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(Reuters Health) - A genetic trait that affects red blood cells and is fairly common among African Americans and Hispanic Americans can cause an important blood sugar test to miss signs of diabetes, researchers say.

The test known as hemoglobin A1c (HbA1c) estimates long-term blood sugar levels by measuring the amount of glucose sticking to red blood cells, but blood cells from people with sickle cell trait don't live as long, so they have less time to collect glucose.

When lead author Mary Elizabeth Lacy from Brown University School of Public Health in Providence, Rhode Island, and her colleagues used standard HbA1c cutoffs to screen for diabetes, we identified 40 percent fewer cases of prediabetes and 48 percent fewer cases of diabetes in individuals with sickle cell trait than in those without sickle cell trait, she told Reuters Health by email.

Sickle cell disease is a serious condition that occurs when a person has two copies of a defective gene responsible for making part of the hemoglobin molecule in red blood cells. Hemoglobin allows the cells to carry oxygen to the tissues that need it, but in people with two copies of the faulty gene, blood cells can turn sickle-shaped, causing painful crises and even death.

People with only one copy of the defective gene are said to have sickle cell trait, and most have no symptoms of sickle cell disease. The gene is most common among people with ancestry in sub-Saharan Africa, Central America and South America, Saudi Arabia, India, Turkey, Greece and Italy.

The U.S. Centers for Disease Control and Prevention estimates that 1 in 13 African American babies are born with sickle cell trait.

In their study of 4,620 African Americans, including 367 with sickle cell trait, Lacys team found that HbA1c levels were 0.3 percent lower in those with the trait than in those without it, even though they had similar blood sugar levels.

While 0.3 percent may seem small, Lacy said, a difference of 0.3 percentage points in HbA1c could be the difference between being identified as high-risk (and being targeted for more frequent monitoring as well as additional diabetes prevention efforts) or not, or receiving a diagnosis of diabetes or not.

Among individuals with no history of diabetes and not taking diabetes medications, testing blood sugar directly detected pre-diabetic elevated blood sugar levels or full-fledged diabetes in equal numbers of people, regardless of whether they had sickle cell trait, the researchers report in JAMA.

But if HbA1c was used instead of blood sugar testing, pre-diabetic elevated blood sugar would be diagnosed in about 29 percent of those with sickle cell trait compared to 49 percent of those without the trait. Similarly, the HbA1c test would identify diabetes in about 4 percent of those with sickle cell trait and about 7 percent of those without the trait.

The results of HbA1c testing need to be interpreted with caution in patients with sickle cell trait, Lacy concludes. These findings were based on one method of HbA1c measurement. While it is approved for use in those with sickle cell trait, we are unable to say whether our findings are due to assay interference or a biological phenomenon in those with sickle cell trait.

Doctors should consider using a glucose tolerance test if they suspect diabetes in people with SCT whose HbA1c is close to the cutoff level, said Dr. Anthony J. Bleyer from Wake Forest School of Medicine in Winston-Salem, North Carolina, who coauthored a related editorial.

I think there needs to be more research in this area. The HbA1c is a really important test that we use all the time. We need to make sure it is accurate for individuals of all races and ethnicities, Bleyer said by email.

Approximately 10 percent of African American patients have sickle cell trait. It is prudent to test African American patients for hemoglobinopathy (sickle cell trait) before relying on HbA1c for diagnosis diabetes/prediabetes and before using HbA1c to monitor blood sugar control, Dr. Kristina Behan from the University of West Florida in Pensacola, who was not involved in the study, said by email.

SOURCE: bit.ly/2ln3Rap and bit.ly/2kovj9m JAMA, online February 7, 2017.

GENEVA The United Nations appealed on Wednesday for $2.1 billion to provide food and other life-saving assistance to 12 million people in Yemen who face the threat of famine after two years of war.

NEW DELHI A group backed by the Bill & Melinda Gates Foundation that works on India's immunization program will now be funded by the health ministry, a government official said, a move in part prompted by fears foreign donors could influence policy making.

The U.S. Food and Drug Administration has approved Amgen Inc's treatment for secondary hyperparathyroidism in adult patients with chronic kidney disease undergoing dialysis, the U.S. biotech company said on Tuesday.

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Sickle cell trait skews common diabetes test - Reuters

Glycemic Response Independent of Initial Diabetic Medication Choice Among HIV-Infected Patients With Diabetes Endocrinology Advisor Data from a longitudinal cohort study of patients with type 2 diabetes infected with HIV aims to elucidate whether initial choice of oral diabetic medication had effects on glycemic control. Glycemic response was not affected by specific diabetic oral ...

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Glycemic Response Independent of Initial Diabetic Medication Choice Among HIV-Infected Patients With Diabetes - Endocrinology Advisor

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Governor declares Feb. 6 Type 1 Diabetes Day - 6 On Your Side

The hemoglobin A1C test for blood sugar, a standard assay for diabetes, may not perform as well in people with sickle cell trait, a study finds. fotostorm/Getty Images/iStockphoto hide caption

The hemoglobin A1C test for blood sugar, a standard assay for diabetes, may not perform as well in people with sickle cell trait, a study finds.

A widely used blood test to measure blood-sugar trends can give imprecise results, depending on a person's race and other factors. This test means diabetes can sometimes be misdiagnosed or managed poorly.

Doctors have been cautioned before that results from the A1C test don't have pinpoint accuracy. A study published Tuesday underscores that shortcoming as it applies to people who carry the sickle cell trait.

Glucose levels in the blood rise and fall all the time, so it can be tricky to look at a single exam to diagnose diabetes or manage the disease in people who have it. But one test gets around this problem.

The A1C test measures sugar that binds to hemoglobin molecules in red blood cells. It provides an average of blood sugar over the past three months, "so this has turned out to be an incredibly powerful test, both for the diagnosis and treatment of diabetes" says Dr. Anthony Bleyer, a kidney specialist at the Wake Forest School of Medicine who was not involved in the study.

The problem is that the test results can vary, depending on circumstance. For example, people with anemia may get inaccurate readings. So do people who carry unusual types of hemoglobin, the best known being sickle cell trait.

Eight to 10 percent of African-Americans carry the sickle cell trait. But only people who inherit two copies of the sickle cell trait, one from each parent, develop the disease.

And a few years ago, scientists realized that A1C readings for African-Americans readings typically don't match those from whites. They are generally higher.

"The test was really standardized based on white individuals, and there were just a small number of African-American individuals in that study," Bleyer says.

And while the difference isn't large, it can matter a lot, especially for people who are close to the line that defines diabetes. Someone who appears to be just under the line and diagnosed as having prediabetes may in fact have a higher level of A1C, which would push them into a diagnosis of diabetes.

Vagaries in these readings can also be misleading for people whose treatment is guided by this test, because doctors may be overly aggressive in controlling blood sugar, to the point that a patient can end up with seriously low blood sugar.

In a report published Tuesday in JAMA, the journal of the American Medical Association, scientists at Brown University and the National Institutes of Health examined data from two large studies to compare test results of African-Americans with and without the sickle cell trait.

The studies used standard A1C tests that had previously been shown to give low readings for people with the sickle cell trait. The scientists were surprised to find how big a difference it made.

About 4 percent of the people in the study who carried the sickle cell trait were diagnosed with diabetes, but they expect a test corrected for bias would have identified about 7 percent nearly twice as many people.

"We were really shocked by that, honestly," says Mary Lacy, a graduate student at Brown University and lead author of the study. "That's huge!"

Likewise, they found 40 percent fewer cases of prediabetes than they expected among people carrying the sickle cell trait.

The test readings are only off by a few tenths of a percentage point, but that was enough to push many people below the cutoff points that indicate diabetes or prediabetes.

This observation is one reason doctors should be cautious in interpreting A1C results, researchers say.

"Doctors generally take the test fairly literally," says Tamara Darsow, senior vice president for research and community programs at the American Diabetes Association. "How much this impacts care and the interpretation of A1C results I think is variable."

The association's guidance document cautions doctors that the A1C tests can be off by plus or minus 7 percent among people with unusual hemoglobin traits. As the new study underscores, that is more than enough variability to affect a diagnosis.

So instead of making a snap diagnosis, particularly for African-Americans, doctors could additionally run some more traditional blood-sugar tests. Those aren't influenced by race or sickle cell status (though they can vary for other reasons).

"Information together from all of these tests can be much more powerful than those taken in isolation," Darsow says.

The American Diabetes Association would ultimately like to come up with more concrete treatment guidelines, but for now their word to doctors is this: Be aware this is an issue and use your best judgment.

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Some people, due to family history or other physical conditions, are dealt a bad hand and have to cope with diabetes.

But for many, diabetes is self-inflicted. We dont exercise or eat smart. After a few years of that, the grim reality is people go to a doctors appointment and find out they have blood sugar issues.

Huntsville Hospitals Diabetes University is program dedicated to helping patients not only navigate, but beat, diabetes.

Untreated, diabetes can lead to blindness, kidney disease, heart attack, and stroke. A serious issue with patients who have diabetes is infections with extremities that lead to amputations.

The focus of Diabetes University is help patients identify blood glucose levels, develop problem solving skills for diabetes, and how to prevent further damage from diabetes.

Also, the all-important portion control and exercise components are critical.

Fighting diabetes is a daily battle. It requires discipline and resolve, and you dont have to fight alone.

Huntsville Hospital Diabetes University is at 420 Lowell Drive, Suite 500 in Huntsville. The number is 256-265-3069.

34.721457 -86.575366

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Do you need help fighting diabetes? - whnt.com

February 6, 2017 Credit: iStockphoto

Consuming one or more pot of "snus" Swedish snuff or dipping tobacco per day increases the risk of developing type 2 diabetes by 70 per cent. This is the same risk increase as previously seen for smokers who smoke one packet of cigarettes a day. The study on the effects of snus was conducted by researchers at Karolinska Institutet and their colleagues at Ume and Lund universities, and is published in the Journal of Internal Medicine.

According to figures from the Public Health Agency of Sweden, 19 per cent of men and 4 per cent of women in Sweden take snus. Type 2 diabetes is also common; seven per cent of the adult population have a diabetes diagnosis and up to 20 per cent are in the risk zone. The disease is a serious one, as it can lead to complications, cardiovascular disease and premature death.

The researchers at Karolinska Institutet and Ume and Lund universities studied pooled data for a total of 54,500 men followed between the years of 1990 and 2013, during which time 2,441 of them developed type 2 diabetes. Owing to the size of the study, the team was able to estimate the effects of snus on never-smokers and thus avoid having the results contaminated by those who use both snus and cigarettes.

Confirm earlier suspicions

"We can confirm earlier suspicions that snus-users have a higher risk of type 2 diabetes, an effect that can seemingly not be explained by them being occasional smokers or having a lifestyle that is less healthy in other respects," says Sofia Carlsson, researcher at Karolinska Institutet's Institute of Environmental Medicine.

There is also a 40 per cent increase in risk at a lower level of consumption (5-6 pots a week). A possible explanation for the result is the effect of nicotine, which experimental studies have shown can impair insulin sensitivity and thus possibly increase the risk of diabetes.

Snus-users expose themselves to at least the same dose of nicotine as smokers, even though they are spared many of the other chemicals contained in cigarette smoke. No increased risk was seen in people who stopped using snus, which suggests that quitting snus can have a beneficial effect in this regard.

"Because snus is relatively uncommon amongst women, we were unable to make corresponding analyses for them, so the impact of snus on the diabetes risk for women is an important matter for future research," says Dr Carlsson.

No less dangerous than cigarettes

From a wider perspective, it is important to point out that existing research suggests that smokers are much more likely to develop cancer and cardiovascular disease than snus-users; it is in terms of type 2 diabetes that snus is no less dangerous than cigarettes.

"The diabetes trend is largely driven by lifestyle factors, so to reduce your risk of diabetes you should not use tobacco, avoid being overweight and be physically active," she says.

Explore further: Smokeless tobacco product snus may increase risk of death among prostate cancer patients

More information: S. Carlsson et al. Smokeless tobacco (snus) is associated with an increased risk of type 2 diabetes: results from five pooled cohorts, Journal of Internal Medicine (2017). DOI: 10.1111/joim.12592

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'Snus' users run greater risk of type 2 diabetes - Medical Xpress

A week after Johnson & Johnson said it was weighing strategic options for its diabetes device divisions, reports emerged that Roche was doing the same with its diabetes testing unit. But diagnostics chief Roland Diggelman put an end to speculation Wednesday, saying the Swiss company wants to expand the biz, Reuters reported.

Bloomberg reported Tuesday that people familiar with the matter said Roche was considering options for its diabetes care unit, including a spinoff or a sale.

Roches diabetes care sales dropped 4% in FY 2016, thanks to pricing pressure in the U.S. But Diggelmann dismissed reports the company was considering a sale, Reuters reported. In fact, he said, the company is on the prowl for new tech that could boost the flagging business.

"We basically have all of the technologies we need in-house in varying degrees of development, so we have to ask ourselves, 'How far are we along?'" Diggelmann said, as quoted by Reuters "We're looking around: Are there new possibilities, are there alternatives?"

Roche faced similar speculation in 2015, after Bayer sold off its diabetes device unit to KKR/Panasonic. But while Roches diabetes business had had a rough couple of years, thanks

To price cuts in the U.S., Diggelmann said at the time: "It's still a good business and a business with a future.

The company markets the Accu-Chek line of devices, which includes blood glucose meters and insulin pumps. It leads the diabetes testing industry, ahead of competitors J&J, Abbott and KKR/Panasonic.

In May last year, Roche Diabetes Care inked a deal with Senseonics to sell the latters Eversense Continuous Glucose Monitoring System in Germany, Italy and the Netherlands. Senseonics system comprises a rice-sized sensor that is implanted just under the skin and measures blood glucose levels for 90 days.

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Roche won't sell diabetes businessit's looking for deals to boost it instead - FierceBiotech

Sarah Cooke listened as her aging diabetic patients vented about trying to cope with the pernicious disease.

Guilt and denial, thats pretty much it, said a woman with short gray hair.

Confused, said another woman wearing wire-rimmed glasses. I dont know what I can eat and what I cant.

Cooke, a clinical dietitian at Loma Linda University Health Care, leads a weekly class as part of an effort to combat the diabetes crisis in Southern California, with elderly residents particularly vulnerable. Cooke recently discovered that about 70 percent of all patients who enter Loma Linda University Medical Center are diabetic.

The important thing is to get to people shortly after theyre diagnosed and get them the resources and proper education, she said. A lot of people have had diabetes for a number of years, have developed complications and never had the opportunity to talk to a dietitian or take a class.

After hearing the diabetic patients complaints, Cooke offers suggestions. During her nine years as a dietitian at Loma Linda, Cooke has seen an increasing number of younger patients who have pre-diabetes. She attributes this to the sodas, sugary energy and coffee drinks, and fast food that many younger people subsist on, in addition to their sedentary lifestyle.

That is translating into an onrush of suffering as these patients age, when the effects of the disease are most pronounced. Diabetes is a disease in which the bodys inability to produce any or enough of the hormone insulin causes elevated levels of glucose (or sugar) in the blood. If untreated, it can lead to hypertension, heart disease, strokes, blindness, kidney disorders, amputations and death.

Physicians anticipate the rate of diabetes among the elderly will increase sharply in the coming years. About 45 percent of all adults in the state have pre-diabetes or undiagnosed diabetes, according to a study by the UCLA Center for Health Policy Research. Up to 30 percent of those with pre-diabetes will develop Type 2 diabetes within five years.

The diabetes rate in the state has increased by 35percent since 2001, according to the study. About 13 million adults in California have pre-diabetes or diabetes and another 2.5million adults have already been diagnosed with the disease, totaling about 40percent of the states population. Nationally, annual medical spending for people with diabetes is almost twice that for people without the disease. A person who is diagnosed with diabetes by age 40 will have lifetime medical spending that is $124,600 more than someone who is not diabetic.

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Education is important in preventing and controlling diabetes, said Dr. Theodore Friedman, an endocrinologist at Martin Luther King Jr. Outpatient Center and chairman of the county Department of Health Services Endocrinology Work Group. He leads a weekly class for diabetics, most of whom are seniors, which emphasizes healthy eating and exercise. He has discovered that elderly diabetic patients are sometimes more amenable to changing their eating and unhealthy habits than younger patients, he said.

Most of my patients say they want to lose weight, he said. Many are on so many medications theyre trying to reduce the number theyre taking. They really want to change, while some younger people feel theyre invincible or theyre too busy to alter their lifestyle.

The rate of adults with diabetes in Los Angeles County (about 10 percent) is slightly higher than the state average (about 9 percent), according to the UCLA study. The county Health Department offers a number of diabetes classes, but some impoverished elderly patients dont have transportation and cant attend regularly. As a result, the department offers eleven classes, some in Spanish and English, posted on YouTube, ranging from nutrition suggestions to stress management to mixing insulin.

In the past, diabetes education was more for wealthy people, Friedman said. Now were trying to educate everyone. Were trying to get patients to get as involved as possible in managing their diabetes.

Although experts say the diabetes rate is concerning all over Southern California, the level varies from county to county. Orange Countys rate is below the state average.

Thats the case in Riverside County, too. But next door, in San Bernardino County, the diabetes-related death rate 32.4 per 100,000 population is more than 50 percent higher than the state average.

Because the problem is so severe among the elderly, extensive community outreach is needed, said Dr. Kevin Codorniz of Loma Lindas division of endocrinology, diabetes and metabolism. The classes at the Diabetes Treatment Center and at other hospitals are an important way to educate patients so they understand the disorder and change their lifestyle to avoid dangerous blood sugar levels.

Carolyn Edwards, who attended the class at Loma Linda, lives nearby in Bloomington. Edwards, 71, a retired hotel front desk manager, was diagnosed with diabetes decades ago, but never assiduously monitored her condition.

When I was working it was easier to keep my sugar levels down because I was much more active, she said. But when I retired it became much more of a challenge. I had stopped fixing meals and just snacked or went to hamburger places. Then my blood sugar went crazy and my doctor suggested I take this class.

For years Edwards had little energy and was often too weak to walk. She frequently felt so dizzy that she occasionally leaned against a wall for support and slowly slid to the floor. After two classes at the Diabetes Center, she said she has made significant changes and already feels more energetic. She now tests her blood sugar twice a day, shops and makes herself healthy dinners every night, and works out on a stationary bicycle at a gym.

Most of the people who participate in the Loma Linda class are in their fifties and older. The first class focuses on the basics of diabetes, the second on nutrition, and the third on blood sugar monitoring and reading food labels. The patients put into practice what theyve learned and then return two months later for a final class, when their weight and blood sugar levels are tested again.

Cooke recently saw a 70-year-old patient with severe diabetes who was almost 50 pounds overweight and had a number of complications, including kidney failure and hyperten-sion. When Cooke asked the woman about her eating habits, the woman mentioned that she consumed eight tortillas. A day? Cooke asked. No, the woman said. Each meal.

That meant she was eating 24 tortillas every day, Cooke said. The woman thought that since tortillas arent sweet, they wouldnt be bad for her diabetes. She didnt realize this was way too much carbohydrates and carbohydrates break down into sugar.

Cooke immediately signed the woman up for a diabetes class.

Corwin writes for the Center for Health Reporting at the Leonard D. Schaeffer Center for Health Policy & Economics at the University of Southern California. Research for the story was supported by the Gary and Mary West Foundation.

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Diabetes crisis grips Southern California - Los Angeles Daily News - LA Daily News

Sacramento Bee

Diabetes among the most expensive American diseases, as drug ... Sacramento Bee With an estimated 30 million Americans struggling with diabetes, the disease is one of the nation's most entrenched chronic conditions. It's also one of the most ... One-third of young Women with Diabetes likely to have Eating Disorder: Studyhttp://www.newsgram.com/ Don't freak out, but you might have diabetes and not know itWRAL.com Stick to This Diet If You Want to Reverse Diabetes Risk Factorsor Avoid Them CompletelyReader's Digest Southernminn.com -Medgadget (blog) all 15 news articles »

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Diabetes among the most expensive American diseases, as drug ... - Sacramento Bee