Diabetes and Cardiovascular Disease
July 2003

People with diabetes are two to six times more likely to develop cardiovascular disease than people without diabetes. Cardiovascular Disease is the major complication and leading cause of death in people with type 2 diabetes. The most important forms of Cardiovascular Disease are coronary heart disease, cerebrovascular disease and peripheral vascular disease. These lead to heart attacks, angina, heart failure, stroke, and gangrene or ulceration of the feet and legs requiring amputation. People with diabetes are also prone to developing Cardiovascular Disease at a younger age and having more severe effects than people without diabetes. Added to this, risk is increased even at the earlier stages of glucose intolerance.

Given current evidence about prevention of diabetes and management of associated Cardiovascular Disease risk factors, IDF’s position is that:

• All people with diabetes should receive education about diabetes and its complications, including Cardiovascular Disease and CVD risk factors.
• Measures should be taken in the community to prevent diabetes from developing in the first place.
• All people with diabetes should have access to medical care not only aiming to control glucose levels optimally, but also emphasizing the importance of management of associated conditions and risk factors, particularly high blood pressure and high blood lipid levels.
• All people with diabetes should receive regular screening for early detection of complications, and markers and risk factors for CVD.
• Healthcare planners need to ensure that their systems can cover the whole range of care provision required to achieve these goals.

People with diabetes face a two to six - fold increased risk of developing cardiovascular disease (CVD). CVD is the major complication of diabetes and is responsible for 50 to 80% of deaths in people with type 2 diabetes. People with type 1 diabetes are also increasingly exposed to the risk of Cardiovascular Disease as their life expectancy continues to improve with advances in insulin therapy and better glycaemic control.

The impact of CVD in diabetes is exacerbated even further by the following factors:

• Type 2 diabetes is occurring in younger age groups, including teenagers and children.
• The risk of CVD is already present in the intermediate state of impaired glucose tolerance or IGT and is increased when diabetes develops.
• As well as being a risk factor in its own right, diabetes is associated with other common risk factors such as high blood pressure and high blood lipids, and these in turn are more harmful in people with diabetes.
• Diabetes damages blood vessels by several mechanisms which then act together to produce more severe and widespread disease than would otherwise be expected.
• Premenopausal protection against coronary heart disease (CHD) is lost in women with diabetes; the epidemic rise of diabetes offsets measures to contain CVD.

IDF recognizes the magnitude of this problem and strongly encourages all possible collaborative measures aimed at controlling the problem. This includes measures based on lifestyle, which have proven to be effective in preventing diabetes and IGT. Inactive lifestyles, tobacco use and poor diets all contribute to the development of diabetes and CVD. Changes in lifestyle such as losing weight when appropriate, avoiding smoking, eating a healthy, balanced diet and making regular physical activity can only be of double benefit in preventing diabetes and also independently reducing CVD risk.

IDF firmly believes that all people with diabetes deserve levels of care which achieve the following aims:

• Optimal glycaemic control: there is conclusive evidence that good control of blood glucose levels can substantially reduce the risk of developing complications and slow their progression in all types of diabetes.
• Attention to all other risk factors: many cardiovascular diseases are potentially preventable if the risk factors can be modified. Apart from lifestyle changes, high blood pressure and high cholesterol are other major risk factors that can be reduced by a combination of simple, cost-effective, national efforts and individual actions.
• Screening for complications and for risk markers such as proteinuria: early detection is essential to enable intervention in the early stages of cardiovascular complications.
• Provision of services to treat CVD and its consequences: adequate healthcare resources need to be made available for the treatment of established diabetes and its cardiovascular complications.

IDF encourages those with responsibility for the provision of healthcare services to guarantee that all steps are taken to ensure that these measures are met. Governments can make a significant contribution by encouraging lifestyle changes, providing health education and investing in prevention programmes. These programmes can be integrated or linked with other health or environmental programmes and have obvious long-term benefits.

References:
1.International Diabetes Federation 2001

Source: International Diabetes Federation