Practical Opinions
In this video, Dr Chilton explains that as the number of metabolic risk factors for cardiovascular disease increases, so too does the prevalence of insulin resistance—even in patients with a low BMI. Have you seen such a correlation in your practice?
Practical Opinions
In this video, Dr DeFronzo asserts that there is a direct correlation between high A1C levels and risk of coronary heart disease. Have you observed this relationship in your practice?
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Microvascular and macrovascular complications of type 2 diabetes
Insulin resistance and its associated risk factors can result in microvascular complications
- By the time type 2 diabetes is diagnosed, 25% of patients have microvascular complications, underscoring the need for early assessment of risk factors.[1]
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- Retinopathy, neuropathy, and nephropathy can lead to debilitating outcomes such as blindness, limb amputation, and renal failure. ADA statistics convey the impact:[6]
- Diabetes is the leading cause of blindness in the US, with up to 24,000 new cases each year attributable to diabetic retinopathy.
- Approximately 82,000 lower-limb amputations are performed each year among people with diabetes.
- Diabetes is the leading cause of treated end-stage renal disease, often leading to the need for dialysis or kidney transplantation.
Insulin resistance and its associated risk factors can result in macrovascular disease
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- 55% of patients with diabetes experience CVD as their primary cause of death.[8]
- Approximately 40% of patients with diabetes die of ischemic heart disease.[8]
- The risk of death due to myocardial event is 2–4 times greater in patients with diabetes than in those without.[8]
Type 2 diabetes is an atherosclerotic risk equivalent[9]
- As insulin resistance progresses to type 2 diabetes, the atherosclerosis risk increases as well.
- The atherosclerotic risk doubles with impaired glucose tolerance.
- When type 2 diabetes is diagnosed, the risk is 3–4 times more severe than in nondiabetic individuals.
The risk of heart disease is increased in patients with
type 2 diabetes[10]
- Patients without diabetes or prior myocardial infarction (MI) were at the lowest risk of experiencing an event.
- Patients with diabetes and prior MI were at the highest risk of experiencing an event.
- The risk of MI was similar between patients without diabetes and with prior MI and patients with diabetes and without prior MI.
- Patients with diabetes should be treated as though they had prior MI (aggressively).
Type 2 diabetes is an independent risk factor for CVD[11]
View a brief video of Dr Robert Chilton as he explains that the prevalence of insulin resistance increases with the addition of metabolic risk factors for CVD.
- CVD risk factors examined were high serum cholesterol, systolic blood pressure elevation, and cigarette smoking.
- After adjustment for age, race, income level, serum cholesterol, systolic blood pressure, and number of cigarettes smoked each day, the relative risk of:
- CVD was 3.0 times higher in men with diabetes.
- CHD was 3.2 times higher in men with diabetes.
A1C as a predictor of CHD in elderly patients[12]
View a brief video of Dr Ralph DeFronzo explaining the relationship between A1C levels and CHD.
- 3.4%–Overall incidence of fatal and nonfatal MI in patients without diabetes.
- 14.8%–Overall incidence of fatal and nonfatal MI in patients with diabetes.
- Poor metabolic control is an important predictor of CHD in elderly patients.
- An inverse relationship exists between metabolic control and CHD risk.
Reducing A1C reduces coronary health risks[13]
- Any reduction in A1C is likely to reduce the risk of microvascular and macrovascular events.
Read more.
References: 1. Peters AL. The clinical implications of insulin resistance. Am J Manag Care. 2000;6(suppl):S668-S674. 2. American College of Endocrinology Task Force on the Insulin Resistance Syndrome. American College of Endocrinology position statement on the insulin resistance syndrome. Endocr Pract. 2003;9:236-252. 3. Katsumori K, Wasada T, Kuroki H, et al. Prevalence of macro- and microvascular diseases in non-insulin-dependent diabetic and borderline glucose-intolerant subjects with insulin resistance syndrome. Diabetes Res Clin Pract. 1995;29:195-201. 4. Standl E. Cardiovascular risk in type 2 diabetes. Diabetes Obes Metab. 1999;1(suppl 2):S24-S36. 5. Saltiel AR, Olefsky JM. Thiazolidinediones in the treatment of insulin resistance and type II diabetes. Diabetes. 1996;45:1661-1669. 6. American Diabetes Association website. Complications of diabetes in the United States. Available at: http://www.diabetes.org/diabetes-statistics/complications.jsp. Accessed April 26, 2007. 7. DeFronzo RA. Insulin resistance: a multifaceted syndrome responsible for NIDDM, obesity, hypertension, dyslipidaemia and atherosclerosis. Neth J Med. 1997;50:191-197. 8. Geiss LS, Herman WH, Smith PJ. Mortality in non-insulin-dependent diabetes. Diabetes in America. 2nd ed. NIH Publication 95-1468. 1995:233-258. 9. Lyon CJ, Law RE, Hsueh WA. Minireview: adiposity, inflammation, and atherogenesis. Endocrinology. 2003;144:2195-2200. 10. Haffner SM, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998;339:229-234. 11. Stamler J, Vaccaro O, Neaton JD, Wentworth D, for the Multiple Risk Factor Intervention Trial Research Group. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care. 1993;16:434-444. 12. Kuusisto J, Mykkänen L, Pyörälä K, Laakso M. NIDDM and its metabolic control predict coronary heart disease in elderly subjects. Diabetes. 1994;43:960-967. 13. Stratton IM, Adler AI, Neil HAW, et al, on behalf of the UK Prospective Diabetes Study Group. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000;321:405-412.
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