It's well known that if diabetics are caught early and vigorously treated, complications are reduced and life can be prolonged. It's therefore important to get treatment to those who need it - but recognition (i.e. diagnosis) comes first, and here the news is not good. The article summarized here describes the status of both diagnosis and treatment in US older persons.

Unfortunately, the new American Diabetes Association (ADA) recommendations about the diagnosis of diabetes concentrate on the fasting blood glucose level, which is a fairly easy test to order. However, many older people can have a normal fasting glucose level, but prolonged raised blood glucose after a meal, i.e. they have glucose intolerance, and are diabetics, with all the risks that this entails, but their illness will not be detected by a simple fasting blood glucose level test.

This suggests that many older diabetics are undiagnosed, and therefore untreated. A recent survey bears this out. As many as 30% to 50% of US adults who really have diabetes do not know that they have the disease.

Equally important, many older diabetics are not receiving adequate treatment. The same survey showed that, among diabetics 65 years old and above, over 70% of those having no drug treatment had adequate control of their blood sugar levels, whereas only 44% of those taking oral antidiabetic drugs and 27% of those on insulin were well controlled.

There is obviously a gap between what is known and what is actually delivered by health professionals. Firstly, more elaborate testing in some patients may be necessary _ this can involve a blood glucose level measured 2 hours after a sugar drink, or a full-blown glucose tolerance test, with ½-hourly blood and urine sampling for 2½ hours after a sugar drink.

Constraints on physicians' time for individual office visits mean that patients often receive inadequate advice on the importance of efficient treatment in a condition which may not have many symptoms, initially. If physician-time is not available, other health professionals (nurse, physician assistants) should be allocated to address the importance of early, complete recognition of people with diabetes.

Once someone has been diagnosed as having diabetes, more time needs to be set aside for educating the person about diet, urine and blood glucose monitoring, correct dosing of medications, and awareness of possible side effects and symptoms of complications. There must be effective follow-up to ensure that proper control of the blood glucose is being maintained, and that there are no signs of complications.

Diabetes represents an extremely common condition in people over 65.