ADA Recommends New Diagnostic Criteria For Diabetes

By Brian McCurdy, Associate Editor

The American Diabetes Association (ADA) recently released its 2003 Clinical Practice Recommendations and one of the highlights is a new methodology of diagnosing diabetes. Using an altered version of a test may change the number of how many people are diagnosed with diabetes, according to the ADA. The ADA recommends practitioners use the following criteria: • Symptoms of diabetes plus casual plasma glucose concentration 200 mg/dl (11.1 mmol/l); or • FPG >126 mg/dl (7.0 mmol/l); or • 2-h PG > 200 mg/dl (11.1 mmol/l) during an OGTT. The new criteria change the previous recommendation of an FPG test result of 140 mg/dl, as established by the World Health Organization (WHO) in 1985. Leon Brill, DPM, says he has found the FPG is “the easiest test to use.” If Dr. Brill has a patient whose FPG result is 126 or higher, he refers the patient to his or her primary care provider. “Since we are a specialty practice, the more common scenario is seeing a patient with symptoms of diabetes and finding a random blood sugar of 200 or more,” says Dr. Brill, a Fellow of the American College of Foot and Ankle Surgeons. In that scenario, he will then order an FPG. In Dr. Brill’s experience, the OGGT requires “time and planning which our patients often do not have.” Likewise, the ADA does not recommend the OGTT for routine use, saying the test can be an “inconvenience to patients.” Does This Affect The Prevalence Of Diagnosis? According to the ADA, one study estimates the total prevalence of diabetes (including those with a medical history) among 40 to 74-year-olds in the United States would be 12.27 percent with the modified FPG criteria. This would actually be lower than the 14.26 percent prevalence using the WHO criteria, according to the ADA. However, the ADA believes that the new criteria and more widespread use of the simpler FPG test may lead to more people being diagnosed with diabetes. “Presently, about half the adults with diabetes in the U.S. are undiagnosed,” notes the ADA, “but many might now be diagnosed if the simpler FPG test were always used.” “Although the number of patients diagnosed with diabetes may go down, ultimately the number will increase due to the easier and less expensive way to diagnose and reach more of the 50 percent that is currently undiagnosed,” adds Dr. Brill. Why change the FPG cutpoint? At an FPG of 126, the prevalence of complications specific for diabetes, such as retinopathy and nephropathy, increases dramatically. The ADA notes there is no evidence to support the 2-h PG being more accurate than the FPG. New Wound Dressing Receives FDA Clearance By Gina DiGironimo, Production Editor Get ready to add a new wound and burn dressing to your armamentarium of treatment options. Cardiotech International recently garnered FDA approval for the CardioTech Antibiotic Hydrogel Wound Dressing, which is indicated for venous stasis ulcers, diabetic ulcers, blisters, pressure sores, lacerations, abrasions and superficial wounds. According to the Massachusettes-based company, the hydrogel dressing is “semi-occlusive and absorptive.” Citing the dressing’s antibiotic mixture of neomycin sulfate, bacitractin zinc and polymyxin B sulfate, the company says the dressing’s absorptive ability facilitates faster coagulation without drying out the wound or the area around the wound. The dressing’s absorption also helps facilitate less frequent dressing changes than other products, according to the company. In Brief Healthpoint, Ltd. has introduced the first unit dose packaging of its prescription ointments Panafil and Accuzyme. The bar coded 6-g units complement the standard 30-g tubes. Panafil is a healing, debriding and deodorizing ointment while Accuzyme is an enzymatic debriding ointment that helps remove dead tissue. Healthpoint also recently announced that its Oasis Wound Matrix has received a conditional letter of inclusion in the United States Pharmacopoeia (USP). According to the company, USP listings are reserved for products that meet “specified standards of quality, identity, strength and purity.” Podiatrists who had questions about their policies were able to get answers right from the top at the recent New York Podiatric Clinical Conference. Anthony Bonomo and Jerry Dolman, the President and Executive Vice-President of Physicians Reciprocal Insurers (PRI), held court and fielded questions from DPMs who attended the conference. According to PRI, numerous discount opportunities are available for podiatrists who meet specific risk, education and experience requirements. For more information, contact (800) 632-6040. Clarification In the January 2003 Wound Care Q&A article, “Expert Insights On New Advances In Wound Care,” the following paragraph should have read as follows: “XCell is another wound care dressing that can provide moisture to the wound if it is dry and absorb moisture from the wound if it is too moist. Dr. Alvarez says this microbially-derived cellulose dressing provides a good environment for autolytic debridement as well as healing. He adds that clinical studies on venous ulcers are underway.” In the January 2003 continuing education article, “Understanding The Link Between Nutrition And Wound Healing,” the multiple choice option of b for question number 5 on the quiz (see page 54) should have been “60 milligrams per day.”

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