From the ‘A’ and ‘B’ of diabetes in the previous article, we now move to the ‘C’. People with high HbA1c and excess Body weight have a high risk of developing Cardiac disease 1,2.
The heart crying its ‘heart’ out
Cardiac illnesses (the narrowing of blood vessels supplying blood to the heart) and heart failure are major causes of death in people with diabetes. People with diabetes are two to four times more likely to get cardiac disease than those without diabetes3. Moreover, a delay of more than one year in reducing the HbA1c to less than 7 after the diagnosis of diabetes significantly increases the risk of conditions like heart attacks, heart failure, and stroke2. In addition, in people with obesity, fat deposition occurs in the arteries of the heart, causing further damage. A 10 kg increase in weight increases the risk of heart disease by 12%4. Early control of HbA1c to less than 7 after the diagnosis of diabetes can reduce the risk of a heart attack by 15-17%, and that of death by 13%2,5. What’s more, this effect persists for decades.!The legacy of early treatment soon after the diagnosis of diabetes and reducing HbA1c to 7% in the first year continues even up to 42 years! Achieving blood sugar levels to normal soon after diagnosis creates a ‘memory’ in the body that helps protect against cardiac complications for years later6,7. Similarly, reducing 5% or more of one’s weight in the year after a diabetes diagnosis improves HbA1c and reduces the risk of heart disease even at 10 years8.
Dr. V. Mohan, Chairman & Chief Diabetologist, Dr. Mohan’s Diabetes Specialities Centres.
A stitch in time = life
However, many people diagnosed with diabetes do not seek treatment early, do not adhere to recommended treatment, and also struggle to lose weight. Less than two-thirds of people with Type 2 diabetes achieve their recommended HbA1C goal, and only about 50% achieve an HbA1C of less than 7%7. Almost 85% of people with diabetes are overweight or living with obesity9. Many patients do not seek early treatment of diabetes or do not follow the recommended treatment due to reasons such as fears about side effects, misunderstanding of treatment, fear of injections (in the case of those who are prescribed insulin), or at times, simply due to frustration with medicines10.
The bad news is time flies. The good news is that certain outcomes are still in your control. It is important to remember that people who achieve HbA1c less than 7 soon after being diagnosed with diabetes are more likely to maintain their blood sugar in their target ranges. In contrast, not reaching targets early after diagnosis reduces a person’s chances of doing so later on in their course of treatment7.
This brings us to the duration of diabetes, the ‘D’ of the disease. Achieving HbA1c control early on delays the onset of diabetes complications10. As the duration of diabetes increases, it is difficult to keep HbA1c under control if it has not been controlled early. If HbA1c remains high for a long period, it increases the risk of complications like eye disease, kidney disease, nerve disease, and heart disease10. Every five-year increase in the duration of diabetes is associated with a 10-25% increase in heart attack risk. People who have had diabetes for more than 10 years have a higher risk of death due to heart disease11. The risk is amplified in people with obesity. After 20 years of obesity, the prevalence of heart failure increases by 70%, and after 30 years, it increases by 90%4.
As you can see, the ABCDs of diabetes are closely interrelated, and early treatment to control HbA1c and reduce weight are non-negotiable to prevent the cardiac complications associated with diabetes.
References
- Sulu C, et al. Treat Obesity to Treat Type 2 Diabetes Mellitus. Diabetes Ther. 2024;15:611–622.
- Paul SK, et al. Delay in treatment intensification increases the risks of cardiovascular events in patients with type 2 diabetes. Cardiovasc Diabetol. 2015;14:100.
- Jyotsna F, et al. Exploring the Complex Connection Between Diabetes and Cardiovascular Disease: Analyzing Approaches to Mitigate Cardiovascular Risk in Patients With Diabetes. Cureus. 2023 Aug 21;15(8):e43882.
- Csige I, et al. The Impact of Obesity on the Cardiovascular System. Journal of Diabetes Research. 2018;2018:Article ID 3407306.
- Khunti S, Khunti K, Seidu S. Therapeutic inertia in type 2 diabetes: prevalence, causes, consequences and methods to overcome inertia. Ther Adv Endocrinol Metab. 2019 May 3;10:2042018819844694.
- Adler AI, et al. Post-trial monitoring of a randomised controlled trial of intensive glycaemic control in type 2 diabetes extended from 10 years to 24 years (UKPDS 91). Lancet 2024; 404: 145–55.
- Getting to Goal: Overcoming Therapeutic Inertia in Diabetes Care. ADA. Available from Link Accessed on 29 Aug 2024.
- Strelitz J, et al. Moderate weight change following diabetes diagnosis and 10 year incidence of cardiovascular disease and mortality. Diabetologia. 2019 Aug;62(8):1391-1402.
- Weight loss and diabetes. Diabetes UK. Available from Link. Accessed on 29 Aug 2024.
- Khunti S, Khunti K, Seidu S. Therapeutic inertia in type 2 diabetes: prevalence, causes, consequences and methods to overcome inertia. Ther Adv Endocrinol Metab. 2019 May 3;10:2042018819844694.
- Jong M, et al. Duration of diabetes and the risk of major cardiovascular events in women and men: A prospective cohort study of UK Biobank participants. Diabetes Research and Clinical Practice. 2022;188:109899.
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