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Hemochromatosis, a genetic metabolic disorder where a person absorbs too much iron in the digestive tract, can result in diabetes, according to researchers at the Centers for Disease Control and Prevention (CDC) in Atlanta.
Dr. Mary Cogswell, an epidemiologist at the CDC, says hemochromatosis is underdiagnosed. She explains that when too much iron accumulates, it can cripple the islets of the pancreas and cause diabetes. Cogswell points out that diabetes is the fourth leading disease associated with hemochromatosis, ranking behind arthritis, severe fatigue and elevated concentrations of liver enzymes.
Vincent Felitti, MD, FACP, an internist in the department of preventative medicine at Kaiser Permanente Hospital in San Diego, says if hemochromatosis is detected early enough in its development, the problems can be reversed.
A problem in diagnosing hemochromatosis is that physicians will often look for the triad of skin pigmentation, diabetes and cirrhosis of the liver before making a diagnosis. By then, Cogswell says, hemochromatosis is already at the end stage, and it is too late to try to reverse the diabetes.
Hemochromatosis is unlikely to be detected in patients with diabetes and liver diseases, unless the doctors look for it specifically.
Tested Once in a Lifetime
Felitti says that people with hemochromatosis frequently exhibit no symptoms. He feels that the general population should be tested for hemochromatosis at least once during their lifetime, adding that the test should come early in life for those who have a family history of the disorder.
"At the very least, all [people with type 2 diabetes] should be tested...when blood sugars are found to be elevated enough to warrant a diagnosis of diabetes," says Felitti. "There are people who have hemochromatosis that do not manifest it in any way except in death."
Richard Dickey, MD, president of the American Association of Endocrinology and a practicing endocrinologist in Hickory, North Carolina, says that testing or special screening for hemochromatosis could be costly.
"Medicare will not pay for it," says Dickey. "...It costs $54 in my lab and [patients] would have to pay for it themselves."
Gerald Rogan, MD, a spokesperson for Medicare, points out that hemochromatosis testing is covered if a person has been diagnosed with diabetes and his or her physician feels there might be a connection with hemochromatosis. However, if the tests are performed in the absence of any signs or symptoms of an illness, they are categorically not covered by Medicare unless authorized by Congress.
Dickey agrees that despite the cost, every person with an endocrine disorder or evidence of liver disease should be tested.
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