Advances in Diabetes Care Tremendous progress is being made in our ability to postpone or avoid the health problems that type 2 diabetes can cause.
Blood-pressure goal has been tightened. New evidence has shown that our old standards for blood pressure were not tough enough. We didn't treat it aggressively enough. This means we were missing a chance to prevent health problems. It is now clear that a lower blood pressure goal will prevent more heart attacks and more kidney disease in diabetics. The new goal for blood pressure in diabetics is less than 130/80. The first number is called systolic pressure. The second number is called diastolic pressure. The American Diabetes Association supports the lower goals. So do heart and kidney specialists, and many primary care doctors. Sweetened drinks have been shown to promote diabetes In 2004, researchers took a look at drinks consumed by women in the Nurses' Health Study. Sweetened drinks appeared to have a major impact on both weight and diabetes. Your body can absorb sweeteners easily, with little digestion. This results in a large spike of insulin in your bloodstream. When dramatic insulin spikes occur over and over, your body may become more resistant to the effects of insulin. This makes it harder for your cells to use sugar for fuel. More sugar stays in your blood. The Nurses' Health Study examined the habits of more than 50,000 American women in an eight-year period. Women who drank one or more sugary drinks daily were almost twice as likely to develop diabetes a women who seldom drank soda. The women who drank sodas regularly also were about 10 pounds heavier. Cholesterol medicines are recommended more often. Two large, recent studies examined the benefit of statin medicines for people who are known to have a high risk of heart attack. Statins reduce LDL cholesterol. In the studies, these drugs lowered the risk of a heart attack even for people whose LDL was already below the treatment goal. This is usually set at 100 milligrams per deciliter (mg/dl) or less. These large studies examined people who already were known to have coronary artery disease. Many people with diabetes have this disease. Smaller studies have been done in diabetics without a diagnosis of coronary artery disease. These studies also suggest a benefit from cholesterol treatment, even when cholesterol levels do not start out high. In 2005, the American Diabetes Association revised its guidelines on cholesterol treatment for people who have diabetes. Cholesterol medicine is now recommended for all people who have coronary artery disease. This applies even if LDL cholesterol is not high. Medicine is also advised for all people who: - Have diabetes
- Are over age 40, AND
- Have a total cholesterol level of least 135 mg/dl (whether or not LDL is high)
For people 40 years old or younger who have diabetes, cholesterol medicine is recommended only if: - LDL is above 100mg/dl AND
- An additional risk factor for heart disease exists. These risks include:
- Smoking
- Family history of heart disease
- High blood pressure
- Diabetes that has been present for 13 years or longer
Drugs that prevent kidney disease: We have more options and more proof. Medicines from the group known as ACE inhibitors are known to slow down kidney damage caused by diabetes. In 2001, a closely related group of drugs also was shown to help prevent kidney disease. They are called angiotensin receptor blockers. One test of this newer drug group showed that diabetics were nearly one-third less likely to begin dialysis if they took the medicine for more than three years. This was the best evidence yet that kidney protection with drugs is worthwhile. Medicines from both groups treat high blood pressure. ACE inhibitors also have been shown to help prevent heart attacks. You are likely to benefit from one of these drugs if: - You have high blood pressure OR
- You show signs of kidney damage from diabetes
Diabetics might be best off taking a drug from both groups, but this strategy is still being tested.
Examples of ACE inhibitors | Examples of angiotensin receptor blockers | benazepril (Lotensin)
captopril (Capoten)
enalapril (Vasotec)
fosinopril (Monopril)
lisinopril (Zestril/Prinivil)
moexipril (Univasc)
perindopril (Aceon)
quinapril (Accupril)
ramipril (Altace)
| candesartan (Atacand)
eprosartan (Teveten)
irbesartan (Avapro)
losartan (Cozaar)
telmisartan (Micardis)
valsartan (Diovan)
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How big is the benefit of diet and exercise? We may soon know. A large study is measuring the benefits of a reduced-calorie diet and regular exercise. It is named the Look AHEAD trial. The study will last until participants have been observed for 11.5 years. It may tell us how much these healthful habits can reduce the risk of heart attack, stroke and premature death.
Last updated November 28, 2007
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