Nobody dies from type 2 diabetes
It may not show up on death certificates, but diabetes certainly contributes to many early exits. In fact, it plays a role in 40 per cent of heart attacks and 30 per cent of strokes across Canada.
Cardiovascular disease ( CVD) is the No. 1 killer of people living with diabetes. “Those with pre- diabetes are equally, if not more, at risk,” says Dr. Harpreet Bajaj, an endocrinologist based in Brampton, Ont. “People don’t think of pre- diabetes as a risk factor for CVD so they are not treating it with appropriate therapies to protect their heart.”
With a practice in a region of Ontario with a high south Asian population, Bajaj sees many patients with pre-diabetes or diabetes. (Ethnicity is a key risk factor for developing the disease, as are age, body mass index and family history).
“When screening at public education events we often find people with high blood sugar who were unaware they have a health issue,” he says. “The diagnosis is often alarming and reinforces the need for early testing and treatment as well as lifestyle changes.”
While lifestyle intervention rates low on the excitement scale, it is a critical first step to controlling blood sugar and avoiding becoming another CVD statistic, notes Bajaj.
Brent Galardo can attest to the benefits of changing i ngrained habits to control diabetes. “Originally, I didn’t believe the diagnosis even though I immediately received an insulin shot at the hospital,” he says. “Then, when I learned about all the associated health issues that came with the disease, I was horrified.”
Galardo i mmediately embarked on a program of healthy eating, increased activity and smoking cessation. “I am now in the best shape of my life and have yet to require medication or insulin shots,” he says. “While I will always have the disease and it will worsen, I now have control over the rate of progression.”
Ultimately, Galardo will need a more comprehensive program of care to deal with his diabetes and the health complications that will inevitably accompany it. However, CVD doesn’t have to be one of them.
Developments in diabetes care — those that go beyond quarterly testing for A1C ( blood sugar averages) and fasting blood glucose levels — now offer a holistic approach to help mitigate the risks of heart disease. For example, new drug classes for type 2 diabetes are not only able to control blood sugar, they can cause weight reduction and help lower the risk of CVD.
Among these are a class of drugs known as the GLP1 analogues, which work by increasing insulin levels and decreasing a hormone responsible for raising blood sugar. In addition, they have been shown to significantly reduce the risk of cardiovascular events, as well as improve weight loss.
Another class of drugs, SGLT2 inhibitors, work by preventing the kidneys from reabsorbing glucose back into the blood, allowing it to pass out in urine, and also has a positive effect on heart health.
“Never until now have we had any drugs in glucose control that have been shown to reduce heart disease outcomes. This is a bonus benefit that allows us to really help people who are living with type 2 diabetes,” says Bajaj.
Technology and its uses are changing lives in general and changing the way we help patients as health- care providers, adds Bajaj. “Therapies for testing and injections are making it easier to adopt some of these new medications,” he says. “However, as the diabetes epidemic continues to grow we must constantly look for more and new ways to reduce the risk factors of those diagnosed with this condition. And, make a concerted effort toward prevention — the truth remains that it is still the only cure for diabetes.