Advances in Diabetes Care

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Harvard Medical School
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Advances in Diabetes Care

Diabetes Type 2
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Advances in Diabetes Care
Advances in Diabetes Care
Research continues to advance our understanding of diabetes and how to treat it.
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Reviewed by the Faculty of Harvard Medical School

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 eased.

Treatment of high blood pressure helps to prevent complication in diabetes. But what number counts as high in a diabetic?

For blood pressure, the first number is called systolic pressure. The second number is called diastolic pressure. Before 2010, many guidelines recommended a blood pressure lower than 130/80 for people with diabetes. This was a lower blood pressure goal than doctors used for other patients. But more recently, guidelines have changed. Now a blood pressure that is lower than 140/90 is recommended for diabetics. This is the same goal that doctors use for most non-diabetic patients. The American Diabetes Association supports the 140/90 goal. So do heart and kidney specialists, and many primary-care doctors.

Why this change? Studies have shown that keeping blood pressure lower than 130/80 can help to prevent stroke. But taking extra medicines to keep blood pressure this low does not seem to prevent other health problems or early death for people with diabetes. Serious side effects such as dizziness with falls, kidney stress and heart rhythm changes also are seen more often in people who use this "low" blood pressure goal. The most significant study that doctors looked to for information about blood pressure goals was called the ACCORD study, published in 2010.

For some diabetics — people who tolerate blood pressure medicine easily and seem to have few or no side effects — a blood pressure goal of 130/80 is probably still appropriate. This lower target (130/80) is also recommended for diabetics who have kidney disease (protein in their urine or a high level of creatinine on blood tests).


Hepatitis B vaccine is recommended.

The American Diabetes Association now recommends that people with diabetes who are 19 through 59 years old get vaccinated against hepatitis B. This virus causes inflammation and scarring in the liver. In order to be immune, you must receive 3 vaccinations in a 6-month period.

In people who do not have diabetes, hepatitis B is usually spread through sexual contact. In people who have diabetes, outbreaks of hepatitis have also occurred from sharing blood-glucose monitoring equipment during stays in care facilities. Most diabetics do not share personal monitoring equipment with others. It is still a good idea to get vaccinated in case you are ever in a situation where you might be exposed through contact with shared monitoring equipment.

A1C test is a new way to screen for diabetes.

The A1C or "hemoglobin A1C" is a useful blood test. It has been used for many years to keep track of glucose control for people with diabetes. Now is has another purpose. New guidelines say doctors can use the A1C to screen for pre-diabetes and to diagnose new diabetes.
If you have an A1C of 6.5% or higher, you are diagnosed with diabetes. An A1C of 5.7 to 6.4% shows high risk for diabetes. This means that you have pre-diabetes.
Added sugars have been shown to promote diabetes.
Sweetened drinks appear to have a major impact on both weight and diabetes. About one-third of the "added sugar" that is consumed in the United States comes from sweetened drinks such as sodas. "Added sugar" is not part of whole fruits and vegetables or other whole foods. It is added during processing, cooking or at the table.
A growing number of research studies have linked diets that are high in added sugar to:
  • Insulin resistance
  • Pre-diabetes and diabetes
  • High blood pressure
  • Cholesterol problems
  • Fatty liver
  • Obesity
Some researchers blame fructose for causing a change in our metabolism. Fructose is found in all common sugars. These include white and brown sugar, molasses, honey and high-fructose corn syrup. In 2009, the American Heart Association published new advice that urged us to reduce the amount of added sugars we eat and drink.
The hazard of sodas and sugars has had the attention of experts since 2004. That's when research on women in the Nurses' Health Study was published. The 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 as 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)



diabetes,cholesterol,heart,ldl,diabetics,high blood pressure,blood pressure,coronary artery disease,kidney,kidney disease,diet,drug,exercise,fructose,heart attack
Last updated October 28, 2013

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