National Diabetes Week runs from 8 July to 14 July 2018. This year it aims to raise awareness of the importance of early detection and treatment of all types of diabetes as part of the ‘It’s About Time’ campaign. The campaign’s main message is that many Australians with either type 1 or type 2 diabetes are diagnosed late: a delay which can put them at risk of life threatening health issues.
The total annual cost of diabetes in Australia is estimated at AUD 14.6 billion. Around 1.7 million Australians have diabetes, including all types of diagnosed diabetes (1.2 million known and registered) and silent, undiagnosed type 2 diabetes (up to an estimated 500,000 individuals). 280 Australians develop diabetes every day. That’s one person every five minutes.
Associate Professor, Graham Jones, a specialist in Chemical Pathology at St Vincent’s Hospital SydPath discussed diabetes with us.
"These are quite extraordinary statistics, particularly when considering that all of these diagnoses are absolutely reliant on laboratory tests. Once a diabetes diagnosis has been made, it will then hopefully lead to a change in a person’s life, encouraging them to respond to the results by making improvements in their lifestyle."
Diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar; therefore, when an individual has diabetes, their body can’t maintain healthy levels of glucose in the blood. There are three main types of diabetes: type 1, type 2 and gestational diabetes.
"Type 2 diabetes is by far the most common type of diabetes and is increasing at the fastest rate. The main things that put someone at risk are being overweight, central adiposity, a lack of exercise, and too much of the wrong kind of food.
"You could describe diabetes as a definitional disease as it’s defined by pathology results. The only way that someone can be diagnosed with diabetes is either through one or more glucose tests, which need to be done in a formal laboratory, or by another laboratory test called HbA1c. Without those tests, it’s not possible to diagnose diabetes. Additionally, the key to monitoring whether the treatment is working is by the use of pathology tests.
"The type of diabetes that an individual has affects the methods of testing. With the most common type, type 2 diabetes, individuals might be expected to have a test called HbA1c, which is a blood test that reflects the average blood sugar over a period of one or two months. Individuals might need to have that test perhaps twice a year. Every year or so, or in some cases more frequently, they will also have their urine tested for protein. Individuals with type 1 diabetes will generally test themselves for blood glucose four or more times every day. They also have their HbA1c tested perhaps four times a year and will be monitored for potential damage to their kidneys by means of urine albumin. Other routine tests include blood tests to identify reduction in kidney function, and also for lipids like cholesterol, HDL cholesterol and triglycerides to ensure that they’re not otherwise at risk of vascular disease,” says A/Prof Jones.
The potential complications of diabetes are the same for type 1 and type 2 diabetes. They include heart attacks, blindness, kidney failure, amputations, and can affect a person’s mental health by causing depression and anxiety.
“We know if the HbA1c is lower than the appropriate level, then it can indicate overtreatment. It’s very important to monitor HbA1c to reduce complications like heart disease, heart attack, vascular disease, kidney disease and eye disease. We know that if there’s a response to treatment then those complications can be reduced.”
Whilst there is no known cure for diabetes, steps can be taken to control blood sugar levels, therefore slowing down the advance of the condition.
“With type 2, if you can reverse the things that might have caused the diabetes in the first place, then the severity tends to be markedly reduced. That means reducing excess weight, eating an appropriate diet and exercising. That can be hard, and often oral medications may be prescribed, which should be taken regularly. If type 2 diabetes becomes more severe, then these patients may need treatment in the form of a little injection under the skin with subcutaneous insulin one or more times a day. In addition, because one of the main ways that diabetes causes ill health is in the vascular system, then attention is placed on things like blood pressure, cholesterol and other lipids. Making sure that the individual is not smoking and is getting exercise is also very important.
"In pathology, most of the effort is focused on doing the basic things very well. For instance, the quality of results for things like HbA1c, blood glucose and urine albumin in Australia is very, very high. Patients can have confidence that the results are the same from different labs and can be relied on to monitor their treatment.
“Some areas of improvement in relation to diabetes are more in therapeutics. There are new medicines coming out, and also for type 1 there are newer monitoring techniques with continuous blood glucose monitors improving all the time. But essentially, what pathologists are doing in the laboratory is absolutely the mainstay for diagnosis and also for monitoring the treatment of diabetes,” says A/Prof Jones.
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This article appeared in the June 2018 Edition of ePathWay which is an online magazine produced by the Royal College of Pathologists of Australasia (http://www.rcpa.edu.au/Library/Publications/ePathway).
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