The Centers for Disease Control report that one third of all deaths in the United States are due to cardiovascular disease or stroke. Adults who are overweight or have obesity are at increased risk of heart disease or stroke, and those with diabetes are two to three times more likely to die from one of these causes. Hypertension and dyslipidemia, which are both common among diabetic and obese populations, are also risk factors. It’s a grim picture.
The complications diabetic patients experience that are related to heart issues led to the acknowledgement of diabetic cardiomyopathy as a condition. The subject of some debate, it is defined by Borghetti, et al. (2018), as the “presence of abnormal cardiac structure and performance in the absence of other cardiac risk factors, such as coronary artery disease, hypertension, and significant valvular disease.” There is consensus that diabetes adversely impacts the heart’s pathophysiological mechanism.
Diabetes also poses greater risks from stroke, including increased likelihood of death. A study of diabetic patients who presented with stroke found that HbA1c level at the time of admission was a strong predictor of mortality and poor functional outcomes. This can be challenging for both the patient and families as strokes are the leading cause of physical disability.
As noted in a previous blog (Diabesity: An Unhealthy Relationship), to treat obesity and type 2 diabetes, singularly or in combination, weight loss, physical activity and behavior modification are recommended. This approach offers the added benefit of an eliminated need for medication. Meal replacements as part of a comprehensive weight management program can contribute to these outcomes. A 2018 article reported on a randomized trial conducted over three years across 49 locations to determine whether intensive weight management would cause remission of type 2 diabetes. The intervention group used total diet replacement for three to five months and went off diabetic and hypertensive medications. At 12 months, 24 percent of the intervention group lost 15 or more kg., and 46 percent of the group were in diabetic remission. Further, quality of life increased more than twice as much for the intervention group than the control group.
Routine laboratory and medical testing, periodic physical examinations and ongoing monitoring are all trademarks of the New Direction program, and are critical during the weight loss and management phases of care for patients with type 2 diabetes and obesity. This is particularly important for patients who will undertake a change to their activity level since that can affect glycemic control, so monitoring blood glucose related to exercise should be incorporated into any treatment plan.
As National Diabetes Month draws to an end, it is important to recognize that while awareness and education are essential, they are just a starting point. Identification of risks and potential health challenges as a precursor to a discussion of behavioral modifications is a more effective approach to initiating much needed change.