Early Detection Of Diabetes A Ray Of Hope

In view of the large reservoir of unknown diabetes that exists, and be­cause there is evidence, though disputed by some, that if the disease is found early and properly managed, it will cause fewer complications and the life-span will be prolonged, early detection of the disease is the most important component of a diabetes control program.

Diabetes can be detected either by examination of the urine for the presence of sugar or by determination of the glucose level of the blood. There is ample evidence that blood tests are superior to urinalyses in the detection of diabetes, being both more sensitive and more specific.

For the determination of glucose in the urine, there are a number of simple and inexpensive methods. Best known is the test employing Bene­dict's solution and heat. Unfortunately, this test is difficult to use in large-scale detection programs because of the need to collect urine specimens in a central location. This difficulty can be overcome by the use of the St. Louis Dreypak, in which a piece of blotting paper is dipped into the urine specimen, allowed to dry, and mailed to a laboratory, where testing with Benedict's solution is carried out. More recently, tests for glycosuria have been developed that depend on the presence in test paper of a specific enzyme, glucose oxidase. In the presence of glucose, color changes develop within a matter of seconds.

In the past, blood sugar determinations were seldom used in mass screening programs because of the technical difficulties inherent in the chemical analysis for glucose and the necessity of obtaining specimens of venous blood. Historically, the Clinitron was the first automated method of blood sugar determination.

Another blood test recently developed is that in which Dextrostix (Ames) are used. These are cellulose strips that have been impregnated with glucose oxidase. A color change develops when a drop of blood has been allowed to permeate the tip for precisely 60 seconds. This can then be compared to standards to give a reasonably accurate quantitative result.

Still another technique is to set up an AutoAnalyzer in some central location, to which blood specimens (with sodium fluoride as preservative) may be mailed for analysis from many different parts of a state. Either venous or capillary blood can be processed by this method.

DIABETES AS A PUBLIC HEALTH PROBLEM

The greatest reservoir of undetected diabetes is in adults. Juvenile diabetes is almost invariably a symptomatic disease, which brings the patient promptly to medical attention. In adults, however, the symptoms are less obvious or even completely lacking. Among adults, the greatest number of diabetics are found among relatives of known diabetics, among the obese, and with increased frequency in each advancing decade of life.

Recently there has been considerable interest in the possibility of detecting prediabetes. There is reason to believe that certain patients with low renal thresholds for glucose, certain patients with spontaneous hypo-glycemia, and some with relatively minor or intermittent abnormalities of carbohydrate metabolism may become frankly diabetic at a later date. Errors in carbohydrate metabolism may be provoked through cortisone administration.

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