Diabetes Mellitus - A Cardiovascular Disease

Executive summary By Shashi Agarwal MD 

“Life is not over because you have diabetes. In diabetes type 2, either the pancreas does not produce enough insulin or the cells in the muscles, liver, and fat do not use insulin properly, or both. People with diabetes are at a much higher risk of developing cardiovascular diseases like heart attack, stroke, peripheral artery disease and heart failure.

prevalence of type 2 diabetes

The incidence of diabetes is reaching epidemic proportions. Elevated blood glucose levels are responsible for 21% of deaths from coronary heart disease and 13% of deaths from stroke. Almost 65% patients with diabetes die of heart attack or a stroke. This cardiovascular risk develops even before diabetes becomes clinically apparent. This data from the Nurses Health Study, was published in the July 2002 issue of Diabetes Care.

Eighty percent of patients with type 2 diabetes are either obese or overweight. Diabetics also carry an abnormal lipid profile. The combination of high blood sugar and high insulin levels are also toxic to the cardiovascular system. Further, more than two thirds of the adults with diabetes suffer from high blood pressure, another major risk factor for cardiovascular disease.

Diabetics also causes many micro-vascular complications. These include diabetic retinopathy, diabetic nephropathy and diabetic neuropathy.

Despite good long-term sugar and blood pressure control, diabetes remains a major cause of blindness, renal failure and amputations. Two landmark studies, the Diabetes Control and Complications Trial, published in the New England Journal of Medicine in 1993 and the United Kingdom Prospective Diabetes Study Group (UKPDS) study published in the British Medical Journal in 1998, have shown that intensive control of blood glucose levels and tight blood pressure control reduce the risk of these micro vascular complications in diabetics.

An earlier report from the UKPDS Study published in the British Medical Journal in 1996, showed that increasing age, poor sugar control, increased systolic blood pressure, raised bad LDL-cholesterol, reduced good HDL-cholesterol levels and smoking were significant risk factors for coronary heart disease in diabetics.

In patients who have impaired glucose tolerance, they can delay diabetes by almost 11 years. Treating diabetes and controlling your sugar may be difficult. Treating diabetes type 2 is therefore just not limited to reducing blood glucose levels.

The American Diabetic Association advocates the use of aspirin in diabetics with an additional risk factor. Diabetics share a common vascular inflammation seen in patients with cardiovascular disease and aspirin appears to be beneficial in decreasing cardiovascular mortality. Dale Evans Rogers, American Singer.