EARLY DETECTION OF DIABETES, THE CV DISEASE

Diabetes is a dreaded disease amongst us, because of its chronicity, and eventual CV outcomes that affects lives. In fact there are many of us who believe that diabetes should be a cardiovascular disease, as high blood sugar per se does not kill, but only through its CVS effects of eye complications, strokes, heart attacks, renal failure and peripheral vascular disease. There fore, we are very keen to pick up diabetes in their earliest possible stage and work hard to prevent it. The many diabetic society have developed for us guidelines for early diagnosis of pre-diabetes. But getting the message through has proven to be very challenging and an anti-diabetes lifestyle si almost taken as synonymous ( by some ) to be anti-life enjoyment lifestyle. However, we must keep pushing the message, as it will do the patient and also the country well, especially in this age of preventive medicine, and healthcare cost containment.

In line with this, the March 4th issue of the New England Journal of Medicine, carried an interesting report of the 14 year follo-up of a community survey of non-diabetics with no CVS, called the " Atherosclerosis Risk in Communities " study or the ARIC study. Dr Elizabeth Selvin and colleagues from the John Hopkins School of Public Health, published their 14 ear followup on 14,348 patients who were followed up for 14yrs after the secone community visit way back in 1990-1992. They found that the Glycated Hemoglobin A-1c was a useful predictor of the coming onset of diabetes and also CV risk. Patients who had a HbA-1c of >5.5% at the second visit back in 1992, after 14 years of follow-up, were much more likely to have future diabetes, CV mortality, strokes. The HbA 1c was a much better predictor then fasting glucose level. The American Diabetic Association takes a HbA 1c level of 5.7-6.5% as an indication of pre-diabetes, and any level of HbA 1c of >6.5% to be indicative of the presence of diabetes.

Therefore, in the issue of the dreaded diabetes, we now have a reliable marker of