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Monday, March 10, 2014
Diabetes is one of the most common chronic diseases affecting people in the United States.
The vast majority, 90-95% of cases of diabetes are Type II Diabetes Mellitus, with 5-10% developing Type I Diabetes Mellitus. Currently, nearly 26 million people suffer from diabetes, of which 7 million adults are undiagnosed. Even more worrisome is the nearly 79 million adults aged 20 years or older who are considered pre-diabetic. There are 1.9 million new cases of diabetes diagnosed annually.1
Diabetes is the leading cause of:
If this were not enough, the association of diabetes and heart disease is a common, but frequently misunderstood and worse yet, poorly treated disorder. Most do not realize that diabetes involves not only elevations on glucose (carbohydrate) levels, but also a metabolic disorder of lipids (fats) and protein metabolism as well, which leads to a significantly increased heart disease risk. Considering the way diabetes contributes to heart disease, it’s no surprise that it’s the leading cause of death in the United States.2
In order to successfully decrease complications of Type I Diabetes Mellitus, mere replacement of insulin can be instrumental in dimishing many of the known complications.
Type II, however, is more complex and insulin replacement is often a later therapy employed, if ever. Targets of therapy include:
Most patients with diabetes are unaware of the enhanced clotting nature of their blood as a result of these many metabolic abnormalities. Patients with diabetes have a two to three fold increased prognosis following any heart attack or unstable angina, than non-diabetics who are of similar ethnicity, race, gender, etc.
Studies have indicated that glucose levels are a continuous risk factor for heart disease. In fact, it is estimated that for every 1% increase in hemoglobin in the blood (HbA1c) there is a 10-30% increase of heart disease. A few recent studies have suggested that reducing glucose levels lower risk of heart disease.
In an effort to objectively evaluate the heart disease imposed by diabetes, the National Institutes of Health sponsored the ACCORD Trial (Action to Control Cardiovascular Risk Reduction). It was designed in the late 90's and began in 2001. After the near decade of clinical care, event data collection and different treatment goals, we may finally have greater insight into the diabetes metabolism problems that lead to increased heart disease and the benefits of treatments according to existing guidelines and beyond.
1Centers for Disease Control and Prevention - National Diabetes Fact Sheet, 2011
2Centers for Disease Control and Prevention -FastStats Leading Causes of Death, 2011
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Last Reviewed: Dec 07, 2012
Laurie Sadler, MD
Formerly, Assistant Professor of Medicine
School of Medicine
Case Western Reserve University
Bette K Idemoto, PhD, RN, ACNS-BC, CCRN
Clinical Nurse Specialist
Frances Payne Bolton School of Nursing
Case Western Reserve University