Sante Wellness Centre

AGGRESSIVE CONTROL OF TYPE 2 DIABETES IMPERATIVE
IN THE PREVENTION OF CARDIAC DISEASE

By: Angela Missaggia RNNP, CV-CNS, MSN

The American Diabetes Association’s 62nd Scientific Sessions was recently hosted in San Francisco, California, and took place this past June. The conference covered numerous concerns, and medical information, related to both Type 1 and Type 2 diabetes. One of the most significant discussions involved the risk of cardiac events, such as a stroke or heart attack, in patients with Type 2 diabetes.

TYPE 2 DIABETES

Type 2 diabetes affects approximately 17 million adults in the US, and is the sixth leading cause of death. The prevalence of diabetes has increased by 49% over the past 10 years, according to the Centers for Disease Control and Prevention, with the figure expected to increase. Type 2 diabetes, formally known as non-insulin dependent type, or adult-onset diabetes, is the most common form of diabetes and affects 90%-95% of patients with the disease. Type 2 diabetes has a gradual onset, a slow progression of symptoms, and occurs mainly in adults over 30 years of age. Symptoms of diabetes include, but are not limited to, excessive thirst (polydipsia), excessive hunger (polyphagia), excessive urination (polyuria), and weight loss. However, many patients with type 2 diabetes remain symptom free, and may have the disease for several years before being diagnosed. The pathophysiology of type 2 diabetes involves two processes: insulin resistance, and impaired insulin secretion. Insulin resistance is characterized by the body’s inability to use insulin efficiently. Impaired insulin secretion, on the other hand, is the inability of the pancreas to produce enough insulin. Insulin, produced and secreted by the pancreas, is essential for the normal metabolism of glucose (blood sugar).

 

PATHOPHYSIOLOGY

With insulin resistance and impaired secretion, abnormally high levels of glucose is maintained within the body’s circulation. Long term effects compromises the body’s circulation: both the microvascular and macrovascular circulation. Microvascular circulation is the blood flow within smaller arteries and veins, whereas macrovascular is that within the larger arteries and veins. Microvascular complications of Type 2 diabetes includes: damage and impairment of vision (retinopathy), compromised kidney function (nephropathy), and disabling pain and numbness to the lower extremities, i.e., legs (neuropathy). Macrovascular complications include: angina, heart attacks, and stroke (coronary artery disease/cardiac events), and poor circulation to the legs (peripheral vascular disease).

NEW DESIGNATION FOR TYPE 2 DIABETES

During the 62nd Scientific Sessions this past June the results of a survey, conducted by the American Diabetes Association and the American College of Cardiology, was presented. According to this survey, diabetes has been identified as the number one risk factor for cardiovascular disease (CVD). 900 physicians were surveyed, and included a nationally representative sample. Of those surveyed, more than 90% of physicians reported the potential for a cardiac event (heart attack or stroke) in a patient with diagnosed diabetes is "very" or "extremely" likely. In addition, new clinical guidelines were issued last year by the National Cholesterol Education Program (Adult Treatment Panel III). According to these clinical guidelines, diabetes is now classified as a coronary heart disease equivalent, meaning "a risk for major coronary events (like heart attack and stroke) is equal to that of established coronary heart disease". (Established coronary heart disease means the patient has already suffered either: a heart attack, angina, or a stroke).

PRIMARY PREVENTION OF TYPE 2 DIABETES

Primary prevention of type 2 diabetes focuses on health care maintenance. Patients need to be aware of, and assume the responsibility for, implementing measures to improve their health and wellness. Principles to remember and employ are: maintaining an ideal body weight, getting regular exercise, improving eating habits, limiting alcohol consumption, and smoking cessation.

MANAGEMENT STRATEGIES FOR DIABETES

Lowering the blood glucose level, and maintaining it within normal limits, is a primary goal. Yet, a significant amount of responsibility exists between the patient and the primary medical provider to reduce ALL cardiovascular risk factors, including smoking cessation, weight management, tight control of high blood pressure (hypertension), and aggressive control of high cholesterol (dyslipidemia). Prior research has shown that, whereas the general perception in diabetics is a greater risk for amputation and blindness, 68% of diabetic patients are unaware of their increased risk for cardiovascular events such as stroke and heart attack.

IMPROVED SCREENING FOR TYPE 2 DIABETES

Since the prevalence of Type 2 diabetes is on the rise, and early diagnosis is the best approach to preventing the complications of diabetes, the American Diabetes Association (ADA) recommends screening every three years in persons over the age of 45. However, for populations at a higher risk for developing the disease, screening should start at an earlier age. Populations at a higher risk for developing diabetes include: obese patients, those with a first-degree relative with diabetes, a member of a high risk ethnic group: Hispanic for example; anyone with a history of underlying cardiovascular risk factors: hypertension, dyslipidemia; and those with a prior history of an abnormal blood glucose test. In these patients annual testing should also be considered.

EMPOWERING THE PATIENT

My recommendation to you, the patient, is to take an active role in your health and wellness. Health care maintenance should be a priority, with consideration to maintaining healthy eating habits, keeping your weight at ideal for your height, including regular exercise into your daily routine, limiting alcohol, and abstaining from smoking. In addition, see your health care provider for appropriate wellness exams, and ask that recommended screening for diabetes be included. For those with diagnosed diabetes, compliance with the treatment plan is paramount. Additionally, discuss with your medical provider the importance of screening for all cardiac risk factors, with the goal of eliminating those that are modifiable: hypertension, dyslipidemia, obesity, and smoking cessation.

CONCLUSION

Type 2 diabetes, although a complicated and challenging disease, can be aggressively treated with the long-term microvascular and macrovascular complications prevented. With diabetes now regarded as the number one risk factor for cardiovascular disease, health care providers need to screen appropriately for it, since early diagnosis and management are primary goals to preventing Sequa lea of the disease. Anyone with underlying diabetes needs to control all other cardiac risk factors, with active participation in the treatment plan.

ADDITIONAL INFORMATION

For additional information or comments relating to the information presented above, please feel free to contact me at the Sante Wellness Centre, Day Spa and Retreat. Also, I invite suggestions for further health and wellness topics.

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REFERENCES

  • Conference News Update, American Diabetes Association 62nd Scientific Sessions.

  • CLINICIAN REVIEWS, October 2002. Lewis, Sandra J. MD. Cutting Cardiovascular Risk in Type 2 diabetes: A Call to Action.

  • CARDIOLOGY REVIEW, BRIDGING THE GAP BETWEEN RESEARCH AND PRACTICE. July 2002. Reasner, Charles A. MD. Aggressive Control of Type 2 Diabetes Using Oral Agents.

  • THERAPEUTIC SPOTLIGHT, October 2002. Uphold, Constance R., Graham, Mary Va. CLINICAL GUIDELINES IN FAMILY PRACTICE.

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