KOCHI: World Diabetes Day celebrated on November 14th every year, is the world’s largest diabetes awareness campaign reaching a global audience of over 1 billion people in more than 160 countries. The campaign draws attention to issues of paramount importance to the diabetes world and keeps diabetes firmly in the public and political spotlight.
Diabetes prevalence has been rising more rapidly in middle- and low- income countries. Diabetes is a major cause of heart attacks, stroke, blindness, kidney failure and lower limb amputation. The number of diabetes patients in India is likely to go up to 120 million in next 20 years. Also, on an average every diabetic spends about Rs 25,000 annually to manage the disease and its associated complications. India has the second largest number of people with diabetes which is at 70 million, next to China which has about 110 million.
Kerala is known as diabetes capital of India as prevalence of diabetes is high, that is, 20 percent which is double the national average of 8 percent. Heart disease is the foremost killer of people with diabetes. 80 percent of diabetic patients die from heart attacks. A diabetic compared with non diabetic has four times the chance of getting heart attack. Only 40 percent of people with diabetes keeps their blood sugar under control. Among those with diagnosed diabetes , 17 percent receives no treatment, 15 percent are diet alone, and 68 percent takes medications. In Kerala, as compared to urban dwellers people from rural Kerala, paradoxically having higher rates of diabetes.
The international diabetes federation has announced that the theme of World Diabetes day 2017 is “Women and Diabetes-Our right to a healthy future”. Diabetes is the ninth leading cause of death in women globally, causing 2.1 million deaths each year. As a result of socioeconomic conditions, girls and women with diabetes experience barriers in accessing cost-effective diabetes prevention, early detection, diagnosis, treatment and care, particularly in developing countries. Socioeconomic inequalities expose women to the main risk factors of diabetes, including poor diet and nutrition, physical inactivity, tobacco consumption and harmful use of alcohol. Two out of every five women with diabetes are of reproductive age, accounting for over 60 million women worldwide. Women with diabetes have more difficulty conceiving and may have poor pregnancy outcomes. One in 7 live births is affected by gestational diabetes, a newly detected diabetes during pregnancy, which is a severe and neglected threat to maternal and child health.
Having diabetes means that you are more likely to develop heart disease and have a greater chance of heart attack and stroke. Over time, high blood glucose can damage your blood vessels and the nerves that control your heart and blood vessels. The longer you have diabetes, the higher the chances that you develop heart disease. People with diabetes tend to develop heart disease at a younger age than people without diabetes. Other risk factors like smoking, high blood pressure, abnormal cholesterol levels, obesity and belly fat, and family history of heart disease can ultimately result in early incidence of heart attacks in diabetics.
Heart attacks account for 60 percent deaths in patients with diabetes. Diabetes affects the heart in many ways: It speeds the progression of atherosclerosis (hardening of blood vessels). Diabetes is often associated with low HDL (good cholesterol) and high triglycerides. This can lead to coronary artery disease, heart attack, or stroke.
Impaired nerve function (neuropathy) associated with diabetes also causes heart abnormalities. Diabetic patients with heart attack may not feel the intensity of chest pain adequately and this puts them in trouble, they come late to hospital and all the life saving treatments get delayed which ultimately increases their death rate.
Due to the extensive atherosclerosis, impaired micro vascular autoregulation and prothrombotic and vasospastic effects of diabetes, angioplasty might be expected to be less effective in achieving adequate reperfusion in diabetics. More over diabetics have more extensive and complex coronary blocks which makes ultimately the angioplasty technically difficult. Hence in principle, Byepass surgery is the preferred treatment modality in diabetic patients with complex coronary abnormalities to achieve a complete revascularization. However after Heart attack , in order to address the immediate severe complications, all patients should if possible undergo primary angioplasty to tackle the culprit vessel for enabling adequate blood flow to the damaged heart muscle.
Prevention is always better and the good news is that there are steps to reduce your risk for heart disease if you have diabetes. Here are seven tips for you: control your weight, get regular physical activity, don’t smoke, maintain tight control over glucose, lower your LDL cholesterol (the bad type) below 70 mg/dl using statins, control your blood pressure, consider incorporating Aspirin to your daily routine.
The author is a Senior Consultant Cardiologist at Lourdes Hospital Kochi.
The views expressed by the author are his own.