Description
Diabetes is a chronic health condition that affects how your body turns food into energy. With diabetes, your body doesn’t make enough insulin or can’t use it as well as it should. When there isn’t enough insulin or cells stop responding to insulin, too much blood sugar stays in your bloodstream. Over time, that can cause serious health problems, such as heart disease, vision loss, and kidney disease. People with diabetes are more likely to develop heart disease and have certain risk factors, such as high blood pressure or high cholesterol, that increase their chances of having a heart attack or a stroke. High blood glucose from diabetes can damage blood vessels and the nerves that control your heart and blood vessels. Over time, this damage can lead to heart disease. Adults with diabetes are nearly twice as likely to have heart disease or stroke as adults without diabetes. High blood pressure, high low-density lipoprotein (LDL) cholesterol, smoking, and secondhand smoke exposure, obesity, unhealthy diet, and physical inactivity are leading risk factors for heart disease and stroke. Proper control and treatment of diabetes is critical as both the prevalence and economic burden of the disease continue to mount.
Summary Listen
- Treating diabetes has evolved from simply managing glycemic control to preventing complications like cardiovascular and kidney issues, focusing on improving patients' quality of life. Early, aggressive treatment is crucial, but must be personalized for each patient, considering their individual needs and conditions. Doctors should ensure patients understand the importance of diet, physical activity, and medication, fostering confidence and adherence to treatment plans.
- Type 2 diabetes development involves genetics, weight gain, and hypertension, leading to insulin resistance and hyperglycemia. Macrovascular complications often begin before a diabetes diagnosis, emphasizing the need for proactive cardiovascular care. Subclinical cardiovascular disease is significantly more prevalent in individuals with diabetes, increasing the risk of cardiovascular events.
- Cardiovascular disease is a major concern for diabetics, with high rates of stroke, myocardial infarction, heart failure, and coronary artery disease. Beyond cardiac issues, diabetes can lead to cardiac autonomic neuropathy, non-alcoholic fatty liver disease, left ventricular diastolic dysfunction, chronic kidney disease, and obstructive sleep apnea. Holistic care is essential to address these interconnected complications.
- Specific medications, such as SGLT2 inhibitors, have demonstrated promising results in reducing A1C levels, improving time-in-range, and offering cardioprotective benefits. These medications can also improve insulin resistance, lower cholesterol, and reduce liver fat. Benefits extend to blood pressure reduction, improved left ventricular function, decreased syncope episodes, and reduced obstructive sleep apnea.
- SGLT2 inhibitors have shown to decrease the likelihood of microalbuminuria and significantly reduce the risk of cardiovascular events. They can also reduce hospitalizations due to heart failure. Treatment approaches have shifted to using medications that not only control blood sugar but also protect the heart, kidneys, and nerves.
- Treatment strategies should consider the presence of atherosclerotic cardiovascular disease, heart failure, stroke risk, and chronic kidney disease when selecting medications. Individualized glycemic targets are essential. Early intervention is vital, aiming for rapid A1C reduction. Patient education and cost-effective treatment options play a crucial role in long-term management.
- Technology, like continuous glucose monitoring devices, can assist in managing diabetes and cardiovascular health, though cost is a consideration. Ultimately, consistent monitoring of blood glucose levels is key. Engaging the patient in the decision-making process and providing them with various medication options with their pros and cons enhances adherence and promotes a better quality of life.
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About the Speakers
Dr Harsh D. Shah,
Consulting Diabetologist Diabconnect, Mumbai
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