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Diabetes and the importance of maintaining it

Dr. Judith Reichman tells about a report on diabetes complications and why a good doctor-patient relationship is important when dealing with this health issue.
/ Source: TODAY

Q: I'm in my 40s and I've been diagnosed with type 2 diabetes. My doctor is very strict and I'm having a hard time keeping up with her recommendations. How important is it to stick to her suggestions for managing my diabetes?

A: You're one of a growing number of individuals – 18 million people in the U.S. are diabetic, and much of this is "fed" by our obesity epidemic (60 percent of women are overweight or obese). A new report just released by the American Association of Clinical Endocrinologists (AACE), and reported in the Journal of the American Medical Association, gives us complication rates related to diabetes. Some of these complications would be preventable if patients was more compliant in their care. Although I don’t want to cause you additional stress, I do want to provide some of these statistics; they may increase your commitment to your diabetes control. The report found that 57.9 percent of those with diabetes have one or more major additional medical complications (14.3 percent have three or more complications).

Now to delineate some of those complications and what organ they were related to — 27.8 percent of those with diabetes had chronic kidney disease, compared to 6.1 percent of those with normal blood sugar levels. Heart attacks occurred in 9.8 percent of those with diabetes vs. 1.8 percent of those who don’t have this disorder. Finally, stroke was found in 6.6 percent of diabetics, compared to 1.8 percent of non-diabetics.

When the report's authors looked at gender, race, and age, they found that men were more likely to have a heart attack or heart failure than women. These conditions are  macrovascular, meaning that the large blood vessels are affected and become blocked. Women, on the other hand, had more microvascular complications (small vessel diseases), and as such they were more likely to develop kidney disease (and failure), vision problems that could lead to blindness or foot damage due to poor blood supply which, in the worse case scenario, could result in horrific infections and need for amputation.

The researchers found that diabetes and diabetes complications caused $22.9 billion in direct medical costs ( physician visits, hospital stays, and prescribed medications. When you talk about the huge amount of money spent on diabetes, it's   not a personal factor until we look at individual medical expenses. This was also addressed in the report. It showed that for a person without diabetes and of average health, annual healthcare costs were $2,848, including $541 of out-of-pocket expenses. (Remember, this the average among many people in many age groups and may not apply to 18-year-olds who don't even get a cold). For those with diabetes and diabetes-related complications, the annual healthcare costs rose to $9,797, including $1,566 of out-of-pocket expenses. ). Elevated blood sugar is neither sweet nor cheap. Even those on the AACE's board were surprised at these huge numbers

Having just given you these dire stats, let me provide some reassurance. Compliance with medications, dietary behavior, and exercise can make a huge difference. You want to maintain good (and strict) glucose control. This can be estimated by a blood test called A1C, your “grade” which represents your average blood sugar over the past two to three months. Aim for levels under 6.5 percent. These actions together with regular visits to the doctor, where your blood pressure, cholesterol, and lipid levels will be followed (and perhaps lowered with medications) and your eyes and extremities checked can all prevent you from becoming a diabetic complication statistic.

Dr. Reichman’s Bottom Line: Diabetes is not a disease that just goes away or takes care of itself. So be sure to strictly control your blood sugar with diet, exercise and appropriate medications. Close medical follow-up is in order… you, in partnership with your doctor, can make a huge difference in the outcome of this disease, your ultimate health and the quality of your life. Dr. Judith Reichman, the TODAY show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of .

PLEASE NOTE: The information in this column should not be construed as providing specific medical advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician.