Most of us with type 2 diabetes realize that our relatives are increased risk compared with the general population. And, knowing how inconvenient it is to have diabetes, we would like to help ensure that our relatives don’t get this disease.
How best can we do this?
The earlier people are diagnosed with type 2 diabetes, the greater the probability that they will be able to reverse the condition. Even better is when a person is diagnosed with prediabetes, before too many beta cells (the cells in the pancreas that produce insulin) have been destroyed.
So one thing relatives could do would be to insist on an annual blood glucose (BG) test by their physician. The problem with this approach is that in early stages of type 2 diabetes, your fasting levels often remain in the normal range but your postprandial (after eating) levels are higher than normal, and standard lab tests usually measure fasting BG.
A way to get around this is to have relatives occasionally test with a home meter after meals. I think a family tradition of testing after Thanksgiving dinner would make sense. But most people don’t like to prick their fingers when it’s not necessary. And one woman said to me, “Why worry about a disease you may never get?”
Now there’s a suggestion that a simple saliva test may predict the risk of type 2 diabetes. This study was done in non-Caucasians: South Asians, Filipinos, and Arabs, but there’s no reason to assume the results would be different in other ethnic groups.
The compound they were measuring is 1,5-anhydroglucitol, which is also the basis of the Glycomark test for short-term glucose control and glycemic variability described by Health Central colleague David Mendosa. The researchers found that the 1,5-anhydroglucitol concentrations in saliva corresponded to the levels in blood, which the Glycomark test uses.
The 1,5-anhydroglucitol comes from most foods and is generally excreted by the kidney. The higher the BG concentrations, the lower the 1,5-anhydroglucitol concentrations. This is because glucose and 1,5-anhydroglucitol compete for uptake by the kidney and secretion in the urine.
Note that most people don’t secrete glucose in urine until BG levels are about 180 mg/dL. So in anyone with pretty good BG control, the 1,5-anhydroglucitol level would not be a good marker. But many many people are walking around with BG levels much higher than this, and they don’t realize they have a problem. A saliva test might alert them to their problem.
Physicians are also becoming more aware that the hemoglobin A1c levels well within what is called the “normal range,” meaning below 6 or 6.5, may not actually be normal. Another study suggested that an A1c greater than 5.5 indicates an increased risk of diabetes within 8 years.
Both studies were discussed in a Medscape article that could be read by many physicians.
Let us hope that physicians not only read these articles but take them seriously. Preventing diabetes is much easier than reversing it once it’s reared its ugly head.
Published On: February 16, 2014