Diabetics can avoid problems with attention to heart risks

Even if they haven't been diagnosed with heart disease, diabetics with classical heart-risk factors like smoking and elevated “bad” cholesterol are at heightened risk of serious heart-related “events” and death, according to a new study.

Among people with diabetes but not heart disease, researchers linked more than a third of cardiovascular “events”—such as heart attack and stroke—and 7 percent of deaths to inadequate control of heart risk factors.

That means those cardiac events and deaths might have been avoided with better control of the known risk factors, the study team writes in Diabetes Care.

“The take home message from this study is that adults with diabetes can reduce their risk of cardiovascular events, and patients should work together with their provider to set a care plan including goals and strategies to reduce modifiable risk factors,” said lead author Gabriela Vazquez-Benitez, a research investigator at HealthPartners Institute for Education and Research in Minneapolis, Minnesota.

“This can include regular care visits, screening, laboratory, weight, and blood pressure,” she told Reuter’s Health in an email.

The risk factors for cardiovascular problems in diabetes are well known and include high blood pressure, smoking and poor control of blood sugar. If more attention were paid to these risk factors, the rate of cardiovascular problems and death could be substantially reduced, the study team argues.

There are nearly 25 million Americans with diabetes and if current trends continue, more than one in three adults are projected to develop the disease.

Stroke and coronary heart disease are the major causes of complications, deaths and healthcare costs in adults with diabetes, they write.

The authors point out that medical advances have improved the health of people with diabetes, especially when it comes to cardiovascular problems. But for people with diabetes as a group, the burden of cardiovascular problems remains very high.

In their study, Vazquez-Benitez and her team analyzed data on nearly 860,000 adults with diabetes.

They looked at rates of major cardiovascular complications such as heart attacks and heart failure, as well as deaths from all causes, plus four risk factors: blood pressure, levels of LDL cholesterol, smoking and blood sugar levels over the months.

The authors emphasize that overall rates of major cardiovascular complications and deaths were “substantially higher” in people with diabetes who already had heart disease, compared to those without it.

But delaying diabetes complications is possible, Vazquez-Benitez said, not only for cardiovascular events but for problems like nerve damage and kidney disease.

“Although there is a genetic component of diabetes, there are modifiable risk factors that can reduce risk of heart attack, stroke and death,” said Deborah Greenwood, a registered nurse and president of the American Association of Diabetes Educators. Lowering blood sugar, LDL cholesterol and blood pressure, as well as quitting smoking can greatly reduce risk, she said.

All adults over 45 should be screened for diabetes so it can be diagnosed and treated early, said Greenwood, who was not involved in the study. For most people with so-called pre-diabetes, she pointed out, losing 5 to 7 percent of body weight and doing 150 minutes of physical activity per week could avert progression to full-blown diabetes.

She also emphasized the importance of participating in diabetes self-management education and partnering with a credentialed diabetes educator to change behaviors and improve modifiable risk factors. “A diabetes educator will work with you to develop a plan specifically tailored to your individual needs, preferences and lifestyle to ensure success,” Greenwood said. — Reuters

Large breakfast, small dinner tied to better diabetes blood sugar

Big breakfasts and small dinners might be a healthier way to eat for people with type 2 diabetes, according to a small new study.

Diabetics in the study who ate big breakfasts and small dinners had fewer episodes of high blood sugar than those who ate small breakfasts and large dinners, researchers found.

Blood sugar—also known as blood glucose—is controlled by the body’s internal clock, with larger blood sugar peaks after evening meals, Dr. Daniela Jakubowicz told Reuters Health in an email.

People with type 2 diabetes often time their meals in opposition to their internal clock, said Jakubowicz, a researcher at Tel Aviv University’s Wolfson Medical Center in Israel.

“They frequently skip breakfast while eating a high-calorie dinner,” she said, adding that skipping breakfast is linked to obesity and poor blood sugar control.

The new study involved eight men and ten women with type 2 diabetes, ages 30 to 70, who were being treated with either the diabetes drug metformin and dietary advice or diet advice alone.

Type 2 is the most common form of diabetes and is often linked to obesity. In type 2 diabetes, the body's cells are resistant to the hormone insulin, or the body doesn't make enough of it. Insulin gives blood sugar access to the body's cells to be used as fuel.

The participants were randomly assigned to follow a meal plan that consisted of either a 700-calorie breakfast and 200-calorie dinner or a 200-calorie breakfast and a 700-calorie dinner. Both diets included a 600-calorie lunch.

After following the assigned meal plans for six days at home, the participants spent a day at the clinic, where blood tests were taken. They repeated the experiment two weeks later with the other diet plan.

The study team found that post-meal glucose levels were 20 percent lower, and levels of insulin were 20 percent higher, when the participants consumed the large breakfasts and small dinners, according to the results in Diabetologia.

“Our study demonstrated that a large breakfast and reduced dinner is a beneficial alternative for the management of glucose balance during the day and should be considered as a therapeutic strategy in type 2 diabetes,” Jakubowicz said.

Jakubowicz said longer studies are needed to see if the benefits would continue over time.

The new results support the advice to eat like a king at breakfast, a prince at lunch and a pauper at dinner, said Anna Taylor in an email to Reuters Health.

“Select your calories with care, however; what you eat, how you eat, and when you eat all play an important role in your nutrition as well as your health,” said Taylor, a registered dietitian at the Cleveland Clinic in Ohio. She wasn’t involved in the study.

She added that it’s important for people to keep in mind that the study’s participants took few medications and had no major complications.

The results might therefore not apply to other groups with diabetes, Taylor said.

She said that people with diabetes who take insulin should speak to their endocrinologists before experimenting with drastic dietary adjustments. — Reuters