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Undiagnosed Diabetes

The American Diabetes Association is committed to educating the public about how to stop diabetes and support those living with the disease. It is estimated that 300,000 people in Western Pennsylvania have diabetes. This number does not include the number of individuals that are undiagnosed; it is estimated that an additional 100,000 or more people are currently undiagnosed of diabetes mellitus. It is important to control and manage diabetes mellitus to prevent other chronic disease. Diabetes mellitus can lead to debilitating complications if left untreated for an extensive amount of time.

Chronic illnesses such as heart disease and diabetes mellitus are two of the leading causes death in Pennsylvania. Intermediate risk factors of heart disease and diabetes mellitus include high blood pressure, raised blood glucose, abnormal blood lipids, and overweight/obesity. Heart disease and diabetes mellitus can be delayed or prevented taking appropriate care of their health1,2. Some common modifiable risk factors include unhealthy diet, physical inactivity, tobacco use, alcohol use, and environmental hazards1,2.

Some risk factors that can cause heart disease and diabetes mellitus cannot be changed; these risk factors include age, gender, race/ethnicity, and family history1,2. It is important to get regular laboratory testing to help prevent or delay the onset of chronic diseases such as heart disease and diabetes mellitus. Many people today live with undiagnosed chronic illnesses, with or without symptoms. Untreated illnesses can lead to greater more catastrophic complications. For example undiagnosed diabetes is associated with lack of awareness, treatment, and control of high LDL-C.

Managing symptoms and treating early could help prevent or delay cardiovascular disease associated with high LDL-C levels. Diabetes mellitus can be diagnosed using an A1C test. A study done between 2003-2006 by the National Center for Health Statistics revealed that the crude prevalence of total diabetes mellitus in adults greater than or equal to age 20 was 9. 6% (20. 4 million), of which 19% was undiagnosed (7. 8% diagnosed, 1. 8% undiagnosed using A1C greater than or equal to 6. 5%)3.

Undiagnosed diabetes mellitus can lead to further complications; one with undiagnosed diabetes may require a higher dosage of lipid lowing medication. Improved screening for diabetes and reducing the prevalence of undiagnosed diabetes may identify individuals requiring more intensive LDL-C reduction4. In the analyses performed by National Health and Nutrition Examination Survey (NHANES), individuals with undiagnosed diabetes had a high prevalence of smoking, hypertension, and dyslipidemia4. Undiagnosed diabetes or uncontrolled diabetes can cause further complication, not just affecting a person’s blood glucose level.

Having diabetes can put you at increased risk of heart disease and stroke. High blood glucose levels in the body can cause damage to nerves and blood vessels. Damage to nerves and blood vessels can lead to complications such as heart disease and stroke. Heart disease and stroke is the leading causes of death among people with diabetes. Uncontrolled diabetes can eventually lead to other complications besides heart disease and stroke. Uncontrolled diabetes can lead to vision disturbances, kidney failure, and even amputations.

As study done by National Health and Nutrition Examination Survey (NHANES) showed that more people with undiagnosed diabetes also had high LDL-C levels as compared to individuals with diagnosed diabetes. The study also found that individuals who were diagnosed with diabetes were more likely to be aware of their high LDL-C level and were currently being treated to reduce their cholesterol level. High LDL-C levels and diabetes can also be contributed by weight and being obese. In recent years, the incidence of obesity and diabetes is rising.

LDL-C levels however have seen a decrease in the rate of occurrence. The decline in occurrence over the years may be a result of improved awareness and more aggressive pharmacologic treatment of high cholesterol4. High LDL-C levels puts individual at increased risk of developing coronary artery disease. Coronary artery disease develops when your coronary arteries become damaged or diseased. The coronary arties are the major blood vessels that supply your heart with blood, oxygen, and nutrients. Cholesterol-containing deposits in your arteries cause damage to the coronary arties.

Deposition of plaque in the coronary arteries causes inflammation in the arties leading to damage to the vessels. Diabetes mellitus and heart disease can be prevented or delayed by making some lifestyle changes. Lifestyle changes that can reduce the risk of diabetes mellitus and heart disease include living a healthy lifestyle: quitting smoking, choosing nutritious food choices, and/or increasing daily physical activity. It is recommended that an individual get 150 minutes of moderate intensity exercise or 75 minutes of high intensity exercise per week.

It is important to maintain a healthy lifestyle and prevent diabetes and heart disease because these diseases can be very debilitating if left untreated and uncontrolled. Uncontrolled diabetes can lead to vision loss, kidney failure, and even amputations. High LDL-C levels can lead to vessel damage, heart attack, and stroke. Diabetes and heart disease can affect anybody, young and old. When one develops diabetes, there are many options to control blood glucose levels in patients with diabetes.

Pharmacological therapies to help individuals control their blood glucose include different types of insulin, sulfonylureas, biguanides, meglitinides, thiazolidinediones, DPP-4 inhibitors, SGLT2 inhibitors, alpha-glucosidase inhibitors, and bile acid sequestrants. These pharmacological medications can be used to reduce blood glucose levels and help patients better manage their diabetes. To better manage LDL-C levels patients are often prescribes a statin, bile acid sequestrant, niacin, fibric derivatives, or a cholesterol absorption inhibitor.

Along with pharmacological therapies, diet can play a huge part in controlling LDL-C levels in patients with or without diabetes. Diabetes mellitus can place a large burden on society. This disease is increasing rapidly and is very costly. Surveillance data is used my epidemiologist to determine the burden and cost associated with the disease. Surveillance data are used to define the prevalence of diabetes mellitus and its risk factors and complications, assess changes in these variables over time, and determine the distribution of diabetes and its risk factors both throughout the United States and in specific populations5.

Non-adherence to medications associated with the disease is a big contributor to the increase in cause due to further complications. Based on a study performed in 2010, the total direct national cost of non-adherence for adults diagnosed with diabetes, hypertension, or dyslipidemia was $105. 8 billion, or an average of $453 per adult6. Diabetes hypertension, and dyslipidemia can lead to heart disease, which will further increase health care costs. Diabetes, dyslipidemia, hypertension, and heart disease are common chronic conditions that are all linked together.

It is important to control blood glucose levels because excess glucose in the body can lead to further compliccations such as hypertension. Studies have shown that many people with undiagnosed diabetes also had higher levels of LDL-C in their blood stream. A high level of LDL-C in the blood vessels puts individuals at a higher risk for heart attacks and strokes. These types of conditions are life long conditions that are very costly to society whether by direct medical cost or cost due to premature death. In most cases these chronic conditions can be prevent or delayed.

The key to reducing medical costs associated with the conditions is through medication adherence, prevention, and early detection. Organizations such as The American Diabetes Association go around the country setting up free screening event for individuals to help them become better aware of their health status and possibly detect signs and symptoms of the disease before damage is done to the body. Organizations also offer free educational programs to teach individuals how to make appropriate lifestyle decisions to either help control, delay, or prevent these chronic conditions.

Lifestyle modifications play a key role in preventing diabetes, hypertension, dyslipidemia, and heart disease. High-risk individuals can benefit more from lifestyle modifications in delaying or preventing the chronic conditions. There are a number of different risk factors that contribute to the chronic conditions, some of the risk factors can be modified while some such as age, gender, and genetics cannot be modified. A large number of the population today is living with undiagnosed conditions such as dyslipidemia, diabetes, and hypertension.

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