MONDAY, Jan. 28 (HealthDay News) -- The number of Americans being diagnosed with and also living with type 2 diabetes is soaring, presenting a major health and economic crisis for the United States, a new study reports.

"What's alarming is we have 47 million uninsured people, but these people [in the study, enrolled under Medicare] are all insured. So in this kind of insured program, we have so many people who are not adhering to the recommended care," said Frank Sloan, lead author of the study published in the Jan. 28 issue of the Archives of Internal Medicine.

Sloan is professor of health policy and management at Duke University Medical Center in Durham, N.C.

The prevalence of type 2 diabetes is increasing not only in an aging population, but in younger persons as well. The condition brings with it high risks of complications such as blindness, kidney disease, eye disease and amputations.

To see whether health outcomes in older people with diabetes in the United States improved from the period 1994 to 2004, the study authors analyzed Medicare claims and other data. This information was compared with two "control" groups of people without diabetes.

Between 1994-95 and 2003-04, the annual incidence of diabetes (new diagnoses) increased by 23 percent, while the prevalence (those living with the disease) increased by 62 percent.

Complication rates among people with diabetes stayed the same or increased. Strikingly, there was a large increase in kidney disease.

Most individuals with diabetes had at least one complication within six years of diagnosis. Almost half had congestive heart failure.

The study points to a stark need for preventive strategies, said Dr. Spyros Mezitis, an endocrinologist at Lenox Hill Hospital in New York City.

"What we're doing is treating, and we're not treating the problem at the beginning," he said. "Already one-third of the budget for Medicare is for diabetes. This is an epidemic, and we're not doing much to prevent it, and we're not doing very well controlling it. It's going to get worse before it gets better."

Jane Bolin, associate professor of health policy and management at Texas A&M Health Science Center School of Rural Public Health in College Station, added: "It starts back at prevention and has to do with healthier lifestyles and teaching people how to monitor themselves. Right now, self-management is not reimbursable [by Medicare] unless done under certain conditions, and it puts a hardship on a lot of patients. I think we're becoming better at diagnosing and dealing with complications, but we need to move back further to prevention."

An estimated 19 million to 20 million Americans have type 2 diabetes, and about one-third of them don't even know they have the disease. It is characterized by high levels of blood sugar that are caused by the body's inability to process the hormone insulin to transport blood sugar to cells for energy.

Another study in the same issue of the journal questions how accurate Medicare data is in reflecting the health and health needs of the U.S. population.

Clinical trials used by Medicare to make decisions about coverage include participants who are not representative of the actual Medicare population, said the study authors, from the University of California, San Francisco, School of Medicine.

Trial participants tended to be younger, male and living in countries outside the United States, the researchers said.

More information

Visit the American Diabetes Association   for more on diabetes.

MONDAY, Jan. 28 (HealthDay News) -- New research suggests the caffeine in those daily cups of java might spell blood sugar trouble for diabetics.

In a small group of 10 diabetics, glucose levels rose by 8 percent when participants took pills filled with the level of caffeine found in four cups of coffee.

"There's reason to believe that caffeine consumption -- and coffee is the most common source of caffeine -- may be harmful to people with type 2 diabetes and make it more difficult for them to keep their glucose levels under proper control," said study author James Lane, a professor of medical psychology at Duke University.

While some research has suggested that the antioxidants in coffee could prevent diabetes in women, laboratory tests have questioned whether caffeine disrupts the body's ability to process blood sugar. "We want to demonstrate that what we've seen in the lab takes place in the real world when people are living their normal lives," Lane said.

In the new study, researchers inserted a small sensor into the abdomens of 10 patients who had diabetes but didn't take insulin. The sensor kept track of blood sugar levels for up to 72 hours.

Over several days, the patients -- all coffee drinkers -- alternated between taking placebos and 500 milligrams of caffeine a day in capsule form. That level of caffeine is equal to four eight-ounce cups of coffee.

The findings appear in the February issue of Diabetes Care.

On days when they consumed the caffeine pills, the blood sugar levels of the patients went up by 8 percent compared to when they took placebos. Glucose also rose after meals, most notably after dinner when blood sugar levels grew by 26 percent.

There are a couple possible explanations, according to Lane. In one, caffeine may interfere with the transfer of glucose from blood into the cells of the body, boosting blood sugar levels. Another possibility, he said, is that caffeine may stimulate the liver to release glucose when it's not needed.

A researcher who studies coffee said the new study has some limitations. For one, it looks at effects over one day, rather than over the long term, said Rob van Dam, a research scientist at Harvard School of Public Health. For another, "it should be noted that effects of caffeine in capsules cannot be directly translated to effects of caffeinated coffee, as studies have previously found less pronounced effects of caffeinated coffee on blood glucose levels as compared with caffeine in isolation," he added.

What to do? Keep coffee consumption under control, Lane suggested. "It would be worthwhile for people with diabetes who drink coffee to try quitting for a time and see if their glucose improves," Lane said. "It's a simple thing that might make their diabetes better."

Decaf may also do the trick. Indeed, van Dam said a previous study showed decaffeinated coffee actually reduced spikes in glucose levels after people ate sugary food. "It may thus be useful for persons with diabetes to try switching from caffeinated to decaffeinated coffee and see whether this improves their glycemic control, he said.

More information

Learn more about diabetes from the National Institutes of Health.

MONDAY, Jan. 21 (HealthDay News) -- Increased blood sugar levels signal a heightened risk of heart disease, especially among women, a new study finds.

In fact, women may face a greater risk for heart disease at lower blood sugar levels than men, according to the report in the Jan. 22 issue of the Journal of the American College of Cardiology.

"The new definition of high fasting glucose, which is defined as a blood sugar between 100 and 125 milligrams per deciliter [of blood], has the same predictive value of diabetes and heart disease as the old definition of fasting glucose, which was 110 to 125 milligrams per deciliter," said lead researcher Dr. Caroline Fox, a medical officer with the Framingham Heart Study.

Moreover, for any level of blood sugar, women have a higher risk of developing diabetes and heart disease compared with men, Fox added.

In the study, Fox and her colleagues collected data on 4,058 men and women who were the children of the original participants in the Framingham Heart Study, a 50-year research project named for a Massachusetts town. During four years of follow-up, 291 people in Fox's trial developed heart disease.

The researchers found that the higher the blood sugar at the start of the study, the greater the likelihood of developing heart disease. Based on the new definition of high blood sugar, the researchers determined that women were at greater risk for developing heart disease than men.

Specifically, women whose blood sugar was at 110 to 125 milligrams per deciliter of blood had the same risk of developing heart disease as women with diabetes.

Dr. John B. Buse, president for medicine & science at the American Diabetes Association (ADA), said this study confirms what other studies have found.

"Women who don't have diabetes usually don't have heart attacks," said Buse, who is director of the Diabetes Care Center at the University of North Carolina. "Women with diabetes, basically, all have heart attacks."

People at risk of diabetes should have their blood sugar measured, Buse added. "If the fasting glucose test is elevated more than 100 milligrams per deciliter [of blood], it means that you are at risk of developing diabetes and you may have some excess risk of heart disease, particularly if you are a woman," he said.

The ADA recommends that everyone over age 45 should have a fasting glucose test, Buse said. "Normal is less than 100 milligrams per deciliter, so 99 is normal, 100 isn't," he said. "If the test is normal it should be repeated every three years."

People under 45 who are overweight and have any risk factors for diabetes should be screened earlier and more often, he said.

More information

For more on diabetes, visit the American Diabetes Association  .