In patients with diabetes, multiple risk factors increase the likelihood of suffering cardiovascular disease (CVD) or death. Researchers have long established that the management of these diabetes risk factors is associated with a decrease in the likelihood of developing CVD. Previously, providers focused on using pharmaceuticals to treat individual contributors to heart risk. Today, a greater understanding of chronic illness has created a shift towards controlling multiple risks at once in a more holistic effort towards health.
A large study, funded by the Danish Heart Foundation, has shown that risk of CVD among patients with diabetes can be better reduced by controlling multiple risk factors simultaneously than by previously used methods. Researchers identified five risk factors for CVD in diabetes patients including elevated hemoglobin, elevated low-density lipoprotein (LDL) cholesterol, albumin in the urine, smoking and elevated blood pressure.
Next, they studied how each of the identified risk factors was associated with heart attack, stroke, heart failure, and death. They found that if patients had these five risk factors under control, they had approximately the same chance of suffering cardiovascular events like heart attack, stroke, and death as the general population.
In the retrospective study, researchers looked at data from 217,274 patients with type II diabetes. Each patient was matched to a control within the general population and followed for a median of 5.7 years. Researchers identified the strongest predictors of death as smoking, exercise, marital status, hemoglobin level and use of lipid-lowering medications.
A strength of the study was its population-based scope. Numbers for the review were taken from the Swedish Diabetes Registry. This registry automatically enrolls all diabetes patients in the country. Additionally, in Sweden, all people have access to the same tax-funded healthcare system, so income does not influence the results.
The results of the study provide strong evidence that doctors and patients should seek to identify and control risk factors early on. This generally is done through a multiple component health plan including plant-based nutrition, exercise, getting enough sleep, quitting smoking and through social support. If necessary, these efforts may be supplemented by pharmaceuticals. Through diet and exercise, some patients can lessen or eliminate their use of pharmaceuticals as part of their treatment.
Patients with two or more cardiovascular risk factors should be examined by a doctor before starting a fitness program. Most people will find that they can start exercising slowly and progressively build up to more formidable workouts. For those seeking professional guidance during workouts, many personal trainers hold additional certifications or training related to diabetes risk management.
In addition to diet and exercise, careful monitoring and potentially the prescription of medications can help to manage a person's overall risk. Activity remains the ideal treatment as it reduces sugar levels in the blood, lowers cholesterol, and lowers blood pressure all without pharmaceuticals. When performed to an adequate level, exercise may help a patient already taking medications to eliminate their use of prescriptions altogether.
The above video, from Johns Hopkins medicine, discusses some lifestyle changes recommended by doctors and how they are used to manage diabetes risk factors.