Two out of three Americans with type-2 diabetes do not have their disease under control and risk early deaths from Stroke, Heart attack or kidney failure as well as Blindness and limb loss, according to a report published on Wednesday.

Doctors and patients alike need to do more to test for diabetes and then to control it with diet, exercise and, if necessary, drugs, the report said.

“Diabetes management actually worsened in the past 10 years,” Dr. Jaime Davidson, a Diabetes expert at the University of Texas Southwestern Medical School in Dallas, told a news conference. “We have the tools but we are not doing better.”

Unlike juvenile or type-1 diabetes, type-2 diabetes is almost exclusively caused by poor diet and a lack of exercise, although it may involve a genetic susceptibility. As many as 18 million Americans now have it, including a growing number of children and young adults.

Type 2 Diabetes Mellitus can be prevented with improved diet and exercise. It can also be controlled with diet and exercise but many people also need medications to control it and some may eventually need insulin.

The American Association of Clinical Endocrinologists and the American College of Endocrinologists commissioned a survey of 157,000 people with type-2, or so-called adult-onset Diabetes. They looked at a blood sugar reading called A1C, and found 67 percent of the patients did not have an adequate A1C level.

“Two out of every three people analyzed in this study were not in control of their blood sugar,” said Dr. Lawrence Blonde of the Ochsner Clinic in New Orleans, a member of the American College of Endocrinologists.

In every state, 50 percent or fewer patients had adequate blood sugar control, they found. The A1C test indicates average blood sugar levels over the past two months or so by measuring how much glucose is attached to red blood cells.

KEEPING TRACK OF GLUCOSE

The average lean, healthy young American adult has an A1C of about 5.1 percent and the highest desirable level is 6.5 percent. An A1C reading of 6 percent correlates to an average daily blood sugar reading of 135, while 7 percent indicates an average of 170 over the preceding weeks.

Blood sugar should be below 110 before eating and no higher than 140 after eating.

A separate, Harris Interactive survey of 501 adults with diabetes showed that more than 60 percent did not know what A1C was. And 84 percent believed they were doing a good job of controlling their blood sugar. When glucose levels are too high, they can damage the insides of the blood vessels, leading to heart attacks and stroke. They can damage the tiny capillaries inside the eyes and kidneys, causing blindness and kidney failure.

“Diabetes doesn’t necessarily hurt,” said singer and actress Della Reese, who has type-2 diabetes. “If you have a backache, the backache will make you take your medication. But this will slip up on you.”

She said people need to do more to make sure they are screened for diabetes, and to take care of themselves if they have it. “The doctors mean well but they are not going to be with you 24 hours a day,” Reese told the news conference.

Surgeon-General Dr. Richard Carmona said 40 percent of Americans aged 40 to 74 now have pre-diabetes. They still have a chance to prevent diabetes itself if they begin to exercise and eat more healthily. “We must do something about this now,” Carmona said.

“Every single year we add 1.2 million Americans with this problem,” Davidson said. “It cost us in 2002 about $132 billion.”

And drugs can help manage diabetes but cannot cure it. “Once complications have set in, you cannot magically reverse it,” said Dr. Paul Jellinger, president of the American College of Endocrinologists.