Diabetes 2002: 

(the "Cliff Notes" Version)

1) Blood pressure: Many of our patients have heard the "quiz" – what’s the most important thing you can do to live better and longer with the disease? And you now know the answer: control your blood pressure!!

Goal blood pressure for those with diabetes is 130/80 or less. This goal, from the National Kidney Foundation, is supported by a lot of data, according to Joslin kidney specialist Dr. Richard J. Solomon. At that blood pressure, annual loss of kidney function approaches that of non-diabetics. And the huge United Kingdom Prospective Diabetes Study (UKPDS) showed that achieving a blood pressure of 142/82 instead of 154/87 cut the heart attack and stroke rate by 44% over 9 years. Tighter sugar control also helped, but not nearly as much – those who got a "long-range" sugar Hemoglobin A-1C ("Glyco") test of 7.0% had a 16% lower rate than those who got 7.9%.

And it can take several drugs to get to the goal – 3 drugs were used in the UKPDS and they still didn’t get everyone to the new goal of 130/80! Uncontrolled hypertensives lose 15 times the kidney function of normals annually. If your BP is 140/90, you’ll still have over 3X normal loss!!

Sadly, of 75,000 U.S. patients who go on to dialysis or kidney transplant every year, 75% are diabetic, hypertensive, or both!

2) Cholesterol: What’s the

second most important thing you can do for better diabetic health? Right again, control your cholesterol!!

Goal LDL ("Lousy Darn Cholesterol" or low density lipo-protein) is 100 or less. And the goal "good" HDL is 45 or more.

This is also the goal for people with known heart attack (myocardial infarction or MI) or other blood vessel disease. It turns out that diabetics have a higher risk of heart attack than non-diabetics who have already had an MI! So reports Lahey Clinic cardiologist Dr. Richard W. Nesto. In the East-West study, diabetics had a 20.2% heart attack risk over 7 years, compared to 18.8% in non-diabetics with previous MI. Even those with "prediabetes" or impaired glucose tolerance (some 20 million in the U.S.) are at risk. Diabetics have less warning symptoms of and poorer survival after MI.

3) And, Yes, Sugar Control is Also Important! The UKPDS showed that better sugar control (lower hemoglobin A-1C) reduced all complications: heart attack, eye disease, and kidney damage. A level of 6% or less (which is what half of our type 2 patients achieve) reduced heart attacks and related events to normal in that study. And intensive therapy did decrease the heart attack rate 14%. Better sugar control also reduced kidney damage by as much as 25% in the UKPDS.

• Stop Smoking! That cuts heart events by 50-70%!
• Regular Exercise can drop rates by 45%.
• A Healthy Weight maintaining it reduces rates by 35-55%
• Mild to Moderate Alcohol intake, in those who already drink, can reduce event rates by 20-40%.
• Aspirin: 650 mg daily reduced heart attacks 17% in a group of diabetics who had never had an MI (primary prevention) and 32% in another group who’d already had an event (secondary prevention); in that group stroke was reduced 27% and heart death 15%.
• And Don’t Forget Feet! Check them frequently (and we will, too!). Your feet help tell your overall vascular and nerve health.