Although many people with type 2 diabetes are worried about losing their vision or having an amputation, the greater risk is to the heart and brain.
About 65% of people with type 2 diabetes die of heart disease or stroke and they are two to four times more likely to die of heart disease than their counterparts in the general population without diabetes.
"When someone does get a diagnosis of diabetes, theyas we understand nowprobably have had prediabetes for as long as 10 years," says Gerald Bernstein, MD, director of the diabetes management program at the Gerald J. Friedman Diabetes Institute at Beth Israel Medical Center in New York City.
"That means by the time their diagnosis is made, their risk for cardiovascular disease is extremely high. And then 10 years later, they will have their first cardiovascular event."
Start with good blood-sugar control
A pivotal multicenter study published in 2005 of people with type 1 diabetes showed that tight blood-glucose control lowers the risk of heart disease. Experts believe that people with type 2 diabetes benefit from the same advice. Keeping your blood sugar level in check can prevent or delay blood vessel damage.
But thats just part of the equation. Its crucial that you keep an eye on blood pressure and cholesterol too.
To help prevent heart attacks and stroke, the National Institute of Diabetes and Digestive and Kidney Diseases recommends that you do the following.
- Fit at least 30 minutes of physical activity into your daily routine. Try walking a half hour every day or 10 minutes after each meal. Take the stairs instead of the elevator. Park at the far end of the lot and hoof it to your destination.
- Eat heart-healthy foods. Enjoy whole-grain breads and cereals, fruit, and vegetables, and cut back on foods loaded in saturated fat and cholesterol. Also avoid processed foods with trans fat.
- Have your blood pressure checked. It should be below 130/80 for most people.
- Lose weight if you are overweight. A registered dietitian can help you plan meals that will help your reach and maintain a healthy weight.
- Kick the habit if you smoke. Ask your doctor about ways to help you quit.
- Have your cholesterol checked. Aim for an LDL or bad cholesterol level that is below 100; an HDL or good cholesterol level that is above 40 if youre male and above 50 if youre female; and triglyceride level that is below 150.
- Ask about a daily aspirin regimen. Taking a low dose of aspirin every day may help reduce your risk of heart disease and stroke. Talk to your doctor before starting an aspirin regimen.
- If youve been prescribed medication, take it as directed.
"People with type 2 diabetes are faced with an enormous challenge. Because they not only have the problem of glucose metabolism that has gone astray, but in most patients, they have an associated problem related to their cholesterol and to their blood pressure, and obviously their weight," says Dr. Bernstein.
"Therefore all of these things have to be attacked with the same vigor."
Ongoing study of heart attack and stroke risk
A multicenter study called Action to Control Cardiovascular Risk in Diabetes, or ACCORD, is following 10,000 type 2 patients at high risk for heart disease for four to eight years.
In 2008 one part of this trial was halted early due to an unexpected finding.
Patients who aimed for a hemoglobin A1C of less than 6% had a greater risk of dying than those who aimed for around 7%.
Many diabetes experts thought that since lowering hemoglobin A1C to less than 7% (which is recommended by the American Diabetes Association) prevents complications, that even lower would be even better. More research is needed to determine if that is indeed true. The rest of the study is ongoing and results are due out in 2010.