A separate study being published in the same issue finds that inconsistent methods for measuring glucose levels in the hospital make it difficult for doctors to help people with diabetes maintain target levels that could increase their chances of surviving serious illnesses. And, a third study points to the dramatically increasing economic burden of diabetes for people in developing countries, such as India.

People with Diabetes Fail to Get Enough Physical Activity

According to a study by researchers at the University of Colorado at Denver and Health Sciences Center, just 39 percent of adults with diabetes are physically active, compared to 58 percent of adults who don't have diabetes. As the number of risk factors for type 2 diabetes (such as obesity and hypertension) increase, the amount of physical activity decreases, the study found.

The results reinforce the need for Americans to become more physically active in general, but also suggest a need to better tailor exercise programs for people who may have physical limitations as a result of their disease, said lead researcher Dr. Elaine Morrato.

"Everyone can benefit from regular, daily physical activity," she said. "But people who have diabetes, or who are at greatest risk for it, have even greater incentive to get out there and exercise. We know for a fact that increased physical activity can greatly reduce the risk for type 2 diabetes and its numerous complications. We need to do a better job reaching, motivating and helping these people to stay active."

The study looked at activity levels for adults with both type 1 and type 2 diabetes. While increased physical activity can't prevent type 1 diabetes (the least common form of diabetes), it can help to prevent complications in both type 1 and type 2 diabetes. Numerous studies have shown that regular physical activity does help to prevent type 2 diabetes, the most common form of this disease.

Studies show that exercising for 30 minutes a day, at least five days per week, along with moderate weight loss, can reduce the risk of developing type 2 diabetes by nearly 60 percent. Dr. Morrato said people who have diabetes may have a harder time exercising because of complications from the disease, such as painful peripheral neuropathy. The challenge is to encourage people to work exercise into their routine before diabetes and its complications develop, or to find ways to help them stay active if complications have already set in.

Managing Glucose in the Hospital: The Need for Consistency

Studies show that when people with diabetes are admitted into the hospital for serious illnesses, they are more likely to survive if their glucose levels are kept under tight control.

But maintaining proper glucose targets isn't that simple, according to a paper by the research team led by Dr. Kathleen Dungan at the University of North Carolina at Chapel Hill. Numerous variables can make it difficult to determine if the patient is actually meeting optimal glucose targets. For example, where blood is taken from and the instrument used to measure glucose levels can produce substantially different results. Medications can also obscure proper blood glucose readings, along with the patient's physiology.

"Nowhere else is there greater potential for multiple confounding factors to be present at once than in the hospital setting," wrote the authors, in the paper's conclusions. Because of this, the researchers advise that glucose targets be individualized for each health care setting, taking into account how measurements will be taken and the needs of specific patient populations.

In India, Diabetes Takes One-Third of Family Income from Poor

The economic burden of diabetes in developing countries has risen substantially over the past decade, as the prevalence of this potentially fatal and often debilitating disease has also grown worldwide.

In India, which lacks a comprehensive health care system, the direct cost of diabetes has doubled since 1998, as it has in the United States. However, the economic burden upon low-incomes families is much higher in developing countries such as India, where reimbursement for care is low to nonexistent. In India, poor urban families spend as much as 34 percent of their total income treating diabetes and its complications; the rural poor don't fare much better, spending up to 27 percent of their income on health-related costs due to diabetes.

Not surprisingly, the economic burden for families grew along with the duration of their diabetes and the number of complications they developed.

Diabetes Care, published by the American Diabetes Association, is the leading peer-reviewed journal of clinical research into the nation's fifth leading cause of death by disease. Diabetes also is a leading cause of heart disease and stroke, as well as the leading cause of adult blindness, kidney failure, and non-traumatic amputations. For more information about diabetes, visit the American Diabetes Association Web site http://www.diabetes.org/ or call 1-800-DIABETES (1-800-342-2383).