At least 10.3 million Americans have been diagnosed with diabetes mellitus, and another 5.4 million are estimated to have undiagnosed diabetes. Onset often precedes diagnosis by several years.
About 90% of diabetic patients have Type II diabetes
Hispanics, blacks, Native Americans, and Asians (especially South Asians) are especially susceptible to diabetes.
Diabetes in women essentially cancels out any hormonal protection.
Diabetes: Type II Diabetes and Insulin Resistance
Type II diabetes is most common form, occurring later in life, and involving combination of impaired insulin-mediated glucose disposal (insulin resistance) and defective secretion of insulin by pancreatic beta cells
Insulin resistance develops from obesity and physical inactivity and insulin secretion declines with advancing age (and accelerated by genetic factors)
Cardiovascular diseases (CVD) account for about 65% of all deaths in diabetics; those with CVD have a worse prognosis than CVD patients without diabetes.
Complications include CHD, stroke, peripheral arterial disease, nephropathy, retinopathy, and possibly neuropathy and cardiomyopathy.
Stroke mortality 3-fold in diabetics vs. nondiabetics. Carotid atherosclerosis and likelihood of irreverisible brain damage from stroke more common in diabetics.
Renal impairment is a severe complication of diabetes; about 35% of pts with Type I diabetes have some renal impairment. End stage renal disease (ESRD) carries a high mortality (20%/year in dialysis pts) and is more common in Hispanics, blacks, and Native Americans
Framingham Heart Study 30-Year Follow-Up: CVD Events in Patients With Diabetes (Ages 35-64) 10 9 20 11 9 6 38 19 3* 30 0 2 4 6 8 10 Age-adjusted annual rate/1,000 Men Women Total CVD CHD Cardiac failure Intermittent claudication Stroke Risk ratio P <0.001 for all values except * P <0.05.
Risk Similar in Patients With Type 2 Diabetes and No Prior MI vs Nondiabetic Subjects With Prior MI Haffner SM et al. N Engl J Med. 1998;339:229-234. 0 1 2 3 4 5 6 7 8 0 20 40 60 80 100 Nondiabetic subjects without prior MI (n=1,304) Diabetic subjects without prior MI (n=890) Nondiabetic subjects with prior MI (n=69) Diabetic subjects with prior MI (n=169) Survival (%) Year
The JNC-VI recommends pharmacologic treatment concurrently with lifestyle management for hypertension in diabetics with a systolic blood pressure of 130mmHg or higher, or a diastolic blood pressure of 85 mmHg or higher.
An angiotensin converting enzyme (ACE)-inhibitor is recommended as first line therapy also because of renal-protective effects in preventing progression of microalbuminuria / proteinuria.
Primary CHD* Prevention in Patients With Type 2 Diabetes: The Helsinki Heart Study 7.4 3.3 10.5 3.4 0 5 10 15 Type 2 (n=135) Others (n=3,946) Type 2 on placebo (n=76) Type 2 on gemfibrozil (n=59) 5-Yr incidence of CHD (%) *Myocardial infarction or cardiac death. NS=not significant. Koskinen P et al. Diabetes Care. 1992;15:820-825. P <0.02 P =NS
Total mortality 232 167 24 15 CHD mortality 172 99 17 12 Major CHD event 578 407 44 24 Any CHD event 871 667 56 41 CABG or PTCA 363 238 20 15 Cerebrovascular event 90 70 12 5 Any atherosclerotic event 961 750 61 46 Nondiabetic Diabetic P S 0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 RR with 95% CIs No. patients Simvastatin Placebo with events better better