Most people with type 2 diabetes in the United States are struggling to cope with their risk factors for heart disease, according to a new analysis aimed at educating doctors and patients about the latest treatments.
According to Dr. Joshua J. Joseph, Assistant Professor of Medicine in the Department of Endocrinology, Diabetes and Metabolism at The Ohio State University College of Medicine at Columbus.
Joseph chaired the panel of experts behind the new American Heart Association report, which was published Monday in Circulation. It offers an overview of the latest scientific evidence on diabetes and heart disease, including evidence of new drugs that have changed diabetes care in recent years.
“This new scientific statement is an urgent wake-up call to follow the latest evidence-based approaches and develop new and innovative methods to improve the management of type 2 diabetes” and reduce the risk of cardiovascular disease, Joseph said in a press release.
Type 2 diabetes is the most common form of diabetes. More than 34 million people in the United States are affected by it, according to the Centers for Disease Control and Prevention.
Cardiovascular disease is a leading cause of death and disability among people with type 2 diabetes, which occurs when the body cannot use the insulin it makes efficiently or when the pancreas loses its ability to produce insulin. Adults with type 2 diabetes are twice as likely to die from cardiovascular causes, including heart attacks, strokes, and heart failure, compared to adults who do not have diabetes.
The report, which looks at the latest scientific evidence on diabetes and cardiovascular disease, suggests that the best care should include healthy lifestyle measures, as well as medications or treatments such as surgery that maintain a healthy weight.
Lifestyle changes and social issues account for up to 90% of the factors associated with treating heart disease in type 2 diabetes. “Social determinants of health, which include health behaviors, socioeconomic factors, environmental factors, and structural racism, have been recognized as profoundly influencing cardiovascular disease and type 2 diabetes outcomes,” Joseph said.
Goals for reducing the risk of cardiovascular disease in people with type 2 diabetes include controlling blood sugar, blood pressure, and cholesterol levels; increased physical activity; healthy eating; maintaining a healthy weight; no smoking; do not drink alcohol; and receiving psychosocial assistance.
The latest AHA scientific statement on controlling blood sugar, or glucose, was published in 2015, just as research began to suggest that glucose-lowering drugs could also reduce the risk of heart attack, stroke, heart failure, or death from cardiovascular disease.
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Since then, such drugs have been studied in several national and international clinical trials, Joseph said. The drugs known as GLP-1 receptor agonists “have changed the game in reducing the risk of heart disease, stroke, heart failure and kidney disease.”
GLP-1 formulations stimulate the release of insulin to control blood sugar levels. They also reduce appetite and help people feel full, which can help with weight management.
Other drugs known as SGLT-2 inhibitors encourage the kidneys to flush excess glucose in the urine, which reduces the risk of heart failure and slows down the deterioration of kidney function that is common in people with type 2 diabetes.
While many of these drugs have become more commonly covered by health plans, cost can be a barrier, Joseph said. And not all patients know that these new drugs are helping to reduce the risk of heart disease, stroke, heart failure, and kidney disease.
The statement also discusses treatments for high blood pressure; the use of statins and other drugs to lower the level of “bad” LDL cholesterol; and the use of daily low-dose aspirin.
The statement encourages doctors and patients to work together on an individualized treatment plan. But helping patients manage their risks goes beyond what happens in healthcare settings, Joseph said.
“One way to further address and improve diabetes management is to break down the four walls of a clinic or hospital through community engagement, clinic-community links, and academic-government partnerships that can help address and support modifiable lifestyles such as physical activity. , nutrition, smoking cessation and stress management. “