Panel urges widespread testing for diabetes.

For the first time, an expert committee convened by the American Diabetes Association (ADA) advises that all people age 45 and older get tested for Type 2 diabetes, the more common form of the blood sugar disorder.

If adopted, the change could lead to the identification of millions of people who had no idea they were suffering from this disease. An estimated 15 million people in the United States have adult-onset diabetes, but only about half are aware of their condition. The remainder suffer from vague symptoms or no symptoms at all, yet they may have damaging concentrations of sugar in the bloodstream.

Research has shown that people with Type 2 diabetes typically are diagnosed only after having had the disorder for 7 years. Type 1 diabetes, which usually strikes children and adolescents, can also go undiagnosed for years. A common symptom of both conditions is excessive thirst.

The panel of 17 experts also advises a change in the standard used to diagnose diabetes. Under the proposed guidelines, people with a blood sugar concentration of at least 126 milligrams per deciliter (mg/dl) of blood would be considered diabetic. Under the old standard of 140 mg/dl, as many as 20 percent of newly diagnosed diabetics have already sustained injury to their eyes or kidneys. Untreated, such damage can lead to blindness or kidney failure.

Earlier diagnosis of the disease should prevent or delay such complications, says panel chair James R. Gavin III, the senior scientific officer at the Howard Hughes Medical Institute in Chevy Chase, Md.

"We feel passionately that people need to take diabetes more seriously," Gavin says. "It's a disease that is completely treatable." Type 2 diabetics often control their blood sugar concentrations with diet and regular exercise, he says. In other cases, they must take insulin or other drugs to combat the disease. Type 1 diabetics take daily shots of insulin.

For adults who get good news after a diabetes test, the panel recommends continued vigilance. It says such people should repeat the test every 3 years. That course of action will prevent hidden damage from accumulating if excessive blood sugar concentrations subsequently develop, the panal predicts.

For adults who are at high risk of developing diabetes, the group opts for a more aggressive course of action, recommending a diabetes test before age 45 and at yearly intervals thereafter. Risk factors for Type 2 diabetes include a family history of the disorder, obesity, and uncontrolled high blood pressure, the panel notes.

"We urge that the [panel's guidelines] be widely disseminated and implemented," comments Richard C. Eastman of the National Institute of Diabetes and Digestive and Kidney Diseases in Bethesda, Md. The federal Centers for Disease Control and Prevention in Atlanta and the American Diabetes Association (ADA) in Alexandria, Va., have also endorsed the panel's report.

The panel announced the new guidelines June 23 at the 57th Annual Scientific Sessions of the ADA held in Boston. A detailed report written by the panel appears in the July Diabetes Care.