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New Guidelines on Heart Disease Prevention and Diabetes – Areas of Controversy and Needed Research

I mentioned in an earlier post that the American Diabetes Association and American Heart Association have just released an update on the prevention of heart disease in adults with type 2 diabetes. This report sheds new light on several important issues related to heart disease prevention, but just as importantly it identifies issues where the research is not clear. These gaps in knowledge illustrate how complex the relationship between diabetes and heart disease can be, and I’ve detailed some below.

  • Blood glucose lowering drugs in relation to their potential benefit to heart disease risk is still not well understood, mostly because studies tend to look short term at blood glucose results and potentially negative side effects rather than secondary benefits. Some diabetes drugs, like metformin, appear to reduce heart disease risks, and several long term studies on other diabetes drugs are underway. More studies are needed.
  • Bariatric surgery has shown impressive results in improving heart disease risk and even putting type 2 diabetes in remission, but these procedures need more long term, carefully controlled studies.
  • Hypoglycemia (low blood glucose) is a common negative side effect of intensive therapy to lower blood glucose, but hypoglycemia may also raise heart disease risks over the long term. The effects of low blood glucose events on heart disease needs more study.
  • Intensive blood pressure lowering therapy (below 140 systolic) has not shown an increased benefit in reducing cardiovascular events except for a potential reduction of stroke risk in some high-risk individuals. More work is necessary to look at patients with type 2 diabetes and a high risk for stroke.
  • Lowering triglycerides is another area needing a targeted study specific to individuals with type 2 diabetes – available studies are unclear regarding a potential benefit.

It may seem as if there is more we don’t know about diabetes and heart disease than what we actually know, but that’s not completely accurate. The need for more research in these areas (and in other areas as well) just illustrates how complex this subject is. Overall, the best advice is to focus on lifestyle (diet and exercise), preferably with individualized or group professional guidance, and to see your doctor regularly so any new treatment strategies can be incorporated into your medical care.

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