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Controlling a killer

New studies on diabetes treatment deliver a troubling message: As more Americans are diagnosed with the disease and at a younger age, fewer than one in eight meets the goals established for healthy blood glucose, blood pressure and cholesterol levels. The human toll is staggering. More than 17-million Americans have diabetes. It is the sixth-leading cause of death in the United States and the principle cause of adult blindness, amputation not caused by an accident and fatal kidney disease.

The health care system, doctors and patients share responsibility for the lack of progress against the disease, which is divided into two types. The more rare type 1 occurs when the autoimmune system destroys the body's insulin-producing cells (previously known as juvenile diabetes, it can also strike later in life).

Type 2 accounts for 90 percent of all cases, and its rise is related to increased obesity in adults and children. While the body still produces insulin, it either produces too little or develops a resistance.

Diabetics should have regular exams that check blood vessels in the back of the eye, blood pressure, cholesterol and blood flow to the feet and legs. Every three months they should have a test that measures average blood sugar, called a hemoglobin A1c test.

Yet even when they follow that regimen, most diabetics still fail to meet important health standards, according to a study published in the Journal of the American Medical Association.

Too few doctors push their diabetic patients to gain optimal control of their blood glucose level, said Dr. James Gavin, head of the National Diabetes Education Project. Patients play a role, as well.

"More diabetes patients are taking medication to control their blood pressure and cholesterol, but too few are making needed lifestyle changes such as exercising, lowering dietary fat and losing weight to control the risk factors for diabetes complications," said Dr. Catherine Cowie of the National Institute of Diabetes and Digestive and Kidney Diseases.

With occurrence of the disease at earlier ages, these are "ominous implications for the future burden of morbidity, mortality and health care costs associated with diabetes," concluded one study. That message should be a wakeup call for diabetes patients, doctors and public health officials alike.