Diabetes and Heart Health

Taking Care of Your Heart by Taking Care of Your Diabetes

In this edition of Patient Pulse, we’re pleased to welcome Dr. Elizabeth Halprin for a discussion on diabetes and heart health. Dr. Halprin is an adult endocrinologist, and her specialty is diabetes. She has a particular interest in diabetes and overall health in underserved populations. She is the Chief of Adult Diabetes at Joslin Diabetes Center in Boston, MA, where she has been practicing for 22 years.

In the webinar, Dr. Halprin addresses:

• The relationship between heart disease and diabetes 

• Why diabetes is a risk factor for a cardiovascular event (such as a heart attack, stroke, or blood clot)

• What you can do to manage your diabetes if you’ve had a cardiovascular event

Key takeaways:

• Lifestyle is essential to managing diabetes – eat well, get some activity, watch your blood sugar, reduce stress, and get enough sleep!

• Set some goals to stay on track, but start small and slow when making changes 

• No matter what you do to improve your diabetes, it will automatically be good for your heart, too

Overview: Dr. Halprin discusses the strong link between diabetes and cardiovascular disease, emphasizing that people with diabetes have twice the risk of heart attack or stroke [1]. Diabetes can damage blood vessels and is often accompanied by high blood pressure and cholesterol, contributing to atherosclerosis. Better diabetes control, as measured by the A1C test, reduces the risk of complications.

Lifestyle changes like losing 5-10% of body weight, reducing carbohydrate intake, increasing physical activity, managing stress, and quitting smoking can significantly improve diabetes management and heart health. Newer diabetes medications offer additional cardiovascular and renal benefits. Setting small, achievable goals and making sustainable lifestyle changes are key to long-term success.

Key Points:

1. Diabetes doubles the risk of heart attack or stroke due to blood vessel damage, high blood pressure, and high cholesterol [1].

2. Better diabetes control, as measured by the A1C test (average blood sugar over 3 months), reduces complication risks. Most people should aim for an A1C under 7%, but individual targets may vary based on hypoglycemia risk [2].

3. Lifestyle factors like diet, physical activity, stress management, and smoking cessation intertwine to improve diabetes control and heart health [3].

4. Losing 5-10% of body weight can significantly improve blood sugar levels [4]. Gradual, sustainable weight loss is recommended.

5. Reducing intake of "white carbohydrates" (white potatoes, bread, pasta, rice) and avoiding sugary drinks, sweets, and excessive artificial sweeteners can aid weight loss and blood sugar control [5].

6. The Harvard Healthy Eating Plate recommends filling half the plate with vegetables and fruits, a quarter with whole grains, and a quarter with healthy proteins [6].

7. Regular physical activity, starting slowly and focusing on enjoyment, balance, strength, and heart rate, is crucial for diabetes management [7].

8. Stress directly affects blood sugar levels [8]. Stress management techniques, adequate sleep, and physical activity are important.

9. New diabetes medications offer additional benefits, such as improved cardiovascular health, kidney protection, and weight loss [9].

10. Setting small, achievable goals and making sustainable lifestyle changes are key to long-term diabetes management and heart health [10].

References:

1. Einarson, T. R., Acs, A., Ludwig, C., & Panton, U. H. (2018). Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007-2017. Cardiovascular diabetology, 17(1), 83. https://doi.org/10.1186/s12933-018-0728-6

2. American Diabetes Association. (2021). 6. Glycemic Targets: Standards of Medical Care in Diabetes—2021. Diabetes Care, 44(Supplement 1), S73-S84. https://doi.org/10.2337/dc21-S006

3. Kolb, H., & Martin, S. (2017). Environmental/lifestyle factors in the pathogenesis and prevention of type 2 diabetes. BMC medicine, 15(1), 131. https://doi.org/10.1186/s12916-017-0901-x

4. Franz, M. J., Boucher, J. L., Rutten-Ramos, S., & VanWormer, J. J. (2015). Lifestyle weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes: a systematic review and meta-analysis of randomized clinical trials. Journal of the Academy of Nutrition and Dietetics, 115(9), 1447-1463. https://doi.org/10.1016/j.jand.2015.02.031

5. Dyson, P. A., Twenefour, D., Breen, C., Duncan, A., Elvin, E., Goff, L., Hill, A., Kalsi, P., Marsland, N., McArdle, P., Mellor, D., Oliver, L., & Watson, K. (2018). Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes. Diabetic Medicine, 35(5), 541-547. https://doi.org/10.1111/dme.13603

6. Harvard T.H. Chan School of Public Health. (n.d.). Healthy Eating Plate. The Nutrition Source. Retrieved April 19, 2023, from https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/