CARDIOVASCULAR DISEASE RISK MANAGEMENT IN PEOPLE WITH DIABETES

Source: Diabetes Care, 2023

Coronary heart disease (e.g., heart attack), cerebrovascular disease (e.g., stroke), or peripheral arterial disease are the leading cause of disability and death for people living with diabetes in most parts of the world, today. The good news is that aggressively managing the common risk factors for these cardiovascular diseases (CVD) can prevent their occurrence, or slow disease progression.

What are the common diet-related risk factors for CVD?

Being overweight or obese (particularly if the excess weight is around the abdomen), having high blood pressure (hypertension), or high cholesterol and triglycerides (dyslipidemia) are the 3 main diet-related risk factors for CVD.

Overweight/obesity

Moderate weight loss (3-7% of initial body weight) has been proven to improve blood glucose, blood pressure, cholesterol and triglyceride levels in people with diabetes – in particular those with type 2 diabetes. Losing larger amounts of weight (>10%) can help many people with recently diagnosed (< 6 years) type 2 diabetes to go into remission.

Personalised Medical Nutrition Therapy from an Accredited / Registered Dietitian will help individuals determine the best long-term dietary strategy and similarly, personalised advice from a suitably qualified health professional (e.g., Exercise Physiologist) will help individuals to develop a long-term physical activity program that best suits their own unique needs.

High blood pressure

People with diabetes who consistently have blood pressure readings higher than 120 / 80 mmHg (millimetres of mercury) can aim to:

• lose a moderate amount of weight (as discussed above),
• reduce the amount of sodium they consume,
• increase the amount of potassium they consume,
• moderate their alcohol consumption, and
• increase their physical activity

People with diabetes that have blood pressure readings consistently higher than 130/80 mmHg may need to take blood pressure lowering medication and should discuss the options with their Medical Doctor.

Dyslipidaemia

People with diabetes who have high LDL cholesterol (≥70 mg/dL or 1.8 mmol/L) or triglycerides (≥150mg/dL or 1.7mmol/L), and/or low HDL cholesterol (<40 mg/dL or 1.0 mmol/L] for men; <50 mg/dL or 1.3 mmol/L for women) can aim to:

• lose a moderate amount of weight (as discussed above),
• reduce the amount of saturated and trans fat they consume,
• increase the amount of omega-3 fat they consume,
• increase the amount of plant stanols/sterols they consume,
• increase the amount of viscous dietary fibre they consume
• increase their physical activity

Lifestyle interventions to improve dyslipidaemia require at least 12 weeks to have an effect. If dyslipidaemia has not significantly improved after trialling lifestyle interventions for a sufficiently long period of time, LDL cholesterol and/or triglyceride lowering medication may be prescribed by a Medical Doctor.

Conclusion

Successful management of these cardiovascular disease risk factors has been proven to decrease morbidity and mortality in people with diabetes over the past decade.

Read more:

• ElSayed and colleagues. 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes-2023. Diabetes Care. 2023
• ElSayed et al. 8. Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes: Standards of Care in Diabetes-2023. Diabetes Care. 2023

Dr Alan Barclay, PhD, is a consultant dietitian and chef with a particular interest in carbohydrates and diabetes. He is author of Reversing Diabetes (Murdoch Books), and co-author of 40 scientific publications, The Good Carbs Cookbook (Murdoch Books), Managing Type 2 Diabetes (Hachette Australia) and The Ultimate Guide to Sugars and Sweeteners (The Experiment Publishing).