Widening awareness of hyperglycemia unawareness

Abstract

Hyperglycemia unawareness is the term suggested to me (M. Muggeo, personal communication, 1997) to encompass very broadly all of the stages in diabetes mellitus from the onset of any degree of hyperglycemia until the diagnosis is actually made. Diabetes and its handmaiden, obesity, are growing in epidemic proportions in the US and worldwide. In contrast to obesity where the diagnosis is recognized quite early by the patient, the family and the physician, the diagnosis of diabetes may be delayed from 5 to 15 years after its onset1-5. A significant minority of adults, when newly diagnosed with Type 2 diabetes, have definable evidence of macrovascular or microvascular complications. Presumably those same individuals, were we able to examine their cells and organs, would show additional evidence of the complications of diabetes. Likewise, with the recognition that hyperglycemia per se is a very powerful determinant of the complications of diabetes, we suspect that even those people with the delayed recognition of hyperglycemia but without evidence of complications at the time of diagnosis already have sustained some of the underlying damage typical of diabetic complications. This is supported by the finding that in this group of patients, there are those who will have an 'accelerated rate' of onset of diabetic complications2 (relative to patients with Type 1 diabetes where the onset of hyperglycemia is very close to the time of the diagnosis). Our interpretation is that the progress of the disease may not really be especially rapid; rather, the dating of the onset has been incorrect.

Abdominal Obesity and Ethnic Differences in Diabetes Awareness, Treatment, and Glycemic Control

“…Microvascular complications of the eyes, kidneys, nerves, and lower extremity amputations are also more common among non‐Hispanic blacks and Hispanics than non‐Hispanic whites (18, 19, 20). Although the reasons for these racial/ethnic disparities are not clear, some investigators suggest that differences in diabetes awareness, treatment, and control may be associated with the higher prevalence of these complications in non‐whites (21). Because of the destructive nature of diabetes (organ damage), understanding awareness, treatment, and control rates in different population groups and the impact of abdominal obesity are imperative in designing prevention regimens for various populations.…”