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Fasting Glucose Levels May Not Be Best Indicator of Diabetes Risk

Posted on: Wednesday, 5 October 2005, 18:00 CDT

WEDNESDAY, Oct. 5 (HealthDay News) -- Blood sugar levels at the high end of "normal," coupled with other risk factors for type 2 diabetes, may help identify apparently healthy men at increased risk of the disease, a new Israeli study suggests.

And, the researchers suspect, the findings may apply to women as well.

"The results suggest that a normal glucose level (a level that is not associated with increased diabetes risk) may have to be defined in a more individualized manner with different values, depending on a person's additional risk factors," said study author Dr. Amir Tirosh, an internist and researcher at the department of internal medicine at Sheba Medical Center.

"People and physicians should not look only on the current definition of normal and abnormal blood glucose levels when assessing an individual's risk to develop diabetes. A careful interpretation of the body mass index, the triglyceride level and the patient's family history of diabetes is needed in order to better identify those at high risk," said Tirosh.

Normal fasting blood sugar levels are considered those that fall below 99 milligrams per deciliter (mg/dl) of blood, while anything between 100 and 125 mg/dl is considered pre-diabetic, according to the National Institute for Diabetes and Digestive and Kidney Diseases. Once fasting glucose levels rise to 126 mg/dl and above, a person is considered diabetic. Fasting glucose levels are taken after a person hasn't eaten for at least eight hours.

The new study suggests that more people may fall into the pre-diabetic category even if they have glucose levels at the high end of normal. One reason it's important to identify people who are pre-diabetic is that they may be in poorer health than those who don't have an impending risk of the disease. A study presented at the American Diabetes Association annual meeting in June found that people with pre-diabetes have health-care costs about one-third higher than those with normal blood sugar levels.

Tirosh said that if type 2 diabetes is identified early, there are steps that can be taken to reduce potential health problems. Those steps include lifestyle changes, such as improved diet and exercise, or medication.

Type 2 diabetes is the most common form of diabetes. In people with type 2 diabetes, either the body doesn't produce enough insulin -- a hormone needed for the body to convert blood sugar to energy for cells -- or the cells ignore the insulin. If left untreated, complications can include heart disease, blindness, and nerve and kidney damage, according to the American Diabetes Association.

"Identifying individuals at high risk for diabetes, particularly among young adults, will hopefully prove beneficial in reducing the epidemic proportions of the disease," said Tirosh, the former head of research and project development section of the Israeli Defense Forces Medical Corps.

For the study, the researchers obtained fasting glucose levels for more than 13,000 men from the Israeli Defense Forces. All were between the ages of 26 and 45. The average follow-up time was 5.7 years.

Among these men, 208 were diagnosed with type 2 diabetes during the study period.

Men who had fasting blood glucose levels at the high end of normal -- between 95 to 99 mg/dl -- had about three times the risk of developing type 2 diabetes as men with blood sugar levels under 81 mg/dl.

Men who had additional risk factors and high-normal blood glucose readings were even more likely to develop type 2 diabetes. For example, obese men with fasting glucose levels between 91 and 99 mg/dl had eight times the risk of developing the disease, compared to non-obese men with blood glucose readings less than 86 mg/dl, the study found.

High triglyceride levels and a family history of the disease also increased the risk of diabetes for those with higher blood sugar levels.

Tirosh said he believes this study's findings would be similar in women.

Dr. Stuart Weiss, an endocrinologist at the New York University Medical Center, said, "This study may make people look more closely at patients who already have elevations, though modest, in blood sugar levels."

"What we've learned over the past few years is that a rise in fasting sugar is seen well after insulin resistance has begun," he added.

A better measure of how well the body is processing glucose is to test blood sugar levels after meals, said Weiss. But this method is more time-consuming, and people need to use blood glucose monitors at home to get an average reading.

More information

To learn more about how type 2 diabetes is diagnosed and for tips on preventing it, visit the National Institute of Diabetes and Digestive and Kidney Diseases.

SOURCES: Amir Tirosh, M.D., internist and researcher, Sheba Medical Center, and former head, research and projects development section, Israeli Defense Forces Medical Corps., Tel-Hashomer, Israel; Stuart Weiss, M.D., endocrinologist, New York University Medical Center, and clinical assistant professor, New York University School of Medicine, New York City; Oct. 6, 2005, New England Journal of Medicine~DIA2~

Source: HealthSCOUT

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