Diabetes is a major risk factor for the development
of cardiovascular disease! From 1994-2002 the prevalence of diabetes increased
by 54% for US adults.1 It is the 6th leading cause of death in the
US contributing to 213,062 deaths in 2000.2 In 2002, there were an
estimated 18.2 million adults in the US with diabetes with 1.3 million new
cases diagnosed each year.2
What is diabetes?
According to the CDC, diabetes mellitus is a
group of diseases characterized by high levels of blood sugar resulting from
problems in the way the body makes insulin, the way of insulin works in the
body, or both.2
Types of diabetes:
Type 1
was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-
onset diabetes. It develops when the body’s immune system destroys beta cells
in the pancreas, the only cells in the body that can make insulin. Insulin is a
hormone that regulates blood glucose or blood sugar. It usually strikes
children and young adults, but can occur at any age. Type 1 diabetes accounts
for 5-10% of all cases of diabetes.2
Type 2 diabetes
was previously called non-insulin-dependent diabetes (NIDDM) or adult-onset
diabetes. It usually begins as insulin resistance in which the body does not
use insulin properly. As the need for insulin increases, the pancreas gradually
loses its ability to make insulin. The risk to develop Type 2 diabetes
increases with older age, obesity, family history of diabetes, history of
diabetes during pregnancy, impaired glucose metabolism, physical inactivity,
and race/ethnicity. It accounts for 90-95% of all cases of diabetes and is
increasingly being diagnosed in children and adolescents.2
Gestational diabetes
is a form of glucose intolerance that some women develop during pregnancy. It
is most common among obese women and women with a family history of diabetes.
During pregnancy, gestational diabetes requires treatment to avoid
complications for the infant. After pregnancy, 5-10% of these women are found
to have Type 2 diabetes. Women who have had gestational diabetes have a 20-50%
chance of developing diabetes in the next 5-10 years.2
Other specific types
of diabetes can result from specific genetic conditions, surgery, medication,
malnutrition, infections, and other illness. These causes account for only 1-5%
of all diagnosed cases of diabetes. 2
Risk Factors for Type 2 diabetes:4
*May not be correct for all ethnic groups
Pre-diabetes: Impaired glucose tolerance and
impaired fasting glucose2
-
Pre-diabetes is used to describe people who
are at risk of developing diabetes. People may have impaired fasting glucose
(IFG) or impaired glucose tolerance (IGT) and some people have both.
-
IFG is a condition in which the fasting blood
sugar level is to high (110-125 mg/dL) after an overnight fast, but not high
enough to be classified as diabetes (fasting blood sugar of 126 mg/dL or
more)
-
IGT is a condition in which the blood sugar
level is elevated (140-199 mg/dL) after a 2-hour oral glucose tolerance
test, but not high enough to be considered diabetes.
- Weight loss and increased physical activity
can prevent or delay the onset of diabetes.
- People with
pre-diabetes are already at
increased risk for heart attack and stroke.
Complications of diabetes:
-
Heart disease
and stroke account for 65% of
the deaths among people with diabetes and death rates are 2-4 times higher
than the rates for adults without diabetes.3
- Death from heart attack or stroke may result
from the high blood pressure and high cholesterol levels that are common in
people with diabetes.
- diabetes can also cause problems in the small
blood vessels or capillaries. This is called microvascular disease and leads
to blindness (diabetic retinopathy), kidney disease and kidney failure
(nephropathy), dental problems such as peridontal (gum) disease, and nervous
system damage (neuropathy) causing impaired sensation or pain in the feet
and hands, slowed digestion of food in the stomach, carpal tunnel syndrome,
and other nerve problems. Some forms of nerve damage may lead to
amputations.2
- Uncontrolled diabetes can lead to possible
life-threatening events, such as diabetic ketoacidosis and coma.
Prevention and Management of Diabetes
Complications:
The American
Diabetes Association in their 2004
Position Statement on Standards of Medical Care4 has given the
following recommendations:
|
Indicator |
Goal |
Frequency |
|
Home blood sugar monitoring |
Before meals:
90-130 mg/dL
After meals:
< 180 mg/dl |
Your doctor will determine your blood
sugar goals and how often you need to check your blood sugar. You may be
asked to check it more often when you are sick or start an exercise
program |
|
HbA1c |
< 7% |
This blood test measures your blood sugar
control over a 2-3 month period. It may be done as often as every 3
months and will be determined by your doctor |
|
Blood Pressure |
< 130/80 |
Lowering blood pressure with diet,
exercise, and/or medications is important to reduce your risk of all
complications related to diabetes |
|
LDL Cholesterol |
< 100 mg/dL |
Your LDL ("bad") cholesterol
should be lowered to the same level as someone who has already had a
stroke or heart attack. Check every 4-6 weeks while medication is being
adjusted, then every 6-12 months as determined by your doctor |
|
HDL Cholesterol |
Men: > 40 mg/dL
Women: > 50 mg/dL |
HDL is the "good" cholesterol
that protects the heart and blood vessels. Check every 4-6 weeks while
medication is being adjusted, then every 6-12 months as determined by
your doctor |
|
Triglycerides |
< 150 mg/dL |
Triglycerides are a type of fat, stored
in your muscles. Good blood sugar control, appropriate diet and/or
medication is used to control. This level is checked with your
cholesterol test |
1Morbidity and Mortality Weekly
Report, Vol. 52, No. 30, Aug. 1, 2003, CDC/NCHS
2National Diabetes Fact Sheet, United States, November 2003, CDC/Diabetes
3diabetes.niddk.nih.gov
4American Diabetes Association, Standards of Medical Care in Diabetes. Diabetes
Care: 27, Supplement 1, 2004.
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