Diabetics need to know more about associated health risks

Practices for avoiding cardiovascular problems are less familiar to patients with diabetes than is control of blood glucose levels.

By Susan J. Landers, amednews staff. March 11, 2002.

Washington -- A physician's role as educator is well-accepted, but patients with diabetes seem to have missed an important lesson. Most are unaware that heart disease and stroke are their greatest health risks, according to a new survey commissioned by the American Diabetes Assn. and the American College of Cardiology.

Three-quarters of the 2,000 surveyed people with diabetes reported having risk factors associated with cardiovascular disease, such as high blood pressure or high cholesterol, but they failed to relate these problems to their diabetes.

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"This research clearly illustrates the gap between perception and reality," said Christopher D. Saudek, MD, president of the diabetes organization. "The harsh reality is that if you have diabetes, you have a two to four times greater likelihood of having a heart attack than if you do not have diabetes," he said.

"Cardiovascular disease is the leading cause of death in the United States, and diabetes is a major risk factor for developing diseases of the heart and blood vessels," added W. Bruce Fye, MD, president-elect of the American College of Cardiology.

Health and Human Services Secretary Tommy Thompson announced the survey results on Feb. 19.

Thompson has made the prevention of diabetes a priority during his first year as HHS secretary. He explained that the disorder has a personal side for him as his father had diabetes, was overweight and died young following a heart attack.

The greatest health risks for people with diabetes are cardiovascular.

"More than 16 million Americans have diabetes and the figure is growing at an alarming rate," he said. Last summer, HHS released results from the Diabetes Prevention Program, a clinical trial involving more than 3,000 people.

That trial demonstrated that relatively moderate changes in diet and exercise can delay and possibly prevent type 2 diabetes among those at high risk of the disease.

Type 2 diabetes accounts for up to 95% of all diabetes cases. The prevalence of type 2 diabetes has tripled in the last 30 years, and much of the increase is due to the dramatic upsurge in obesity, according to HHS.

Missing health advice

The survey also yielded some good news. In their visits with health care professionals, 75% of people with diabetes say they ask questions about managing their disease. On the other hand, about half of those surveyed said the health care professional never discussed ways in which they could reduce their risks for heart disease and stroke. In addition, more than one-third of those surveyed said quitting smoking was not discussed.

Most people with diabetes knew more about other disabilities associated with the disease -- such as blindness and amputation -- than they did about often-fatal cardiovascular complications. Many knew little about steps they could take to reduce their cardiovascular risks, such as taking aspirin or prescription medications, lowering their cholesterol and quitting smoking.

Type 2 diabetes accounts for 95% of all cases.

A certain amount of information is very familiar to those with diabetes. "People with diabetes know how important it is to control their blood glucose, but too little attention is paid to the role of cholesterol and blood pressure," said Allen M. Spiegel, MD, director of the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health.

Education is vital, said Dr. Saudek. "This research points out that people with diabetes, especially older adults and high-risk groups, such as African-Americans and Hispanics, need to know that good diabetes management is more than just lowering blood glucose," he said.

"We need to heighten the awareness among people with diabetes -- and those prone to developing diabetes as a result of obesity -- about working closely with their physicians to aggressively reduce all of their cardiovascular risk factors, including smoking, obesity, hypertension and high cholesterol," said Dr. Fye. "If we can achieve that, the impact on individual lives and the entire population will be tremendous."