Caring for cardiovascular problems in people with diabetes and pre-diabetes

1. What is diabetes and prediabetes? Diabetes mellitus, also known as diabetes mellitus, is a chronic disease associated with impaired carbohydrate metabolism in the body, characterized by high blood sugar.
Diabetes can be divided into two main classifications based on a lack of insulin - the hormone that helps lower blood sugar in the body is produced by beta cells of the pancreas. Type 1 diabetes is associated with pancreatic islet beta cell deficiency causing absolute insulin deficiency. Type 2 diabetes is associated with decreased insulin secretion by the body and decreased insulin sensitivity or insulin resistance, leading to less effective insulin. In addition, some people may develop gestational diabetes or diabetes secondary to another medical condition or medication.
Pre-diabetes is a condition in which blood sugar is elevated but not yet reached the threshold for diagnosis of diabetes, characterized by fasting blood sugar from 5.6-6.9mmol/l and/or blood sugar after 2 hours of drinking 75g of sugar. (glycemic tolerance test) is in the range of 7.8-11mmol/l and/or HbA1C is in the range of 5.7-6.5%. People who are prone to prediabetes include those who are obese, have high blood pressure, have high triglycerides, low HDL, have a parent or sibling with diabetes...

2. Why does diabetes affect your cardiovascular system? Diabetes is increasing worldwide. It is estimated that by 2045, more than 600 million people worldwide will have type 2 diabetes, and a similar number will have prediabetes. In the future, the number of people with diabetes will continue to increase sharply in Asian Countries due to the rise of sedentary lifestyles and processed foods.
Diabetes affects the vascular system in the body by accelerating the process of atherosclerosis due to oxidative stress, inflammatory reactions and microthrombosis, affecting the normal function of the vascular endothelium. .
According to data from studies, diabetes is an independent risk factor for a 2-fold increase in the risk of cardiovascular events (including death from vascular disease, myocardial infarction, and stroke). High blood sugar also leads to small vessel diseases such as retinopathy, glomerular disease and neuropathy.

3. What to do to prevent diabetes? To prevent diabetes, you should follow a healthy diet and exercise regularly, maintain optimal weight or lose weight if BMI ≥23kg/m2 or waist circumference ≥94cm in men and ≥80cm in female. Smoking cessation may reduce the risk of diabetes by reducing the systemic inflammatory response.
Healthy people should go for a checkup every 6-12 months to screen for risk and detect diabetes early. People with prediabetes should be re-evaluated annually. Usually, the doctor will advise and screen by testing the fasting blood sugar index or the average blood sugar index of 3 months HbA1C in people ≥ 45 years old, women with a history of gestational diabetes, adults with diabetes BMI ≥23kg/m2 (for Vietnamese) and those with at least one diabetes risk factor such as:
Parents or siblings with diabetes High-risk race (Asian people are considered as high-risk race) Sedentary lifestyle High blood pressure Dyslipidemia History of cardiovascular events Polycystic ovary syndrome If you have similar risk factors, take the initiative to go to the hospital for advice. risk consultation and control.

4. What can be done to reduce cardiovascular risk in diabetics? A healthy lifestyle not only helps to reduce the risk and delay the onset of diabetes, but also helps diabetics reduce the risk of cardiovascular events such as heart attack and stroke.
Optimal blood sugar control, usually the blood sugar target is based on the 3-month average glycemic index HbA1C <7%, avoiding hypoglycemia. Elderly people have many comorbidities, HbA1C can be considered to 7.0-7.5% to avoid hypoglycemia. Metformin, liraglutide, and SGLT2 inhibitors such as dapagliflozin or empagliflozin may be considered as an option for initial glycemic control alone or in combination in patient populations based on cardiovascular risk assessment. In particular, with the current scientific evidence, the benefits of reducing the risk of cardiovascular events, hospitalization for heart failure, and reducing the progression of chronic kidney disease, SGLT2 inhibitors are becoming the first choice in patients with chronic kidney disease. Diabetics are at high to very high cardiovascular risk.
Long-term use of blood lipid control drugs not only lowers blood fat but also reduces the risk of cardiovascular events. The physician will evaluate each individual patient and discuss the goal of reducing LDL <2.6mmol/l or <1.8mmol/l or <1.4mmol/l depending on the average, high cardiovascular risk level. or very high.
In the case of diabetic patients with hypertension, the doctor will advise the optimal blood pressure lowering goal for each specific patient, considering cardiovascular risk, age, and tolerability. .. Normally, systolic blood pressure should be in the range of 120-130mmHg, diastolic blood pressure should be in the range of 70-80mmHg. In the elderly (>65 years), systolic blood pressure should be in the range of 130-139 mmHg.
Listening to advice from medical staff, adherence to treatment and regular check-ups are the keys for diabetics to live healthier and happier lives.