Diabetes and cardiovascular disease

`Are we prepared for the epidemic of the 21st century?´

The global prevalence of Type 2 diabetes mellitus is rapidly accelerating towards a disastrous impact in just two decades.

In 2000, a study by Wild et al.* showed the prevalence of diabetes for all age-groups worldwide at around 2.8 %. In 2030, this could have become 4.4%. In other words, the total number of diabetics is projected to rise from 171 million in 2000 to 366 million in 2030.
Most diabetics not only suffer a glucose metabolism disorder but about two thirds of them die of cardiovascular disease. Diabetics more frequently suffer atherosclerotic involvement of the arteries supplying the heart, the legs and the brain than non-diabetics. Thus, in the future, national healthcare systems will be stretched by the growing numbers of diabetics. According to the International Diabetes Federation (IDF), in industrialised countries 25% of medical expenditures for diabetes goes on treatments of long-term complications, largely cardiovascular disease. Hence, the IDF demands that all diabetics have access to medical care, not only to optimise control over glucose levels but also to emphasise the importance of the management of associated conditions and risk factors – particularly smoking, high blood pressure and high blood lipid levels.
How good is hospital staff awareness of cardiovascular risk factors control for diabetics? ‘Suboptimal,’ Marco Roffi MD, Director of the Interventional Cardiology Unit at Geneva University Hospital Geneva, told EH reporter Karoline Laarmann. ‘Several European studies have shown that diabetics hospitalised with myocardial infarction receive evidence-based treatment, for example early coronary revascularisation and potent platelet inhibition, less frequently than non-diabetics. So, although diabetics are at higher risk, they are treated less well.’ Besides coronary artery disease, other complications can be stroke and peripheral arterial disease on the macrovascular level, and diseases affecting the eye (loss of vision), kidney (failure due to dialysis or transplants) and nerves (leg numbness or pain) on the microvascular level. Awareness, Dr Roffi emphasised, must improve among physicians as well as patients: ‘The best treatment is a holistic approach. This means that with diabetics it is particularly important first to treat all the other cardiovascular factors on top of diabetes (smoking, high blood pressure, high cholesterol); then to have optimal blood glucose control – especially in view of microvascular complications – and finally to make really profound lifestyle changes (regular physical activity). Negative factors, such as smoking, hypertension or hyperlipidemia potentiate the risk of heart attack or stroke even more in the diabetic than in a non-diabetic patient. Of course, to comply with diet and regular exercise are difficult targets to achieve, but necessary, so physicians definitely must begin to pay more attention to diabetics before they develop cardiovascular complications.’
*Wild S, Roglic G, Green A, et al. Global Prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27(5):1047-53


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