Type 2 diabetes.(Women's Health Adviser)

Type 2 diabetes currently affects an estimated 7.5% of American adults, and the incidence is expected to reach 9% by 2005, according to American Diabetes Association Clinical Practice Recommendations. The chronic hyperglycemia associated with the condition can impact nearly every organ system and increase the risk of heart disease, stroke, and peripheral vascular disease.

Yet diabetes is often not diagnosed until these complications appear, and about one-third of individuals with diabetes may be undiagnosed. When left untreated, prediabetic conditions--including impaired fasting glucose levels and impaired glucose tolerance--significantly increase the risk of cardiovascular disease and frank diabetes. But early identification of these conditions, and treatment with diet and exercise, can reduce the risk of later developing type 2 diabetes and its attendant problems.

* Risk Factors. The risk of developing type 2 diabetes increases with age, obesity, physical inactivity, and a family history of type 2 diabetes. The disease is more common in those who are black, Hispanic, Native American, and of Asian or Pacific Island descent. Hypertension and dyslipidemia are also risk factors. Women who have had gestational diabetes, who have delivered a baby weighing more than 9 pounds, and who have polycystic ovary syndrome also have a significantly increased risk of developing type 2 diabetes.

* Screening. Studies have shown that screening is most effective when done in a clinical setting. In a community setting, patients often fail to follow up on a positive screen. In addition, there's no way to ensure appropriate repeat testing for those with negative screens. Community screening inappropriately tests patients at low risk and misses those at high risk.

The American Diabetes Association (ADA) recommends that screening begin at age 45 and be offered every 3 years for all patients, particularly those who are overweight (body mass index of at least 25). The 3-year interval allows plenty of time to repeat any false-negative test results, but is short enough to preclude serious complications if diabetes develops in the interim.

Testing may begin at a younger age or be offered more frequently to patients who are overweight and have at least one additional risk factor. Women with gestational diabetes face a ...