Diabetes and heart disease: A call for integrated management

Did you know that only 7% of people in India with previously diagnosed diabetes meet treatment targets for blood glucose, lipids, and blood pressure, and this value is much lower in those with undiagnosed diabetes¹? High blood pressure is also present in almost 60% of individuals with diabetes. Heart diseases are the most common cause of death and disability in patients with diabetes². According to clinical experts, having diabetes doubles your risk of experiencing heart disease or stroke compared to those without diabetes and at a younger age³.

When high blood glucose persists for a long time, it can damage blood vessels, leading to serious heart complications. Adding to the adversity, people with diabetes have other conditions that can increase their risk for heart disease, including high blood pressure, dyslipidemia, and high triglyceride levels. A major concern is that none of these conditions have obvious symptoms; hence, detecting the disease is challenging. Statistical data reveals that people with diabetes have higher chances of heart failure^4,5. Hence, timely screening and early detection play a significant role in heart disease and diabetes.

The role of screening
Indian data reflects a substantial burden of heart diseases and heart failure in individuals with type 2 diabetes⁵. It is recommended that all individuals with diabetes should be screened yearly for heart disease-related risk factors. Factors that increase the risk of heart disease in people with diabetes are the duration of diabetes, obesity or overweight, high blood pressure, lipid abnormality, smoking, family history of heart conditions, chronic kidney disease, and the presence of albumin in the urine. Early detection facilitates a timely, multipronged therapeutic approach to initiate treatment to manage blood glucose, lipid levels, and high blood pressure⁶.

The tricky affair: Controlling weight to manage diabetes and& reduce heart disease
It is important to mention here that obesity or overweight is common in patients with diabetes mellitus, especially type 2 diabetes mellitus and is linked to an increased risk of heart disease².

A customised therapeutic lifestyle change is necessary to manage diabetes and control weight6. Managing weight in diabetes patients is very important because of its implications for metabolic, physical, and psychological complications. Reducing weight can delay the progression of prediabetes into type 2 diabetes, lower the need for diabetes medications, improve cardiovascular outcomes, and better quality of life. In fact, any magnitude of weight loss directly improves glucose levels in the blood and heart disease-related risk factors. Long-term benefits for heart health can be achieved through a sustained loss of more than 10 -15% of body weight. The treatment approach for managing obesity or overweight is done through lifestyle and nutrition therapy, medicines, or metabolic surgery⁶.

References

1. Anjana RM, et al. Lancet Diabetes Endocrinol. 2023; 11(7): 474-89.
2. Leon BM, et al. World J Diabetes. 2015; 6 (13): 1246-1258.
3. Dal Canto E et al. Eur J Prev Cardiol. 2019 Dec;26(2_suppl):25-32.
4. Diabetes and heart disease. Diabetes UK. Accessed from here. Accessed on March 19, 2024
5. Rajput R, et al. Indian Heart Journal. 2023; 75(6):436-42.
6. Standards of care in diabetes-2024. Diabetes Care. 2024; 47 (Supplementary 1): S179-S218.

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