time to take off the blinders and look at the whole picture. Like an elephant in the room, it’s pretty impressive.

1) New Zealand researchers discover that, even in you’ve never had a diagnosis of diabetes, your chances of dying go way up if your blood hemoglobin A1C is elevated. Most alarmingly, the death response is dose-related, so the higher your blood test, the greater your chance of dying. And this study found people dying even though the researchers didn’t follow them for that long – only 3-5 years after one blood test. How bad was it? “In those without known diabetes at baseline, a 1% increase in A1C level was associated with a 16% increase in mortality rate.” Sheesh. This is serious news for everyone – including those of us walking around thinking that all this diabetes stuff doesn’t apply to us. Maybe it does – in the most crucial way imaginable.

2) Now that you’re paying attention, you may be asking What the heck is a hemoglobin A1C test, anyways? If so, you get Doc Gurley extra credit points. Hemoglobin A1C is a test that doctors like, while the standard prick-your-finger random glucose test is the one that diabetic patients can do themselves. Hemoglobin A1C looks at glucose levels over the past 3 months – by looking at your red blood cells. It gives a rough measure of how elevated (over time) your sugar has been. A finger-stick glucose is a random pinprick to see what your sugar level is right this minute. One blood test doesn’t translate into the other, which is a huge problem for doctors and patients when they’re talking about two different values, with two different implications. Until now that is – researchers created a conversion value, one they’re calling the estimated average glucose. Lots of diabetes organizations are waving pom-poms, trying to get everyone to switch over to using the estimated average glucose. It may, however, take more than cheerleading to get everyone using this value, if their description of it is any clue. Get a load of this explanation – the average is calculated “by combining weighted results from at least 2 days of continuous glucose monitoring performed four times, with seven-point daily self-monitoring of capillary glucose performed at least 3 days per week.” Anyone understand that? patient? doctor? Anyone?

3) So now we’re stepping back and gazing at the elephant stage. We’ve got an important blood test that may predict your chances of dying in just a few years (even if you don’t have a diabetes diagnosis), we’ve got an uber-geek conversion factor for calculating that blood test based on fingersticks that diabetics can do themselves. Are we now overwhelmed and depressed? Heck no – that’s because our third recent diabetes news item is from those hilarious, hope-inspiring people (you guessed it) – Finnish researchers! Huh? That’s right. The Finnish Diabetes Risk Score is big news – researchers have found a set of easy, simple, non-invasive questions that anyone can use to determine your risk of developing diabetes. And, if that wasn’t good enough, they went to the next step and looked at whether or not changing the lifestyle of people at risk reduced or delayed the onset of diabetes. The answer was an overwhelming Yes! You Can! The people with the biggest response to lifestyle changes were actually those who were older, and those who scored the worst. If that’s not hopeful, good news, then what is?

Here’s the huge, pachyderm punchline – if your weight is creeping up, if you’re worried you’re at risk for diabetes, there are simple ways to find out if that’s true. Check out the Finnish Diabetes Risk Score for yourself. And, when you go in for a check-up, even if your fingerstick glucose is fine, ask your doctor for a hemoglobin A1C test (print up the article and take it with you if need be). And if, heaven forbid, your hemoglobin A1C test is elevated, you’ll now have lots of motivation to make those lifestyle changes that we all should probably be making (whole grains, better diet, more exercise) – but this time you’ll stick with it. Because now, more than ever, you know there’s good evidence that what you’re doing could save your health, and even your life. This week’s diabetes news, when you look at it all together, takes on elephant-sized importance – a crucial test, a better way to compare results, and effective change for people at risk.
If that’s not big, what is?

Addendum: If you have trouble getting to the specifics of the Finnish Diabetes Risk Score, here are some more details about how it’s done, and links –

Here is the original article describing the exact components of the Finnish Diabetes Risk Score. It is made up of seven parts – your BMI (calculated from your height and weight), your waist circumference, your age, any history of high blood pressure or high blood sugar, information about daily consumption of fruits, berries, or vegetables, and information about physical activity. The questions are impressively specific and clear-cut – for example, the physical activity questions are “do you, in your spare time, read, watch TV, and work in the household with tasks that don’t strain you physically?” If the answer to that is yes, the next question is – “is your work mainly done sitting and does not require much walking?” A yes to both questions puts a person is a low exercise category. A combination of results on all seven of these factors decides your Finnish Diabetes Risk Score.

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