Here’s an interesting study looking at the prevalence of diabetic retinopathy in patients across the spectrum of blood sugar control. It showed that individuals with a Hgb A1c greater than 5.5% have the biggest increase in retina damage due to sugar exposure. A Hgb A1c of 5.5% is equivalent to an average blood sugar of 111 mg/dL. For reference, diabetes is diagnosed when a fasting blood sugar is 126 mg/dL on two occasions. That means that individuals who have not been diagnosed with diabetes may already have retina damage from high blood sugars.
Now is the time to change. Call our office at 539-0270 to schedule an appointment with our Nutrition Counselors and take control of your blood sugar. Save your vision!
Association of A1C and Fasting Plasma Glucose Levels With Diabetic Retinopathy Prevalence in the U.S. Population
Implications for diabetes diagnostic thresholds
OBJECTIVE To examine the association of A1C levels and fasting plasma glucose (FPG) with diabetic retinopathy in the U.S. population and to compare the ability of the two glycemic measures to discriminate between people with and without retinopathy.
RESEARCH DESIGN AND METHODS This study included 1,066 individuals aged ≥40 years from the 2005–2006 National Health and Nutrition Examination Survey. A1C, FPG, and 45° color digital retinal images were assessed. Retinopathy was defined as a level ≥14 on the Early Treatment Diabetic Retinopathy Study severity scale. We used join point regression to identify linear inflections of prevalence of retinopathy in the association between A1C and FPG.
RESULTS The overall prevalence of retinopathy was 11%, which is appreciably lower than the prevalence in people with diagnosed diabetes (36%). There was a sharp increase in retinopathy prevalence in those with A1C ≥5.5% or FPG ≥5.8 mmol/l. After excluding 144 people using hypoglycemic medication, the change points for the greatest increase in retinopathy prevalence were A1C 5.5% and FPG 7.0 mmol/l. The coefficients of variation were 15.6 for A1C and 28.8 for FPG. Based on the areas under the receiver operating characteristic curves, A1C was a stronger discriminator of retinopathy (0.71 [95% CI 0.66–0.76]) than FPG (0.65 [0.60 – 0.70], P for difference = 0.009).
CONCLUSIONS The steepest increase in retinopathy prevalence occurs among individuals with A1C ≥5.5% and FPG ≥5.8 mmol/l. A1C discriminates prevalence of retinopathy better than FPG.
“Why do you have a question about wearing seat belts? You’re a doctor not a policeman.” This adolescent was expressing a rather common question among both youth and adults. But the reality is the answer to that question, especially among youth, may have more impact on their health than almost anything else we will talk about in their visit.
What do adolescents and young adults (say age 10-24) die from in the U.S.? Only 5% die from heart disease and other congenital diseases. Seventeen percent die from a mix of causes such as infections and various uncommon maladies. The three other causes that make up all the rest are suicide (11%), homicide (13%), and unintentional injury (accidents) at a whopping 48%. Obviously the fact that suicide and homicide make up nearly a quarter of the deaths of youth is heart-breaking. But today we want to focus in a little more on the nearly half of deaths in youth which are caused by accidents.
Out of these accidental deaths, almost ¾ of these are from motor vehicle accidents, and a substantial percentage of these involve alcohol. Another 7% of accidental deaths in youth occur from unintentional poisoning, 5% from drowning, 3% from other recreational vehicle crashes, and 2% from firearms accidents.
Just to name one other example of accidental injury, over 25,000 traumatic brain injuries needing emergency room treatment occur in youth from bicycle accidents every year, usually in youth not wearing a helmet.
What about other behaviors that may cause disease or other unwanted outcomes? Although 15-24 year olds make up only about a quarter of sexually-active individuals, they incur almost half of the sexually-transmitted infections, including 17% of the new HIV infections. Also, three quarter of a million teens become pregnant each year, although the numbers are trending down a bit.
Substance abuse shows some slight drop in alcohol and tobacco use, but other substances such as marijuana, meth, and prescription drug abuse are not falling off or are increasing.
Finally, over the last 20 years, the US has experienced an obesity epidemic. In 1991, only four states reported an obesity prevalence rate over 15%, and no states reported rates above 20%. In 2009, every state except for Colorado reported an obesity prevalence rate at or above 20%, with 9 states exceeding 30%, including Tennessee. Between 1980 and 2008, obesity among adolescents shot up from 5% to 18%.
So, life happens, and we certainly can’t control it all… but our choices bring consequences, some sooner and some later, some good and some not so much. High tech medicine can certainly bring life-extending treatments for many maladies. But, for adults, and even more-so for youth, a few consistent good choices may make a world of difference – choices such as:
- Buckling your seat belt every time you drive or ride in a car.
- Not driving when you’re impaired or buzzed nor riding with someone else who is.
- If you’re on a bike, motorcycle, snowboard, 4-wheeler or similar fast-moving objects and you have a brain, protect it with a helmet.
- Skip the unhealthy, addicting substances that will wreck your life, health, and freedom in the long run, even if they’re advertised as making you feel cool and in in the short run.
- Save yourself sexually for the person you’ve committed to be with for a lifetime
- Skip the sugary drinks and refined carbs (starches) and go easy on the portions
- Stay physically active and limit your screen time (phones, computers, t.v.)
No doubt these sound old-fashioned, but they can impact your life and health more than the most expensive, high-tech treatments. So, it can be a corny cliché from grade B movies, but somehow in real life it still has some remarkable power: “Make good choices… and keep on making them; they make a difference.”
Check out this piece on getting to work helping patients instead is sitting around acting like no one knows what to do.
What to do if my foot caught fire
Remember that simple isn’t always easy and hard isn’t always complicated.
Come see our Nutrition and Wellness Counselors if you want to know the simple and not complicated way to get your health back.