Diabetes Mellitus and Cardiovascular Disease

How common is DM?

There are 200 million people worldwide who have DM. The numbers are projected to double by 2020.

What is DM?

Insulin is an essential hormone which is secreted from the pancreas (a gland adjacent to the stomach). It transports glucose from blood into various cells for example, muscle, liver and fat tissue where this is stored as glycogen. In DM there is either no insulin production or the cells where insulin acts become resistant and do not respond. In such conditions, glucose is not taken up by the body tissues and therefore, the levels of glucose in the blood increases.

What is the treatment of DM?

This can be in the form of tablets which can either increase insulin production or increase the ‘sensitivity’ of various body tissues to insulin. Furthermore, in the total absence of insulin production or extreme tissue resistance to insulin action, patients may require exogenous insulin through injections or various delivery devices. For more information visit www.diabetes.org.uk.

Is there an association between heart disease and DM?

There is strong evidence that patients with DM have a 15-fold increased risk of developing heart disease in their lifetime. Furthermore, almost a third of patients admitted to hospitals with suspected angina or heart attacks have DM. The presence of DM increases the risk of in-hospital mortality after a heart attack by several-fold. This has led to the development of international guidelines that consider DM as a ‘heart attack-equivalent’.

What do I do if I or my loved one has DM?

  • My straight forward recommendation is to control your blood glucose! This involves a multi-pronged attack. Regular check of pre-meal blood glucose levels with regular adjustment of medications in consultation with your doctor. Remember, long-term elevated glucose levels lead to accelerated changes in the blood vessels that lead to cholesterol accumulation and the risk of a heart attack.
  • Involve the services of a dietician, at least once to help identify a tailored diabetic diet. In simple terms, avoid fizzy drinks, fried food, fat, excessive red meat, sweets, and salt. Consume poultry, fish (salmon, shrimps, sea bass, tuna and trout), fruits, vegetables and pulses. For pasta and bread prefer whole grain based products. Use cooking oil with high concentration of unsaturated fatty acids such as canola, corn, olive, sunflower and soybean.
  • Main organs affected by DM, are the eyes, nerves supplying the extremities, kidneys, heart, brain and major blood vessels. Any complication involving one organ increases the risk of developing a complication with another organ (see figure below).
  • Patients above the age of 40 years are advised the use of aspirin (a blood thinner) in the absence of any contraindications (such as stomach ulcers, or allergy) especially if they have other risk factors for example high blood pressure, smoking, elevated cholesterol levels, and a family history of premature heart attack i.e. <65 years of age. Please liaise with your doctor regarding this.
  • Also, it is important to have an annual check of one’s cholesterol levels which if significantly abnormal may require treatment. Guidelines recommend a low-density lipoprotein cholesterol (LDLc) levels less than 100 mg/dl.
  • Careful control of blood pressure (below 130/80 mm of mercury) as increased blood pressure greatly increases the prevalence of diabetic complications.
  • The glycosylated haemoglobin levels (HbA1c) a measure of the preceding 3-month glucose control should be less than 7.0%.
  • Last but not least are regular exercise (up to 30 minutes a day, 5 days a week) and the avoidance of smoking.
  • As you can recognise this condition requires regular input from multiple disciplines of medicine. Furthermore this condition can involve several organs and has considerable morbidity and mortality associated with it. Therefore, I would advise a regular follow-up with a doctor who has a special interest in the management of DM.

dm

Figure. Common complications of Diabetes Mellitus.