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Manage Your Blood Sugar, Control Your Heart

Insulin resistance associated with high blood pressure and other risk factors.

High blood glucose in adults with diabetes increases the risk for heart attack, stroke, angina, and coronary heart disease. More than 29 million people, or about 9% of the U.S. population, have diabetes. According to the Center of Disease Control (CDC), “Managing your diabetes can lower your risk for heart disease and stroke.” Heart disease comprises several medical conditions that can easily be prevented, if caught ahead of time. Lifestyle modification, such as regular physical activity, smoking cessation, and healthy diet is the key, however, people with prediabetes, at risk for diabetes, or with diabetes, commonly have other comorbidities, for instance, hypertension and hyperlipidemia that can be treated to prevent cardiovascular disease (CVD).

Although improvement in medical innovation has increased the survival rate of heart-related complications, the incidence of diabetes is on the rise, which adds on to newer cardiovascular-related cases. Patients with diabetes are either unable to produce enough insulin, unable to use insulin properly, or in some cases, both. The long-term effects of elevated blood sugar levels building up damages the blood vessels leading to devastating complications, such as CVD, nerve damage, vision and kidney problems. Hence, the best way to prevent the progression of heart disease is to prevent diabetes itself. Blood sugar levels must be monitored regularly and patients must know how to adjust their medications with their meal plan if the blood sugar before eating is ≥130 mg/dL, if the post-prandial blood sugar after 2 h is ≥180 mg/dL, if the blood sugar is <70 mg/dL, or or <90 mg/dL with symptoms.

High blood pressure (HBP) is one of the major risk factors for heart disease that has shown association with insulin resistance. Having both diabetes and HBP amplifies the risk for heart diseases. Individuals with insulin resistance or diabetes in combination with one or more of these risk factors are at even greater risk of heart disease or stroke. However, by managing their risk factors, patients with diabetes may avoid or delay the development of heart and blood vessel disease. Controlling HBP reduces the risk of CVD among persons with diabetes by 33% to 50%, and the risk of diabetic kidney, eye, and nerve disease by ~33%. In general, the risk for diabetes-related complications is reduced by ~12% for every 10 mmHg reduction in systolic blood pressure4. Moreover, studies have shown that control of cholesterol or blood lipids (HDL, LDL, and triglycerides) can reduce CVD complications by 20% – 50%. Patients with diabetes with premature coronary heart disease often have a triad of high LDL (bad) cholesterol, low HDL (good) cholesterol, and high triglycerides. The target levels should be lower than those without diabetes with HDL >40 for men and >50 for women, LDL <100, and TGs <150. These goals can be achieved with a low-fat, high-fiber, lower-calorie meal plan, and weight loss with physical activity.

Evidence suggests that a sedentary lifestyle and being overweight or obese can increase blood glucose, blood pressure and blood fat levels. Weight control and smoking cessation are two modifiable risk factors that can prevent CVD. Physical activity can improve cardiovascular risk, decrease insulin concentration and increase insulin sensitivity with a modest weight loss of 7% of body weight (15 pounds if you weigh 200 pounds). The Diabetes Prevention Program, a study sponsored by the National Institutes of Health (NIH), has proven that optimizing a healthy weight with a 30-min. physical activity for five days a week can reduce the development of type 2 diabetes over three years by >50%. Emphasis on healthy eating habits that are low-fat and high-fiber with low-salt meal plan is important as well. Lastly, smoking cessation is emphasized because smoking doubles the risk of CVD in people with diabetes, since nicotine constricts blood vessels and restricts blood flow.

In conclusion, diabetes is a major complication of CVD and causes death 2 times higher among adults with versus without diabetes. There is no universal way to avoid cardiovascular complications, but its progression can either be prevented or delayed by keeping blood glucose, blood pressure and cholesterol levels under control. Developing an action plan with the help of a provider can lower the chances of having a heart attack or stroke by managing Diabetes ABCs (A1C test, blood pressure, cholesterol, and stopping smoking).

Practice Pearls:

  • Adults with diabetes can lower their chances of having a heart attack or stroke by managing diabetes.
  • Adults with diabetes are 2 times more likely to die from heart disease or stroke than person without diabetes.
  • Adults with diabetes must take charge of modifying risk factors by developing a plan by eating healthy, being active, being aware, and managing their goals.

References:

  1. “Diabetes | NIDDK.” National Institutes of Health. U.S. Department of Health and Human Services, n.d. Web. 13 Feb. 2017.
  2. Nathan DM, Cleary PA, Backlund JY, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005 Dec 22; 353(25): 2643­2653.
  3. National Institute of Diabetes and Digestive and Kidney Diseases. National diabetes statistics fact  sheet: general information and national estimates on diabetes in the United States, 2005. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health; 2005.
  4. Taan G. How to prevent or delay heart disease in diabetics. Diabetes & Metabolism. 2016 Sep; 42(4): 301.
  5. “Diabetes, Heart Disease, and You.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 2016 23 Nov. Web. 13 Feb. 2017.