In the course of reporting for an upcoming article on prediabetes (arriving online and in print in about a month), I interviewed endocrinologist Irl B. Hirsch, FACP, and he offered a few tidbits that didn't fit into the story but seemed worth sharing:
An increase in type 1 diabetes among adults. When asked what was the one thing he'd most like primary care docs to do to improve diabetes care, Dr. Hirsch suggested that they be alert to the fact that not all middle-aged new diabetics are type 2. "In my era we were all taught type 1 is kids, type 2 is adults. Often these people are misdiagnosed as type 2s. They are treated with pills, yet they need insulin," he said. Experts aren't sure why, but there's been a serious uptick in these cases in recent years, so if you see high glucose in a thin patient without a strong family history for example, keep type 1 in mind, Dr. Hirsch advised.
New ideas about screening methods. Citing a recent paper in the Journal of Clinical Endocrinology and Metabolism, Dr. Hirsch suggested that there may be a movement afoot to use A1cs as a diabetes screening tool. A1cs are reliable, don't require fasting and reflect longer-term glycemia, the consensus of experts who wrote the paper concluded. "What's interesting about that is that nobody recommends that we use A1c's for screening but about 50% of physicians already do," said Dr. Hirsch.