MILLIONS OF AFRICAN AMERICANS AT INCREASED RISK FOR -1)

(Philadelphia—July 19)  About 40 percent of adults ages 40 to 74 – or 41 million people -- have 
pre-diabetes, a condition that raises a person’s risk of developing type 2 diabetes, heart disease, and stroke. 
African Americans are twice as likely as whites of similar age to develop diabetes.  To help reduce this
potential epidemic, the U.S. Department of Health and Human Services’ (HHS) National Diabetes Education
Program (NDEP) launched a public awareness campaign today called “More Than 50 Ways to Prevent
Diabetes” with Philadelphia’s Fun, Fit & Free! healthy lifestyle program.  The campaign delivers the
message that African Americans can prevent type 2 diabetes. The event took place at the North Philadelphia
Seventh-Day Adventist Church, where the city’s model healthy lifestyle program is based.  
 
“More than 50 Ways to Prevent Diabetes” is part of NDEP’s Small Steps. Big Rewards. Prevent type 2
Diabetes campaign, which targets groups at high risk for diabetes.  The “More than 50 Ways” campaign uses
humorous rhymes to encourage lifestyle change, such as “Less on your plate, Nate” and “Dance it away,
Faye.”  These messages are offered on motivational tip sheets, radio and print public service advertisements,
and posters.  More than 200 public and private partners will help to distribute the materials throughout the
country.
 
“We are asking African Americans to find out if they are at risk for type 2 diabetes, and we’re showing them
how to take action to prevent it,” said HHS Secretary Tommy G. Thompson.  “The key is regular physical
activity and modest weight loss—as little as 5 to 7 percent of your body weight.  I want to encourage people
to take this message of good health to their families and their communities, so we can put an end to the
diabetes epidemic.” 
 
Philadelphia native Frenchy Risco is a member of NDEP’s “Small Steps. Big Rewards. Team to Prevent type
2 Diabetes.”  This team was assembled by NDEP to put a human face on the populations that are at high risk
for the disease. Each member is actively working in his or her community to prevent diabetes.   Mr. Risco
recently graduated from the Fun, Fit & Free! cooking class and is one of the city’s lay healthy cooking chefs. 
 
Risco’s healthy life choices came as a result of taking a six-week course offered by the Fun, Fit & Free!
program.  Created by the City of Philadelphia as a public-private partnership, the program helps city residents
lose weight through free cooking classes, walking tours, and healthy food menus. The program has been
lauded by Secretary Thompson as a “fun and challenging” way for city residents to learn to incorporate
physical activity into their daily routines and to make wise food choices. 

MILLIONS OF AFRICAN AMERICANS AT INCREASED RISK FOR -2)

“Diabetes is ravaging our community. We must spread the word about the many ways we can beat this
devastating disease,” said Risco. “I adopted my healthy lifestyle and committed myself to informing my
brothers and sisters about the rewards it brings—freedom from blindness, from amputation, from daily
injections of insulin.  My best friend had his leg amputated as a result of diabetes.  I can’t give him a new 
leg, but I can help inform others about taking small steps now to avoid that fate in the future.”
 
Dr. James R. Gavin, III, Chair of NDEP and President of Morehouse School of Medicine, says the partnership
of community-based healthy living programs and a national public awareness campaign is a prescription for
making real inroads to stem the diabetes epidemic in the African American community.  
 
“Every minute of every day, another American develops type 2 diabetes,” said Dr. Gavin at the news
conference announcing the outreach effort. “Nearly three million African Americans have been diagnosed
with diabetes and millions more are likely to develop the disease in the coming years, unless we get serious
about prevention today.” 
 
“This is a job all of us must take part in. African Americans do not have to suffer from diabetes and its
complications.  Knowing how to eat healthy and increasing their physical activity are keys to longer, 
healthier lives. We must get the word out that type 2 diabetes prevention is proven, possible, and powerful.” 
 
HHS’ NDEP is a federally funded program, co-sponsored by the National Institutes of Health and the Centers
for Disease Control and Prevention, and is a leading source for information about diabetes care and
prevention.  NDEP has more than 200 partner organizations that form a network to reach the health care
community and those affected by diabetes at the federal, state, and local levels.
 
For more information about the campaign and free materials, including tip sheets and the GAMEPLAN for
Preventing type 2 Diabetes – tools to help people lose weight, get active, and track their progress – visit the
NDEP website at www.ndep.nih.gov or call 1-800-438-5383.

Ten Ways to Shape Up Your Family Reunion to Prevent Type 2 Diabet

Family reunions offer a chance to bond with relatives, learn about your
heritage, share recipes, and celebrate with your whole family. When
learning about your heritage, it is also important to find out if type 2
diabetes runs in your family. Having a family history of type 2
diabetes increases your risk for developing the disease. Take the first
step today toward lowering your risk for type 2 diabetes and
improving your health and the health of future generations. Find out if
you have a family history of the disease. 
 
Diabetes affects the lives of millions of African Americans in the
United States. But there’s hope for you and your family. Research shows that losing a small
amount of weight – 5 to 7 percent of your current weight or 10 to 14 pounds for a 200-pound
person – can reduce the risk of type 2 diabetes by more than half. The key step to preventing or
delaying the onset of type 2 diabetes is to lose a small amount of weight by making healthy food
choices and being physically active 30 minutes a day, 5 days a week. Beginning with your next
reunion and afterwards, follow these 10 tips from the National Diabetes Education Program
(NDEP) to shape up your family, lose weight, and prevent or delay the onset of type 2 diabetes: 
 
Choose activities your entire family will enjoy. 
1.  Dance it away! A dance contest is a fun way to show the younger people in your family the
dances you used to do when you were their age – and they can show you some of their moves
as well! Or turn up the music and do the Electric Slide, the Cha Cha Slide, and other favorite
group dances.   
2.  Be physically active with younger relatives. Play with younger children, nieces, nephews,
and cousins. Go swimming, toss a softball, or do jumping jacks. 
3.  Get up, get out, get moving! If your family reunion is held in a park, go for a bike ride, a
brisk walk on a nature trail, or any other activity that helps get your heart rate up.  
4.  Focus on fun! Activities such as scavenger hunts, potato sack races, and double-dutch
contests are easy ways to have fun and be physically active.  
5.  Make it a family affair. Involve everyone in a friendly game of basketball, flag football,
volleyball, or tag.  
 
Have a plan for what, when, and how much you will eat.
6.  For starters, try a salad with a twist. Prepare a rainbow fruit salad with a large peeled and
diced mango; 1 peeled and sliced kiwi; 2 cups blueberries, halved strawberries, and seedless
grapes; 2 nectarines; and 2 sliced bananas. Top with a small amount of honey-orange
dressing made with ? cup unsweetened orange juice, 2 tablespoons lemon juice, 1/4 teaspoon
ground ginger, 11/2 tablespoon honey, and a dash of nutmeg. Number of servings: 12    
Source: National Heart, Lung, and Blood Institute’s Stay Young at Heart Recipe Collection
7.  Why fry when you can bake, broil, or grill? Instead of fried chicken, fire up the grill and
remove the skin and fat from chicken breasts, drumsticks, or thighs and lightly coat them
with barbeque sauce. Instead of fried catfish, try baked fish seasoned with herbs, spices, or
lemon juice. 

8.  Try low-fat versions of your favorite side dishes. Prepare homemade macaroni and cheese
with nonfat and low-fat milk and cheese. Smother greens with smoked turkey or low-sodium
chicken broth instead of fatback.   
9.  Re-think your drink. Whenever possible drink water – the healthy, no-calorie beverage.
Instead of a regular 20-ounce soda or sweetened fruit drink, choose sugar-free soda.  
10. Reach for a healthy treat. Instead of cobblers, cakes, or pies for dessert, eat a piece of fresh
summer fruit such as peaches, nectarines, or apricots. Also, try old-fashioned bread pudding
prepared with 11/2 cup skim milk, 10 slices whole-wheat bread, 3 egg whites, 1/2 teaspoon
cinnamon, 1/4 teaspoon nutmeg, 1 teaspoon vanilla extract, and a little brown sugar. To
prepare bread pudding, preheat oven to 350 °F. Lightly coat 8”x 8” inch baking dish with
vegetable oil spray. Lay slices of bread in baking dish in two rows, overlapping like shingles.
In medium bowl, beat together egg whites, milk, brown sugar, and vanilla. Pour egg mixture
over bread. In small bowl, stir together cinnamon, nutmeg, and clove and sprinkle over bread
pudding. Bake pudding for 30 to 35 minutes at 350 °F, until it has browned on top and is firm
to touch. For a topping, simmer apple-raisin sauce prepared with 11/4 cup apple juice, 1/2 cup
raisins, 1/2 cup apple butter, 1/4 teaspoon ground cinnamon, 1/4 teaspoon ground nutmeg, and 2
tablespoons molasses in a medium saucepan for five minutes. Number of servings: 9  
Source: National Heart, Lung, and Blood Institute’s Keep the Beat: Heart Healthy Recipes    
 
To order your free copy of the More than 50 Ways to Prevent Diabetes tip sheet and other free
resources to help African American families lower their risk for type 2 diabetes, contact the
National Diabetes Education Program at 1-888-693-NDEP (6337) or visit
www.YourDiabetesInfo.org. You can also check out the National Kidney Disease Education
Program’s Make Health a Family Reunion Affair guide by visiting www.nkdep.nih.gov or
calling 1-866-454-3639.

NIH Encourages African Americans to Discuss Kidney Disease at Fam

As African Americans across the country prepare for family reunions this summer, NIH is encouraging them to bring 揾ealth to the table?by alerting family members about their risks for kidney disease.

The National Kidney Disease Education Program (NKDEP) is launching an initiative this week to encourage African Americans who are attending reunions to reach out to relatives who have leading risk factors for kidney disease — diabetes or high blood pressure.

揗any people know family members who have diabetes or high blood pressure. Our goal is to make them aware of their risk for kidney disease and to encourage them to get tested and take steps to protect their kidneys,?says Dr. Thomas Hostetter, director of NKDEP.

African Americans are four times more likely than whites to develop kidney failure. Furthermore, diabetes and high blood pressure account for 70 percent of kidney failure in African Americans. Because diabetes and high blood pressure run in families, reunions offer good opportunities to discuss kidney disease.

揔idney disease has no early warning signs,?said Dr. Hostetter. 揘ot knowing the risks can have disastrous consequences. But there is good news. Once diagnosed, kidney disease can be treated and kidney failure can be prevented or delayed.?

To help families talk about kidney disease, NKDEP has created a free, online Kidney Connection Toolkit containing everything needed to share important kidney health information at reunions, including simple guides for conducting a 15-minute Make the Kidney Connection health discussion, identifying and talking with family members at risk, and distributing kidney disease prevention information to attendees.

Organizations partnering with NKDEP on the initiative are the National Urban League, the International Society on Hypertension in Blacks, the National Medical Association, and the COSHAR Foundation. Partners are spreading the word and the toolkit throughout the summer.

For more information and to download the NKDEP toolkit, visit www.nkdep.nih.gov/familyreunion.

The National Kidney Disease Education Program is an initiative of the National Institute of Diabetes and Digestive and Kidney Diseases, one of the National Institutes of Health.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — is comprised of 27 Institutes and Centers and is a component of the U. S. Department of Health and Human Services. It is the primary Federal agency for conducting and supporting basic, clinical, and translational medical research, and investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit

NIH Encourages African Americans to Make Health A 揊amily Reunion?

As African-American families across the country plan their reunions this summer, the National Kidney Disease Education Program (NKDEP), an initiative of the National Institutes of Health, is encouraging them to talk about several health issues that disproportionately affect African Americans — diabetes, high blood pressure, and kidney disease.

The NKDEP urges African Americans attending reunions to reach out to relatives who have diabetes and/or high blood pressure — the leading risk factors for kidney disease. Diabetes and high blood pressure account for 70 percent of kidney failure. African Americans are nearly four times more likely than Caucasians to develop kidney failure.

揇iabetes and high blood pressure are all too common in African-American families,?said Griffin P. Rodgers, M.D., acting director of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 揟he NKDEP recognizes reunions as an opportunity for families to discuss how these conditions can cause kidney disease and why it is so important to get tested.?/p>

To help families talk about kidney disease, the NKDEP has created a free Kidney Connection Guide containing fact sheets about diabetes, high blood pressure, and kidney disease. The guide outlines three approaches to promote discussion among family members: presenting a 15-minute Make The Kidney Connection health overview, conducting one-on-one discussions with family members at risk, and distributing kidney disease information to attendees. In addition, the guide encourages families to use the U.S. Surgeon General抯 online tool, called 揗y Family Health Portrait,?to trace illnesses suffered by parents, grandparents, and other relatives.

揔nowing your family history can save your life. It抯 important to take advantage of every opportunity to discuss these important medical issues with your loved ones,?says U.S. Surgeon General Richard H. Carmona, M.D., M.P.H.

The goal of the NKDEP is to make the connection between kidney disease, diabetes and high blood pressure, and to encourage those at high risk to get tested.

揗any people have family members with diabetes or high blood pressure, or both. That抯 why it is so important for them to talk to their families about these risk factors for kidney disease, and help them understand there are steps they can take to protect their kidneys,?said Josephine P. Briggs, M.D., director of NIDDK's Division of Kidney, Urologic, and Hematologic Diseases.

To promote its family reunion initiative, the NKDEP is working with a number of organizations, including the International Society on Hypertension in Blacks, the National Medical Association, and the COSHAR Foundation, which is raising awareness through Kidney Sunday events at African-American churches nationwide. For more information and to download a free copy of the NKDEP Kidney Connection Guide, visit

African Americans and Kidney Disease Fact Sheet

Kidney Disease in African Americans

• African Americans are nearly four times more likely than Caucasians to develop kidney failure,¹ which requires dialysis or a kidney transplant.

• An NKDEP survey of African Americans found that only eight percent named kidney disease as a consequence of high blood pressure, and only 17 percent named kidney disease as a consequence of diabetes. Of those surveyed who had high blood pressure and diabetes, only 10 percent and 29 percent, respectively, identified kidney disease as a negative consequence of not treating their conditions.²

• African Americans make up about 12 percent of the population but account for 32 percent of people with kidney failure.¹

• Among new patients whose kidney failure was caused by high blood pressure, more than half (51.2 percent) are African-American.¹

• Among new patients whose kidney failure was caused by diabetes, almost one third (31.3 percent) are African-American.¹

• African-American men ages 20 to 29 are 10 times more likely to develop kidney failure due to high blood pressure than Caucasian men in the same age group. African-American men ages 30 to 39 are about 14 times more likely to develop kidney failure due to high blood pressure than Caucasian men in the same age group.¹


• 
  

  Kidney Disease in the United States

  
  
  
  
  • Approximately 20 million Americans have kidney disease.³
  
  
  
  
  • Early kidney disease has no symptoms. If left undetected, it can progress to kidney failure with little or no warning.
  
  
  
  
  • By the end of 2003, more than 128,000 people were living with a kidney transplant, and almost 325,000 were on dialysis – a number that has nearly tripled since 1988.¹
  
  
  
  
  • Public and private spending to treat patients with kidney failure in the United States in 2003 was $27.3 billion,¹ up from around $22 billion in 2001.
  
  
  
  
  • The most common causes of kidney failure are diabetes and high blood pressure, together accounting for about 70 percent of new cases.¹
  
  
  
  
  • By 2030, more than 2 million people will be receiving treatment for kidney failure.⁴
  
  
  
  
  • Kidney disease can be effectively treated if detected early. ACE (angiotensin-converting enzyme) inhibitors^5,6,7,8 or ARBs^9,10 (angiotensin receptor blockers) can prevent or slow progression of kidney disease to kidney failure

Diabetes & High -Have you talked to a doctor

If you have diabetes or high blood kidneys pressure, ask about your kidneys at your next doctor’s appointment.
Both of these conditions can damage your kidneys and lead to kidney disease.
Kidney disease from diabetes or high blood pressure does not go away.  Instead, it gets worse over time.  If not treated, kidney disease
You have two kidneys located near the can lead to kidney failure, where center of your back.  Their job is to filter
your only options are dialysis or a your blood.  Small blood vessels in your
kidney transplant. 

People with Diabetes and Sickle Cell Trait Should Have Reliable A

Campaign Informs Physicians and Patients

A new information campaign of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health, highlights the importance of using accurate methods to test hemoglobin A1c in people with diabetes who have sickle cell trait or other inherited forms of variant hemoglobin. The specific needs for testing blood glucose control in these patients are explained in two booklets, "Sickle Cell Trait and Other Hemoglobinopathies and Diabetes: Important Information for Physicians" and "For People of African, Mediterranean, or Southeast Asian Heritage: Important Information about Diabetes Blood Tests" from NIDDK抯 National Diabetes Information Clearinghouse at www.diabetes.niddk.nih.gov.

Studies have repeatedly shown that intensive control of blood glucose, blood pressure, and cholesterol reduces heart disease and the other complications of diabetes. The hemoglobin A1c blood test (or simply the A1C test) is an essential tool in diabetes care because it shows a patient抯 average level of blood glucose control in the previous 2 to 3 months. Physicians base their treatment decisions in large part on the A1C test results. Inaccurate A1C readings, whether falsely high or low, may lead to the over treatment or under treatment of diabetes.

The A1C test, though essential in diabetes management, is not recommended for diagnosing diabetes. However, if an A1C test is given to a person not known to have diabetes and the result is higher than normal, a fasting blood glucose test is needed to confirm a diabetes diagnosis.

The National Glycohemoglobin Standardization Program (NGSP) at the University of Missouri School of Medicine, supported by the NIDDK and Centers for Disease Control and Prevention (CDC), is working to improve and standardize the measurement of A1C in laboratories around the world. The NGSP website (www.NGSP.org) lists the test methods that accurately measure A1C in patients with hemoglobin variant S, also known as sickle cell trait, and variant C, another common variant in the United States.

"In the United States, more than 3,000 labs rely on 20 different methods to measure A1C in people with diabetes," says Randie Little, Ph.D., who heads the NGSP. "However, six of these methods yield unreliable results in patients with sickle cell trait. Health care professionals caring for people with diabetes should know that specific A1C tests should be used in this group of patients."

Many individuals are unaware they have a hemoglobin variant such as sickle cell trait because the condition usually causes no symptoms. In diabetes patients of African, Mediterranean, or southeast Asian descent, several situations may suggest the presence of a hemoglobin variant:

• an A1C result does not correlate with results of self blood glucose monitoring
  
• an A1C result is different than expected or radically differs from a previous test result after a change in lab A1C methods
  
• an A1C result is more than 15 percent.

"If you see a significant discrepancy between a patient抯 A1C reading and the results of routine blood glucose monitoring, consider the possibility that your patient may have a hemoglobin variant and find out if your lab is using an accurate method to measure A1C," advises NIDDK Director Griffin P. Rodgers, M.D.

Hemoglobin is the oxygen-transporting protein in red blood cells. Mutations in the genes that code for the protein, which occur more frequently in people of African, Mediterranean, and southeast Asian descent, cause variations in the structure or amount of hemoglobin. Researchers have identified hundreds of hemoglobin variants in the human population, affecting millions of people worldwide.

The most common variant is sickle cell trait in which a person inherits a gene for hemoglobin S and a gene for hemoglobin A, the usual form of hemoglobin. Sickle cell trait affects about 8 percent of African Americans. Having sickle cell trait or another hemoglobin variant does not increase a person抯 risk for developing diabetes.

In sickle cell disease, a person inherits two genes for hemoglobin S, which causes the malformation, or sickling, of red blood cells, leading to anemia, repeated infections, and periodic episodes of pain. The A1C test is not used in diabetes patients with sickle cell anemia due to the shortened life span of red blood cells.

Diabetes afflicts nearly 21 million people in the United States, but its burden is disproportionately felt by minorities, including African Americans, Hispanic/Latino Americans, American Indians and Alaska Natives, Asian Americans, and Pacific Islanders. About 13 percent of African Americans age 20 and older suffer from diabetes, a rate that is nearly twice that of non-Hispanic whites.

The NIDDK conducts and supports research on diabetes; endocrine and metabolic diseases; digestive diseases, nutrition, and obesity; and kidney, urologic and hematologic diseases. Spanning the full spectrum of medicine and afflicting people of all ages and ethnic groups, these diseases encompass some of the most common, severe, and disabling conditions affecting Americans.

For information about the CDC, an agency of the U.S. Department of Health and Human Services, see www.cdc.gov.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

What are some common hemoglobin variants?

Most people have only one kind of hemoglobin called hemoglobin A. Some people have both hemoglobin A and another kind such as hemoglobin S, C, or E. These less common forms of hemoglobin are called hemoglobin variants. You can have a hemoglobin variant but not know it because you might not have any symptoms of blood disease. Having a variant without symptoms of the disease is also called having the trait or being a carrier.

Many people have heard of sickle cell trait, which occurs most often in people of African heritage. Again, having the trait means you inherited a gene for a hemoglobin variant from one parent. Genes carry information about which characteristics are passed down from parents to children. People with sickle cell trait usually have no symptoms. (Inheriting genes from both parents for the variant hemoglobin “S,” however, results in sickle cell disease, which is painful. You would know if you had sickle cell disease.)

People of Mediterranean or Southeast Asian heritage also can inherit hemoglobin variants. Some of these variants cause no symptoms; others cause some health problems. Variant hemoglobin does not increase your risk for diabetes.

What is the A1C test?

The A1C blood test, also called the hemoglobin A1C test or glycohemoglobin, provides information about your average blood glucose levels for the past 2 to 3 months. People with diabetes should have the A1C test at least twice a year. Your doctor uses the results of your A1C tests to see whether you need changes in your diabetes medicine, meal plan, or physical activity routine to keep your diabetes under control.

How do hemoglobin variants affect the A1C test and my diabetes ca

A variant form of hemoglobin in your blood can give you false A1C test results. If your test result is falsely high, your doctor might change your diabetes medicine or make other changes in how you take care of your diabetes. These changes could cause low blood glucose, or hypoglycemia. If your test result is falsely low, your doctor might make changes in your treatment that could cause your blood glucose to stay too high, increasing your risk for diabetes problems in your eyes, nerves, and kidneys. Not all A1C tests are affected by variant hemoglobin. Your doctor can take steps to make sure you get accurate results from your A1C test.

How will I know whether I have a hemoglobin variant?

Many people with hemoglobin variants have no symptoms. You might be at risk for having a hemoglobin variant if

• you are of African, Mediterranean, or Southeast Asian heritage


• members of your family have sickle cell trait or sickle cell anemia


• the results of your self blood glucose monitoring don’t match the results of your A1C test


• your A1C result is different than expected


• your A1C result is high—more than 15 percent


• your most recent A1C result is very different from your last A1C result

Laboratory tests can confirm whether you have a hemoglobin variant.

Where can my doctor find more information about hemoglobin varian

The fact sheet Sickle Cell Trait and Other Hemoglobinopathies and Diabetes: Important Information for Physicians provides information online at www.diabetes.niddk.nih.gov/dm/pubs/hemovari-A1C. Or your doctor can request a copy by calling the National Diabetes Information Clearinghouse at 1–800–860–8747.

How can I know if my diabetes is well-controlled if I have a hemo

Some A1C tests give accurate results in people with a hemoglobin variant. Your doctor can arrange for your A1C test to be done at a laboratory that gives accurate results for people with a hemoglobin variant. Your daily blood glucose tests can also show how well-controlled your diabetes is, but each blood glucose test gives information at only one point in time.

Points to Remember

If you are of African, Mediterranean, or Southeast Asian heritage, you are at risk for having a hemoglobin variant.

You can have a variant form of hemoglobin but not know it.

Hemoglobin variants don’t cause diabetes but they can affect diabetes test results.

If you have a variant form of hemoglobin, the results of your A1C test might not be accurate. The results might show that your average blood glucose level is higher or lower than the actual level.

Your doctor needs accurate results from your A1C test in order to plan how best to control your diabetes.

Your doctor can read more about hemoglobin variants and the A1C test in Sickle Cell Trait and Other Hemoglobinopathies and Diabetes: Important Information for Physicians, a fact sheet available from the National Diabetes Information Clearinghouse.

National Diabetes Information Clearinghouse

1 Information Way
Bethesda, MD 20892–3560
Phone: 1–800–860–8747
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: ndic@info.niddk.nih.gov
Internet: www.diabetes.niddk.nih.gov

The National Diabetes Information Clearinghouse (NDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1978, the Clearinghouse provides information about diabetes to people with diabetes and to their families, health care professionals, and the public. The NDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about diabetes.

Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This publication was reviewed by Randie R. Little, Ph.D., National Glycohemoglobin Standardization Program, University of Missouri School of Medicine.

This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired.

When to Suspect that a Patient with Diabetes Has a Hemoglobinopat

People who carry one gene for a hemoglobinopathy are often unaware. Several situations may indicate the presence of a hemoglobinopathy:

• when results of self-blood-glucose monitoring have a low correlation with A1C results


• when an A1C result is different than expected


• when an A1C result is more than 15 percent


• when a patient’s A1C test result is radically different from a previous test result following a change in laboratory A1C methods

Diagnosis of Hemoglobinopathies

Carrier state can easily be detected by hemoglobin electrophoresis. Most states now screen for common hemoglobin variants in newborns and report results. In addition, pre-pregnancy genetic testing and prenatal screening are done in some high-risk populations or in women with a family history of a variant. Screening may also be done in parents of children with identified variants and patients with red blood cell abnormalities, such as unexplained anemia.

Statistically speaking…

Hemoglobin S and C

African Americans have an increased risk of inheriting sickle cell trait, the condition in which people have both hemoglobin A (HbA), the usual form of hemoglobin, and hemoglobin S (HbS), a variant. They also are at risk for having hemoglobin C (HbC), another variant. About one in 12 African Americans has sickle cell trait. African Americans are nearly twice as likely to have diabetes as Caucasians of similar age. About 13 percent of African Americans aged 20 years or older have diabetes.¹ Therefore, many African Americans have both diabetes and sickle cell trait.

Hemoglobin E

People of Southeast Asian descent are at risk for having hemoglobin E (HbE), another hemoglobin variant. Prevalence of diabetes in Asian Americans varies among subpopulations. Studies have shown that some groups of Asian Americans in the United States are 1.5 to 2 times as likely to have diabetes as Caucasians of similar age.¹

¹ National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health (NIH). National diabetes statistics. Available at: www.diabetes.niddk.nih.gov/dm/pubs/statistics/index.htm. Posted November 2005. Accessed July 5, 2007.

The A1C Test

The American Diabetes Association (ADA) does not recommend use of the A1C test for diagnosis of diabetes. Instead, the fasting plasma glucose test should be used to diagnose diabetes in children and nonpregnant adults. The ADA recommends use of the A1C test as part of the initial assessment and in continuing care of people with diabetes. Physicians should perform the A1C test

• at least twice a year in patients who are meeting treatment goals and have stable glycemic control


• quarterly in patients not meeting treatment goals or when changes are made in therapy

In addition, point-of-care testing for A1C can help in making timely decisions about changes in therapy.

ADA Targets for the A1C Test

Group	Target
Patients in general	Less than 7 percent
Individual patients	As close to normal as possible—less than 6 percent—without significant hypoglycemia
Patients with a history of severe hypoglycemia, those with limited life expectancies, very young children, older adults, and patients with comorbid conditions	Less stringent goals

Effect of Hemoglobinopathies on A1C Test Results

With some assay methods, A1C tests in patients with hemoglobinopathies result in falsely high outcomes, overestimating actual average blood glucose levels for the previous 2 to 3 months. Physicians may then prescribe more aggressive treatments, resulting in increased episodes of hypoglycemia. Some assay methods used with some hemoglobinopathies may result in falsely low outcomes, leading to under-treatment of diabetes.

The A1C test is not recommended for diagnosis of diabetes in the general population because it is not sufficiently sensitive. Also important, in patients with hemoglobinopathies, results may be falsely elevated, so physicians may erroneously conclude a patient has diabetes. Confirmation with a fasting blood glucose is required for a diagnosis of diabetes to prevent inappropriate treatment decisions.

Technically speaking…

The A1C test measures the amount of glycated hemoglobin in the blood, which indicates average blood glucose levels over the preceding 2 to 3 months. Also called glycated hemoglobin or glycohemoglobin, the A1C test is based on the addition of glucose to hemoglobin over the typical 120-day life span of a red blood cell. Formation of glycated proteins is proportional to the concentration of glucose in the blood. The A1C test helps gauge risk of long-term complications; studies have demonstrated substantial reductions in long-term complications of diabetes with lowering of A1C.

Hemoglobinopathies

Hemoglobin molecules in red blood cells transport and distribute oxygen to cells throughout the body. Hemoglobin is composed of heme—the portion of the molecule containing iron—and globin—a protein made up of amino acid chains.

Hemoglobin variants occur when mutations in the globin genes result in changes in the amino acids of the globin protein. Hundreds of variants have been identified; a small number of variants are common and have clinical significance. Hemoglobin variants are inherited in an autosomal recessive manner.

Common Types of Hemoglobinopathies

Table 1 summarizes the affected populations, prevalence, and outcomes of common hemoglobinopathies. These hemoglobinopathies may either falsely raise or lower A1C results, depending on the variant and the assay method.

People who are heterozygous for a variant are said to have a trait or to be carriers and are usually asymptomatic. Those who are homozygous generally have a disease condition. Hemoglobin SC (HbSC) is a compound heterozygous condition, meaning that the patient has inherited genes for two variants: HbS from one parent and HbC from the other.

Table 1. Common Hemoglobinopathies: Populations Affected, Prevalence, and Outcomes

Hemoglobin (Hb) Variant	Populations Affected	Prevalence (in the United States unless otherwise noted)	Outcome with One Abnormal Gene and One Normal Gene (Heterozygous State)	Outcome with Two Abnormal Genes (Homozygous State)
Hemoglobin S (HbS)	African Americans Hispanic Americans/Latinos Also found in East India, the Mediterranean, and the Middle East	About one in 12 African Americans has sickle cell trait 1 About one in 100 Hispanic Americans/Latinos has sickle cell trait 2 Sickle cell anemia occurs in one of every 500 African American births 1 Sickle cell anemia occurs in one of every 1,000 to 1,400 Hispanic American/Latino births 1	Sickle cell trait (also called HbAS): usually asymptomatic	Sickle cell anemia (also called HbSS disease): sickled red blood cells that interfere with circulation and decrease life span of red blood cells; can result in hemolytic, splenic sequestration, and aplastic crises and multiple complications
Hemoglobin C (HbC)	African Americans People of West African descent	About 2.3% of African Americans have HbC trait 3	HbC trait (also called HbAC): asymptomatic	HbC disease (also called HbCC disease): mild hemolytic anemia, mild to moderate enlargement of the spleen
Hemoglobin E (HbE)	Asian Americans, especially those of Southeast Asian descent Common in Cambodia, Indonesia, Laos, Malaysia, Thailand, and Vietnam. Also seen in southern China, India, the Philippines, and Turkey	Prevalence of HbE may be 30% in Southeast Asia 3	HbE trait (also called HbAE): asymptomatic	HbE disease (also called HbEE disease): mild hemolytic anemia, microcytosis, and mild enlargement of the spleen
Hemoglobin SC (HbSC)	African Americans and people of West African descent Also found in East India, the Mediterranean, and the Middle East		N/A	HbSC disease (also called sickle-hemoglobin C disease): mild hemolytic anemia and moderate enlargement of the spleen; may have blocking of blood vessels as in sickle cell anemia but milder symptoms
Hemoglobin F (HbF) elevated	Occurs in patients with hereditary persistence of fetal hemoglobin, sickle cell anemia, severe anemias, leukemia, and other conditions	About 1.5% have more than 2% HbF but some groups may have concentrations as high as 12% 3	N/A	Those with elevated HbF and sickle cell anemia may have a milder form of sickle cell anemia

¹ National Heart, Lung, and Blood Institute, NIH. Sickle cell anemia. Available at: www.nhlbi.nih.gov/health/dci/Diseases/Sca/SCA_All.html. Posted May 2007. Accessed June 27, 2007.

² National Human Genome Research Institute, NIH. Learning about sickle cell disease. Available at: www.genome.gov/10001219. Posted February 2007. Accessed July 3, 2007.

³ Bry L, Chen PC, Sacks DB. Effects of hemoglobin variants and chemically modified derivatives on assays for glycohemoglobin. Clinical Chemistry. 2001;47(2):153–163.

Information about Assay Methods for Patients with Hemoglobinopath

The NGSP provides a table on the NGSP website at www.ngsp.org/prog/index2.html describing the effects of frequently encountered Hb variants and derivatives on glycohemoglobin measurement for more than 25 assay methods. The NGSP website also includes a list of references for the information summarized in the table.

According to the NGSP, as of July 2007, 14 percent of laboratories are using assay methods with clinically significant HbAS interference; 13 percent use methods with clinically significant HbAC interference. However, after upcoming changes in reagents expected to be complete by the end of 2008, only about 5 percent of laboratories will be using methods resulting in significant HbAS or HbAC interference.

Alternative Tests

Physicians may wish to consider using other measures of average blood glucose levels, such as the fructosamine test, also called glycated serum protein or glycated albumin, with patients who have hemoglobinopathies where an accurate A1C result cannot be obtained. Serum proteins show average glucose levels over a much shorter period of time than the A1C test, usually about 2 to 3 weeks. Moreover, the fructosamine test is not standardized and the relationship of results of this test to glucose levels or risk for complications has not been established.

Anticipated Changes in A1C Reporting

A plan is under way to change how A1C results are reported. Final details will be determined based on the results of a study in progress. Results may be provided in the following ways:

• with the current name and units—as a percentage


• with the current name and as mmol hemoglobin A1C/mole hemoglobin


• as A1C derived average glucose, also called ADAG, in mg/dL or mmol/L—if study results confirm acceptability of this option

Other Conditions that Can Affect A1C Test Results

A number of other conditions, such as those that reduce the life span of red blood cells, can affect A1C results. Recent acute blood loss or hemolytic anemia can falsely lower A1C results. Intake of large amounts of vitamin C or vitamin E can falsely lower or elevate results. Iron deficiency anemia can falsely elevate results.

Points to Remember

• 
  

  Hemoglobinopathies are inherited hemoglobin variants caused by globin gene mutations.



• 
  

  People of African, Mediterranean, or Southeast Asian descent are particularly at risk for having hemoglobin variants.



• 
  

  Hemoglobin variants may confound results of the A1C test, which indicates average blood glucose levels over the preceding 2 to 3 months.



• 
  

  False A1C test results can lead to false diagnosis or over-treatment or under-treatment of diabetes in people with hemoglobinopathies.



• 
  

  Information to assist in selecting the best assay methods is available from the National Glycohemoglobin Standardization Program (NGSP).



• 
  

  The most common hemoglobin variants include hemoglobin S, C, and E.



• 
  

  People who are homozygous for a hemoglobin variant may have a disease condition—for example, those who are homozygous for the hemoglobin S variant have sickle cell anemia. Those who are heterozygous for a variant are said to have a trait or to be carriers and are usually asymptomatic.



• 
  

  A booklet for people with diabetes about hemoglobin variants and the A1C test, For People of African, Mediterranean, or Southeast Asian Heritage: Important Information about Diabetes Blood Tests, is available from the National Diabetes Information Clearinghouse or online at www.diabetes.niddk.nih.gov/dm/pubs/traitA1C.

The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory

The Diabetes Epidemic Among African Americans

WHAT IS DIABETES?
?  Diabetes is a group of diseases marked by high levels of blood glucose resulting from defects in
insulin production, insulin action, or both. Diabetes can lead to serious complications and premature
death, but people with diabetes can take steps to control the disease and lower the risk of
complications.
?  Diabetes is one of the leading causes of death and disability in the United States. Total health care and
related costs for the treatment of diabetes run about $174 billion annually. 
 
WHAT ARE THE DIFFERENT TYPES OF DIABETES?
?  Type 1 diabetes (formerly called juvenile diabetes) results when the body’s immune system attacks
and destroys its own insulin-producing beta cells in the pancreas. People with type 1 diabetes must
have insulin delivered by injection or a pump. Symptoms of type 1 diabetes – increased thirst and
urination, constant hunger, weight loss, blurred vision, and extreme fatigue – usually develop over a
short period of time. If type 1 diabetes is not diagnosed and treated, a person can lapse into a life-
threatening coma.
 
?  Type 1 diabetes accounts for 5 to 10 percent of all diagnosed cases of diabetes. 
 
?  Type 2 diabetes (formerly called adult-onset diabetes) occurs when the body does not make enough
insulin or cannot use the insulin it makes effectively. This form of diabetes usually develops in adults
over the age of 40 but is becoming more prevalent in younger age groups – including children and
adolescents. The symptoms of type 2 diabetes – feeling tired or ill, unusual thirst, frequent urination
(especially at night), weight loss, blurred vision, frequent infections, and slow-healing wounds – may
develop gradually and may not be as noticeable as in type 1 diabetes. Some people have no
symptoms. 
 
?  Type 2 diabetes accounts for about 90 to 95 percent of all diagnosed cases of diabetes.   
 
?  A person is more likely to develop type 2 diabetes if they:
o  have a family history of diabetes 
o  are a member of an ethnic group like African Americans 
o  are overweight or obese 
o  are 45 year old or older 
o  had diabetes while pregnant (gestational diabetes) 
o  have high blood pressure 
o  have abnormal cholesterol (lipid) levels 
o  are not getting enough physical activity
o  have polycystic ovary syndrome (PCOS) 
o  have blood vessel problems affecting the heart, brain or legs
o  have dark, thick and velvety patches of skin around the neck and armpits (This is called
acanthosis nigricans, A-can-THO-sis NI-gri-cans.)
 
?  Gestational diabetes develops during pregnancy. Women who have had gestational diabetes have a
40 to 60 percent chance of developing diabetes, mostly type 2, in the next five to 10 years. 
 
HOW MANY AFRICAN AMERICANS HAVE DIABETES?
?  3.7 million; 14.7 percent of all non-Hispanic blacks ages twenty and older have diagnosed and
undiagnosed diabetes
?  11.8 percent had diagnosed diabetes according to age adjusted 2004-2006 national survey data 
 

WHAT IS THE LINK BETWEEN CARDIOVASCULAR DISEASE AND DIABETES?
?  Cardiovascular disease is the leading cause of death for people with diabetes – about 68 percent die of
heart disease or stroke.
?  Adults with diabetes have heart disease death rates about two to four times higher than adults without
diabetes.
?  The risk for stoke is two to four times higher among people with diabetes.
?  About 75 percent of adults with diabetes also have high blood pressure.
?  Smoking doubles the risk for heart disease in people with diabetes.
 
WHAT CAN AFRICAN AMERICANS DO TO PREVENT HEART DISEASE OR STROKE AND
OTHER DIABETES COMPLICATIONS?
?  Diabetes is a self-managed disease. People with diabetes must take responsibility for their day-to-day
care. The chances of having diabetes complications can be reduced or delayed significantly by
keeping blood glucose (blood sugar), blood pressure, and cholesterol levels (called the ABCs of
Diabetes) in the target range. 
?  The National Diabetes Education Program recommends the following targets for reducing the risk of
heart disease and stroke for people with diabetes: 
 
A1C (Blood Glucose)  Blood Pressure  Cholesterol (LDL)
Less than 7 percent  Less than 130/80 mmHg  Less than 100 mg/dl
(check at least twice a year)  (check every doctor’s visit)  (check once a year)
  
?  People with diabetes can manage their disease by eating healthy foods, being physically active, taking
diabetes medicine as prescribed, and testing blood glucose levels.
?  Community education and support programs can help people with diabetes and their families to
manage their diabetes.
 
CAN TYPE 2 DIABETES BE PREVENTED?
?  YES! The Diabetes Prevention Program (DPP), an important trial sponsored by the National Institutes
of Health, showed that type 2 diabetes can be delayed or prevented in overweight adults with pre-
diabetes, including African Americans. Pre-diabetes is a condition where blood glucose levels are
higher than normal, but not yet high enough for a diagnosis of diabetes. 
?  Risk factors for pre-diabetes are the same as those listed for type 2 diabetes.
?  To prevent diabetes, the people who participated in the DPP study:
 
?  Lost 5 to 7 percent of their body weight (that is 10 to 14 pounds for a person who weighs 200
pounds).
?  Were physically active for 30 minutes a day, 5 days a week. Most participants chose brisk walking.
?  Made healthier food choices and limited the amount of calories and fat in their diet.
 
WHERE CAN I GO FOR MORE INFORMATION?
For more information about preventing and controlling diabetes, call 1-888-693-NDEP (6337) or visit the
National Diabetes Education Program website at www.YourDiabetesInfo.org.

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Points to Remember

• Diabetic neuropathies are nerve disorders caused by many of the abnormalities common to diabetes,such as high blood glucose.
• Neuropathy can affect nerves throughout the body,causing numbness and sometimes pain in the hands,arms,feet, or legs,and problems with the digestive tract,heart,sex organs,and other body systems.
• Treatment first involves bringing blood glucose levels within the normal range.Good blood glucose control may help prevent or delay the onset of further problems.
• Foot care is an important part of treatment.People with neuropathy need to inspect their feet daily for any injuries.Untreated injuries increase the risk of infected the risk of infected foot sores and amputation.
• Treatment also includes pain relief and other medications as needed,depending on the type of nerve damage.
• Smoking signigicantly increases the risk of foot problems and amputation.If you smoke,ask your health care provider for help with quitting.

How are diabetic neuropathies treated?-2

Gastroinestinal Problems
To relieve mild symptoms of gastroparesis-indigestion,belching,nausea,or vomiting-doctors suggest eating small,frequent meals;avoiding fats;and eating less fiber.When symptoms are severe, doctors may prescribe erythromycin to speed digestion, metoclopramide to speed digestion and help relieve nausea,or other medications to help regulate digestion or reduce stomach acid secretion.
To relieve diarrhea or other bowel problems,doctors may prescribe an antibiotic such as tetracycline, or other medications as appropriate.
Dizziness and Weakness
Sitting or standing slowly may help prevent the light-headedness,dizziness,or fainting associated with blood pressure and circulation problems.Raising the head of the bed or wearing elastic stockings may also help.Some people benefit from increased salt in the diet and treatment with salt-retaining hormones.Others benefit from high blood pressure medications.Physical therapy can help when muscle weakness or loss of coordination is a problem.
Urinary and Sexual Problems
To clear up a urinary tract infection,the doctor will probably prescribe an antibiotic.Drinking plenty of fluids will help prevent another infection.People who have incontinence should try to urinate at regular intervals-every 3 hours,for example-since they may not be able to tell when the bladder is full.
To treat erectile dysfunction in men,the doctor will first do tests to rule out a hormonal cause.Several methods are available to treat erectile dysfunction caused by neuropathy.Medicines are available to help men have and maintain erections by increasing bliid flow to the penis.Some are oral medications and others are injected into the penis or inserted into the urethra at the tip of the penis.Mechanical vacuum devices can also increase blood flow to the penis.Another option is to surgically implant an inflatable or semirigid device in the penis.
Vaginal lubricants may be useful for women when neuropathy causes vaginal dryness.To treat problems with arousal and orgasm,the doctor may refer women to a gynecologist.
Foot Care
People with neuropathy need to take special care of their feet.The nerves to the feet are the longest in the body and are the ones most often affected by neuropathy.Loss of sensation in the feet means that sores or injuries may not be noticed and may become ulcerated or infected.Circulation problems also increase the risk of foot ulcers.
More than half of all lower-limb amputations in the United States occur in people with diabetes-86,000 amputations per year.Doctors estimate that nearly half of the amputations caused by neuropathy and poor circulation could have been prevented by careful foot care.
Follow these steps to take care of your feet:

• Clean your feet daily,using warm-not hot-water and a mild soap.Avoid soaking your feet.Dry them with a soft towel and dry carefully between your toes.
• Inspect your feet and toes every day for cuts,blisters,redness,swelling,calluses,or other problems.Use a mirror-laying a mirror on the floor works well-or get help from someone else if you cannot see the bottoms of your feet. Notify your health care provider of any problems.
• Moisturize your feet with lotion,but avoid getting the lotion between your toes.
• After a bath or shower,file corns and calluses gently with a pumice stone.
• Each week or when needed,cut your toenails to the shape of your toes and file the edges with an emery board.
• Always wear shoes or slippers to protect your feet from injuries.Prevent skin irritation by wearing thick,soft,seamless socks.
• Wear shoes thar fit well and allow your toes to move.Break in new shoes gradually by first wearing them for only an hour at a time.
• Before putting your shoes on,look them over carefully and feel the insides with your hand to make sure they have no tears,sharp edges,or objects in them that might injure your feet.
• If you need help taking care of your feet,make an appointment to see a foot doctor,also called a podiatrist.

How are diabetic neuropathies treated?--1

The first treatment step is to bring blood glucose levels within the normal range to help prevent further nerve damage.Blood glucose monitoring,meal panning,physical activity,and diabetes medicines or insulin will help control blood glucose levels.Symptoms may get worse when blood glucose is first brought under control,but over time, mainteaining lower blood glucose levels helps lessen symptoms.Good blood glucose control may also help prevent or delay the onset of further problems.As scientists learn more about the underlying causes of neuropathy,new treatments may become abailable to help slow,prevent,or even reverse nerve damage.
As described in the following sections,additional treatment depends on the type of nerve problem and symptom.If you have problems with your feet,your doctor may refer you to a foot care specialist.
Pain Relief
Doctors usually treat painful diabetic neuropathy with oral medications,although other types of treatments may help some people.People with severe nerve pain may benefit from a combination of medications or treatments.Talk with your health care provider about options for treating your neuropathy.
Medications used to help relieve diabetic nerve pain include:

• tricyclic antidepressants,such as amitriptyline,imipramine,and desipramine(Norpramine,Pertofrane)
• other types of antidepressants,such as duloxetine(Cymbalta),venlafaxine,bupropion(Wellbutrin),paroxetine(Paxil),and citalopram(Celexa)
• anticonvulsants,such as pregabalin(Lyrica),gabapentin(Gabarone,Neurontin),carbamazepine,and lamotrigine(Lamictal)
• opioids and opioid-like drugs,such as controlled-release oxycodone,an opioid;and tramadol(Ultram),an opioid that also acts as an antidepressant

Duloxetine and pregabalin are approved by the U.S. Food and Drug Administration specifically for treating painful diabetic peripheral neuropathy.

You do not have to be depressed for an antidepressant to help relieve your nerve pain.All medications have side effects,and some are not recommended for use in older adults or those with heart disease.Because over-the-counter pain medicines such as acetaminophen and ibuprofen may not work well for treating most nerve pain and can have serious side effects,some experts recommend avoiding these medications.

Treatments that are applied to the skin-typically to the feet-include capsaicin cream and lidocaine patches (Lidoderm,Lidopain).Studies suggest that nitrate sprays or patches for the feet may relieve pain.Studies of alpha-lipoic acid,an antioxidant,and evening primrose oil have shown that they can help relieve symptoms and may improve nerve function.

A device called a bed cradle can keep sheets and blankets from touching sensitive feet and legs.Acupuncture,biofeedback,or physical therapy may help relieve pain in some people.Treatments that involve electrical nerve stimulation,magnetic therapy,and laser or light therapy may be helpful but need further study.Researchers are also studying several new therapies in clinical trials.

How are diabetic neuropathies diagnosed?

Doctors diagnose neuropathy on the basis of symptoms and a physical exam,During the exam,your doctor may check blood pressure ,heart rate,muscle strength,reflexes,and sensitivity to position changes,vibration,temperature,or light touch.
Foot Exams
Experts recommend that people with diabetes have a comprehensive foot exam each year to check for peripheral neuropathy.People diagnosed with peripheral neuropathy need more frequent foot exams.A comprehensive foot exam assesses the skin.
mmuscles,bones,circulation,and sensation of the feet.Your doctor may assess protective sensation or feeling in your feet by touching your foot with a nylon monofilament--similar to a bristle on a hairbrush--attached to a wand or by pricking your foot with a pin.People who cannot sense pressure from a pinprick or monofilament have lost protective sensation and are at risk for developing foot sores that may not heal properly.The doctor may also check temperature perception or use a tuning fork,which is more sensitive than touch pressure, to assess vibration perception.
Other Tests
The doctor may perform other tests as part of your diagnosis.

• Nerve conduction studies or electromyography are sometimes used to help determine the type and extent of nerve damage.Nerve conduction studies check the transmission of electrical current through a nerve.
• Electromyography shows how well muscles respond to electrical signals transmitted by nearby nerves.These tests are rarely needed to diagnose neuropathy.
• A check of heart rate variability shows how the heart responds to deep breathing and to changes in blood pressure and posture.
• Ultrasound uses sound waves to produce an image of internal organs.An ultrasound of the bladder and other parts of the urinary tract,for example,can show how these organs preserve a normal structure and whether the bladder empties completely after urination.

How can I prevent diabetic neuropathies?

The best way to prevent neuropathy is to keep your blood glucose levels as close to the normal range as possible.Maintaining safe blood glucose levels protects nerves throughout your body.

What is focal neuropathy?

Focal neuropathy appears suddenly and affects specific nerves,most often in the head,torso,or leg.Focal neuropathy may cause

• inability to focus the eye
• double vision
• aching behind one eye
• paralysis on one side of the face,called Bell's palsy
• severe pain in the lower back or pelvis
• pain in the chest,stomach,or side
• pain on the outside of the shin or inside of the foot
• chest or abdominal pain that is sometimes mistaken for heart disease,a heart attack,or appendicitis

Focal neuropathy is painful and unpredictable and occurs most often in older adults with diabetes.However,it tends to improve by itself over weeks or months and does not cause long-term damage.

People with diabetes also tend to develop nerve compressions, also called entrapment syndromes.One of the most common is carpal tunnel syndrome,which causes numbness and tingling of the hand and sometimes muscle weakness or pain.Other nerves susceptible to entrapment may cause pain on the outside of the shin or the inside of the foot.

What is proximal neuropathy?

Proximal neuropathy,sometimes called lumbosacral plexus neuropathy,femoral neuropathy,or diabetic amyotrophy,starts with pain in the thighs,hips,buttocks,or legs,usually on one side of the body.This type of neuropathy is more common in those with type 2 diabetes and in older adults with diabetes.Proximal neuropathy causes weakness in the legs and the inability to go from a sitting to a standing position without help.Treatment for weakness or pain is usually needed.The length of the recovery period varies,depending on the type of nerve damage.

What is autonomic neuropathy?

Hypoglycemia Unawareness
Normally,symptoms such as shakiness,sweating,and palpitations occur when blood glucose levels drop below 70 mg/dL.In people with autonomic neuropathy,symptoms may not occur,making hypoglycemia difficult to recognize.Problems other than neuropathy can also cause hypoglycemia unawareness.For more information about hypoglycemia,see the fact sheet.
Heart and Blood Vessels
The heart and blood vessels are part of the cardiobascular system,which controls blood circulation.Damage to nerves in the cardiovascular system interferes with the body's ability to adjust blood pressure and heart rate.As a result,blood pressure may drop sharply after sitting or standing,causing a person to feel light-headed or even to faint.Damage to the nerves that control heart rate can mean that your heart rate stays high,instead of rising and falling in response to normal body functions and physical activity.
Digestive System
Nerve damage to the digestive system most commonly causes constipation.Damage can also cause the stomach to empty too slowly, a condition called gastroparesis.Severe gastroparesis can lesd to persistent nausea and vomiting, bloating,and loss of appetite.Gastroparesis can also make blood glucose levels fluctuate widely,due to abnormal food digestion.
Nerve damage to the esophagus may make swallowing difficult,while nerve damage to the bowels can cause constipation alternating with frequent,uncontrolled diarrhea,especially at night.Proplems with the digestive system can lead to weight loss.
Urinary Tract and Sex Organs
Autonomic neuropathy often affects the organs that control urination and sexual function.Nerve damage can prevent the bladder from emptying completely,allowing bacteria to grow in the bladder and kidneys and causing urinary tract infections.When the nerves of the bladder are damaged,urinary incontinence may result because a person may not be able to sense when the bladder if full or control the muscles that release urine.
Autonomic neutopathy can also gradually decrease sexual response in men and women,although the sex drive may be unchanged.A man may be unable to have erections or may reach sexual climax without ejaculating normally.A woman may have difficulay with arousal,lubrication,or orgasm.
Sweat Glands
Autonamic neuropathy can affect the nerves that control sweating.When nerve damage prevents the sweat glands from working properly, the body cannot regulate its temperature as it should.Nerve damage can also cause profuse sweating at night or while eating.
Eyes
Finally,autonomic neuropathy can affect the pupils of the eyes,making them less responsive to changes in light. As a result, a person may not be able to see well when a light is turned on in a dark room or may have trouble driving ar night.

What is autonomic neuropathy?

Autonomic neuropathy affects the nerves that control the heart,regulate blood pressure,and control blood glucose levels.Autonomic neuropathy also affects other internal organs,causing problems with digestion,respiratory function,urination,sexual response,and vision.In addition,the system that restores blood glucose levels to normal after a hypoglycemic episode may be affected,resulting in loss of the warning symptoms of hypoglycemia.

Autonomic neuropathy affects the nerves in your heart,stomach,intestines,bladder,sex organs,sweat glands,eyes,and lungs.

What is peripheral neuropathy?

Peripheral neuropathy,also called distal symmetric neuropathy or sensorimotor neuropathy,is nerve damage in the arms and legs.Your feet and legs are likely to be affected before your hands and arms.Many people with diabetes have signs of neuropathy that a doctor could note but feel no symptoms themselves.Symptoms of peripheral neuropathy may include:

• numbness or insensitivity to pain or temperature



• a tingling,burning,or prickling sensation



• sharp pains or cramps



• extreme sensitivity to touch,even light touch



• loss of balance and coordination

These symptoms are often worse at night.

Peripheral neuropathy may also cause muscle weakness and loss of reflexes,especially at the ankle,leading to changes in the way a person walks.Foot deformities,such as hammertoes and the collapse of the midfoot,may occur.Blisters and sores may appear on numb areas of the foot because pressure or injury goes unnoticed.If foot injuries are not treated promptly,the infection may spread to the bone,and the foot may then have to be amputated.Some experts estimate that half of all such amputations are preventable if minor problems are caught and treated in time.

Neuropathy Affects Nerves Throughout the Body

Peripheral neuropathy affects

• toes
• feet
• legs
• hands
• arms

Autonomic neuropathy affects

• heart and blood vessels
• digestive system
• urinary tract
• sex organs
• sweat glands
• eyes
• lungs

Proximal neuropathy affects

• thighs
• hips
• buttocks
• legs

Focal neuropathy affects

• eyes
• facial muscles
• ears
• pelvis and lower back
• chest
• abdomen
• thighs
• legs
• feet

What are the types of diabetic neuropathy?

Diabetic neuropathy can be classified as peripheral,autonomic,proximal,or focal.Each affects different parts of the body in various ways.

• Peripheral neuropathy,the most common type of diabetic neuropathy,causes pain or loss of feeling in the toes,feet,legs,hands,and arms.
• Autonomic neuropathy causes changes in digestion,bowel and vladder function,sexual response,and perspiration.It can also affect the nerves that serve the heart and control blood pressure, as well as nerves in the lungs and eyes.Autonomic neuropathy can also cause hypoglycemia unawareness, a condition in which people no longer experience the warning symptoms of low blood glucose levels.
• Proximal neuropathy causes pain in the thighs,hips,or buttocks and leads to weakness in the legs.
• Focal neuropathy results in the sudden weakness of one nerve or a group of nerves,causing muscle weakness or pain.Any nerve in the body can be affected.

What are the symptoms of diabetic neuropathies?

Symptoms depend on the type of neuropathy and which nerves are affected.Some people with nerve damage have no symptoms at all.For others, the first symptom is often numbness,tingling,or pain in the feet.Symptoms are often minor at first,and because most nerve damage occurs over several years,mild cases may go unnoticed for a long time.Symptoms can involve the sensory,motor,and autonomic-or nivoluntary-nervous systems.
in some people,mainly those with focal neuropathy,the onset of pain may be sudden and severe.
Symptoms of nerve damage may include:

• numbness,tingling,or pain in the toes,feet,legs,hands,arms,and fingers
• wasting of the muscles of the feet or hands
• indigestion,nausea,or vomiting
• diarrhea or constipation
• dizziness or faintness due to a drop in bliid pressure after standing or sitting up
• problems with urination
• erectile dysfunction in men or vaginal dryness in women
• weakness

Symptoms that are not due to neuropathy,but often accompany it,include weght loss and depression.

What causes diabetic neuropathies?

The causes are probaly different for different types of diabetic neuropathy.Researchers are studying how prolonged exposure to high blood glucose causes nerve damage. Nerve damage if likely due to a combination of factors:

• metabolic factors,such as high blood glucose,long duration of diabetes,abnormal blood fat levels,and possibly low levels of insulin
• neurovascular factors,that cause inflammation in nerves
• mechanicalinjury to nerves,such as carpal tunnel syndrome
• inherited traits that increase susceptibility to nerve disease
• lifestyle factors,such as smoking or alcohol use

What are diabetic neuropathies?

Diabetic neuropathies are a family of nerve disorders caused by diabetes.People with diabetes can,over time,develop nerve damage throughout the body.Some people with nerve damage have no symptoms.Others may have symptoms such as pain,tingling,or numbness---loss of feeling---in the hands,arms,feet,and legs.Nerve problems can occur in every organ system,including the digestive tract,heart,and sex organs.
About 60 to 70 percent of people with diabets have some form of neuropathy. People with diabetes can develop nerve problems at any time, but risk rises with age and longer duration of diabets.The highest rates of neuropathy are among people who have had diabetes for at least 25 years.Diabetic neuropathies also appear to be more common in people who have problems controlling their blood glucose,also called blood sugar,as well as those with high levels of blood fat and blood pressure and those who are overweight.

Gene Therapy Improves Diabetic Neuropathy in Study

WEDNESDAY,April 29 (HealthDay News)--Gene therapy shows promise in treating diabetic polyneuropathy,a disorder that commonly affects diabetics who've had the disease for many years,a new study finds.
Researchers in Boston found that intramuscular injection of vascular endothelial growth factor (VEGF)gene may help patients with diabetic polyneuropathy.The study included 39 patients who received three sets of injections of VEGF gene in one leg and 11 patients who received a placebo.
Six months after treatment,the patients who received the VEGF gene injections showed greater improvements in sensory symptoms and pain than those who received the placebo.
Loss of sensation and pain in the legs and feet,weakness,and balance problems are among the symptoms associated with diabetic neuropathy.The loss of sensation means that ulcerations on the feet may go undetected, which can lead to ampuation.
"Most patients had fairly severe neuropathy,and the expectation for improvement was therefore not high,"Dr.Allan Ropper,executive vice chair of the neurology department at Brigham and Women's Hospital in Boston,said in a hospital news release.
"The VEGF gene used in the study in active without packaging it in a virus,which is a major safety advantage,according to the researchers."
"The study shows that this form of gene transfer therapy can be performed relatively safely,but further investigation using a larger study group is needed before it can be introduced as a mainstream therapy,"Ropper said.
The study was presented in Seattle at the annual meeting of the American Academy of Neurology.

Diabtes --------Begining

Carrot cake study on sugar in type 2 diabetes-(2)

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Professor Gary Frost,who led the study,explained in this study,the energy intake of these patients was spread evenly over a day.Correspondingly,they did not gain weight of show an increase in blood glucose levels at the end of the study;in addition,their cholesterol levels and insulin sensitivity did not change.He added the results of this small,short-term study support other scientific studies,which suggest that there could be more flexibility with sucrose in the diets of patients with type 2 diabetes.There is evidence from other studies(reviewed by Kirk et al 2000)that inclusion of sucrose may help people to lower their fat intake,which in turn may be beneficial to overall health.

Professor Frost continued this research is in line with the dietary guidelines set by the American Diabetes Association(2007),which state that sucrose does not cause a greater increase in blood glucose levels than an equivalent amount of starch.Therefore sucrose of sucrose-containing foods should be treated similarly to other carbohydrate containing foods by people with diabetes;either substituted for other carbohydrates in the total daily intake,or managed with appropriate diabetes medication.

Carrot cake study on sugar in type 2 diabetes-(1)

New study adds to new thinking on sugar in the diabetes diet Patients with type 2 diabetes are often advised to cut out sucrose (table sugar) all together.However,in recent years this traditional advice has been questioned by some researchers who suggest that moderate amounts of sugar can be safely consumed as part of the diet of patients with diabetes.Now a new study has been published that is consistent with this revised approach.It showed that patients who increased their daily sugar intake(in the form of carrot cake) but maintained a stable body weight,showed no adverse changes in their blood glucose.

The study was conducted by the Department of Nutrition and Dietetics at London'sHammersmith Hospital.There slices of carrot cake were added to the daily diets of nice,overweight type 2 diabetes patients over 24 days (bringing their daily total to 88g or 18 teaspoons of sugar).Consumption of the carrot cake slices was evenly distributed across the day.Several measurements were recorded at the beginning and end of the study,including the patients'weight,blood sugar(glucose) levels,cholesterol levels,and insulin sensitivity(which is a measure of how well the body responds to the hormone insulin).

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Diabetes：Functional Waning of Naturally Occurring CD4+ Regulatory T-Cells Contributes to the Onset of Autoimmune Diabetes

Key Words:APC,antigen-presenting cell-CFSE,carboxyfluorescein succinimidylester-FACS,fluorescence-activated cell sorter-HBSS,Hanks'balanced salt solution-H-E,hematoxylin-eosin-IL,interleukin-IPEX,immune dysregulation, polyendocrinopathy,enteropathy,and X-linked inheritance-MAB,monoclonal antibody-nTreg,naturally occurring Foxp3+CD4+ regulatory T-cells-pancLN,pancreatic lymph node-Teff cell,effector T-cell ,tumor necrosis factor-a

OBJECTIVE-In this study,we asked whether a possible quantitative or qualitative deficiency in naturally occurring Foxp3+CD4+ regulatory T-cells (nTreg),which display potent inhibitory effects on T-cell functions in vitro and in vivo,may predispose to the development of type 1 diabetes.

RESEARCH DESIGN AND METHODS-We assessed the frequency and function of Foxp3+ nTreg cells in primary and secondary lymphoid tissues in the NOD animal model of type 1 diabetes.

RESULTS-We show that the cellular frequency of Foxp3+nTreg cellsin primary and secondary lymphoid tissues is stable and does not decline relative to type 1 diabetes-resistant mice.We show that thymic and peripheral CD4+CD25+ T-cells are fully functional in vivo.We also examined the functional impact of CD4+Foxp3+ nTreg cells on the development of autoimmune diabetes,and we demonstrate that nTreg cells do not affect the initial priming or expansion of antigen-specific diabetogenic T-cells but impact their differentiation in pancreatic lymph nodes.

Mreover,CD4_Foxp3+ nTreg cells also regulate later events of diabetogenesis by preferentially localizing in the pancreatic environment where they suppress the accumulation and function of effector T-cells.Finally,we show that the nTreg cell functional potency and intra-pancreatic proliferative potential delines with age,in turn augmenting diabetogenic responses and disease susceptibility.

CONCLUSIONS-This study demonstrates that Foxp3-expressing nTreg cells in NOD mice regulate diabetogenesis,but temporal altetations in nTreg cell function promote immune dysregulation and the onset of spointaneous autoimmunity.

Articleβ Cells Can Be Generated from Endogenous Progenitors in Injured Adult Mouse Pancreas

Novel strategies in diabetes therapy would obviously benefit from the use of beta(B) cell stem/progenitor cells.However,whether or not adult B cell progenitors exist if one of the most controversial issues in today's diabetes research.Guided by the expression of Neurogenin 3(Ngn 3),the earliest islet cell-specific transcription factor in embryonic development, we show that B cell progenitors can be activated in injured adult mouse pancreas and are located in the ductal lining.Differentiation of the adult progenitors if Ngn 3 dependent and gives rise to all isget cell types,including glucose responsiveB cells that subsequently proliferate,both in situ and when cultured in embryonic pancreas explants.Multipotent progenitor cells thus exist in the pancreas of adult mice and can be activated cell autonomously to increase the funtional B cell madd by differentiation and proliferation rather than by self-duplication of pre-existing B cells only.

Ablation of CD11c-Positive Cells Normalizes Insulin Sensitivity in Obese Insulin Resistant Animals

Obese adipose tissue is characterized by infiltration of macrophages.We and others recently showed that a specific subset of macrophages is recruited to obese adipose and muscle tissue.This subset expresses CD11c and produces high levels of proinflammatory cytokines that are linked to the development of obesity-associated insulin resistance.Here,we used a conditional cell ablation system,based on transgenic expression of the diphtheria toxin receptor under the control of the CD11c promoter,to study the effects of depletion of CD11c+ cells in obese mouse models.Our results show that CD11c+ cell depletion results in rapid normalization of insulin sensitivity.Futhermore,CD11c+ cell ablation leads to a marked decrease in inflammatory markers,both lacally and systemically,as reflected by gene expression and protein levels.Together,these results indicate that these CD11c+ cells are a potential therapeutic target for treatment of obesity-related insulin resistance and type II diabetes.

Deficiency of a -arrestin-2 signal complex contributes to insulin resistance

Insulin resistance, a hallmark of type 2 diabetes,is a defect of insulin in stimulating insulin receptor signalling 1,2,which has become one of the most serous pubkic health threats.Upon stimulation by insulin,insulin receptor recruits and phosphorylates insulin receptor substrate proteins 3,leading to activation of the phosphatedylinositol-3-OH kinase (PI(3)K)-Akt pathway.Activated Akt phosphorylates downstream kinases and transcription factors,thus mediating most of the metavolic actions of insulin 4,5,6.B-arrestins mediate biological funcions of G-protein-coupled receptors by linking activated receptors with distinct sets of accessoty and effecter proteins,thereby determining the specificity,efficiency and capacity of signals 7,8,9,10,11.Here we show that in diabetic mouse models,B-arrestin-2 is severely downregulated.Knockdown of B-arrestin-2 exacebates insulin resistance,whereas administration of b-arrestin-2 restores insulin sensitivity in mice.Further investigation reveals that insulin stimulates the formation of a new B-arrestin-2 signal complex,in which b-arrestin-2 scaffolds Akt and Src to insulin receptor.Loss or dysfunction of B-arrestin-2 results in deficiency of this signal complex and disturbance of insulin signalling in vivo,thereby contributing to the development of insulin resistance and progression of type 2 diabetes.Our findings provide new insight into the molecular pathogenesis of insulin resistance, and implicate new preventive and therapeutic strategies against insulin resistance and type 2 diabetes.

Common Variants of Hepatocyte Nuclear Factor 1B are Associated with Type 2 Diabetes in a Chinese Population

Department of Endocrinology and Metabolism, Jiao Tong University Affiliated sixth people's Hospital,shanghai diabetes institute,shanghai clinical center for diabetes.
Objective:Hepatocyte nuclear factor 1B(HNF 1B)is a transcription factor that is critical for pancreatic cell formation and glucose homeostasis.Previous studies have reported that common variants of HNF 1B were associated with type 2 diabetes in Caucasians and West Africans.However analysis in the subjects from the Botnia study and Malm?Preventive Project produced a conflicting result and the role for HNF 1B in type 2 diabetes susceptibility has remained unclear.We therefore investigated common variants across the HNF 1B gene in achinese population.
Research Design and Methods:Fifteen tagging SNPs were analyzed for association with type 2 diabetes in subjects with type 2 diabetes (n=1,859) and normal glucose regulation(n=1,785).
Results:Consistent with the initial study,we observed evidence that the risk G allele of rs4430796 in intron 2 was significantly associated with type 2 diabetes (odds ratia [OR] 1.16 [95 CI% 1.05 - 1.29],P=0.0035,empirical p=0.0475).
Furthermore,the at-risk G allele was associated with earlier age at diagnosis in the type 2 diabetic subjects(P=0.0228).
Conclusions:The result of this study provides evidence that variants in the HNF 1B region contribute to suscepribility to type 2 diabetes in the chinese population.

the Diabetes war

Come on!You will win in this Diabetes war.

Come on!You will win in this Diabetes war.

Come on!You will win in this Diabetes War.

Diabetes War

Come on!You will win in this Diabetes war.

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