New advice to doctors on lowering diabetes-heart disease risks

Jun 5 2004

Every year, the American Diabetes Association (ADA) issues Clinical Practice Recommendations, a series of updated recommendations, to help health care providers treat people with diabetes using the most current research available. This year's revisions reflect a better understanding of how to prevent or delay diabetes-related complications, such as heart disease, the leading cause of death for people with diabetes.

More than 18 million Americans are currently living with diabetes -- a chronic condition that can lead to life-threatening illness. People with diabetes are two-to-four times more likely than others to develop heart disease, for example, and are more likely to die from heart attacks than people who don't have diabetes.

"These Guidelines, which are updated annually, can serve as an incredible resource for health care professionals by giving them the most up-to-date medical information available," said Nathaniel Clark, MD, MS, RD, National Vice President, Clinical Affairs, American Diabetes Association. "New research is published almost daily. What we do is constantly review all of that research so that we can provide these increasingly busy practitioners with information about the most effective treatment options for people with diabetes."

The updated Guidelines, which can be downloaded to a Palm OS Device, include new recommendations for several key areas of care, including lowering blood pressure and blood glucose levels, treating high cholesterol, use of aspirin and more aggressive physician interventions to help people who smoke find methods to help them quit. Smoking greatly increases the risk for heart disease in all people, but for people who have diabetes, who are already at increased risk for cardiovascular problems, smoking cessation is even more critical.

The updated Guidelines reflect the results of several scientific studies, including the Heart Protection Study, the largest-ever cholesterol and diabetes study using a statin, a type of cholesterol-modifying medication. This study found that people with diabetes could reduce their risk of having a heart attack or stroke with treatment of a statin, even if their cholesterol levels are normal. As a result, the ADA Guidelines now recommend that statins be considered for people with diabetes over the age of 40 who have a total cholesterol level that is greater than or equal to 135.

"This is promising news because 99 percent of people over the age of 40 with diabetes have a total cholesterol equal to or greater than 135," said Dr. Clark. "And many are not taking a statin to lower their cholesterol."

The guidelines also recommend a blood pressure goal of less than 130/80 mmHg for people with diabetes and make suggestions regarding which drug classes might be used. They call for lowering blood glucose levels, as measured by the A1C test, to less than 7 percent for most people with diabetes and less than 6 percent for individual patients as appropriate. Aspirin is recommended for those with diabetes unless contraindicated.

The updated Guidelines include extensive revisions on smoking and diabetes. The recommendations state that smoking as a risk factor for cardiovascular disease among people with diabetes is not being adequately addressed by health care providers. They call upon doctors, nurses and other providers to intervene more assertively by asking patients whether they smoke, assessing whether they are willing to try a cessation program and then helping them to get started with an effective smoking cessation treatment plan.

For more information about the ADA's new Clinical Practice Guidelines published in the January issue of Diabetes Care, please visit www.diabetes.org. Diabetes Care, published by the American Diabetes Association, is the leading peer-reviewed journal of clinical research into the nation's fifth leading cause of death by disease. Diabetes also is a leading cause of heart disease and stroke, as well as the leading cause of adult blindness, kidney failure and non-traumatic amputations. For more information about diabetes, visit the American Diabetes Association Web site http://www.diabetes.org or call 1-800-DIABETES (1-800-342-2383).