NYTimes: Looking Beyond Sugar to the Heart.

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> June 6, 2004

>

> Looking Beyond Sugar to the Heart

> By SUSAN GILBERT

>

>

> CONTROLLING diabetes used to be a simple, if demanding, routine that

> required keeping track of the level of sugar in the blood. In recent

> years, the regimen has become more complicated with the discovery that

> heart disease is a more serious threat to people with Type 2 diabetes

> than the complications caused by high blood sugar.

>

> As many as 80 percent of people with diabetes will develop

> cardiovascular disease; the disorder raises the chance of heart

> problems by roughly twice as much for women as for men, according to a

> report in the May issue of The Archives of Internal Medicine. And yet,

> the report found that women with Type 2 diabetes were less likely than

> men to be prescribed drugs to lower the risk of cardiovascular disease.

>

> " Diabetes is a particularly troubling disease for women, " said Dr.

> Elsa-Grace V. Giardina, director of the Center for Women's Health at

> Columbia and an author of the study. " For women, you have to err on the

> side of overtreatment. "

>

> These are the main bases to cover:

>

> BLOOD PRESSURE Many experts consider controlling blood pressure to be

> the most important action a diabetic can take.

>

> The National Institutes of Health recommends that Type 2 diabetics

> take medication to lower their blood pressure if it is higher than

> 130/80; the trigger point for nondiabetics is 140/90. Diuretics,

> angiotensin II receptor blockers and ACE inhibitors are among the

> medications cited.

>

> Similarly, diabetics are considered pre- hypertensive, and should be

> counseled to pursue an exercise and weight loss plan, at lower readings

> than nondiabetics.

>

> CHOLESTEROL Most people with Type 2 diabetes should be taking statins,

> according to guidelines issued in April by the American College of

> Physicians, even if their cholesterol and other lipid levels are normal

> or low. The recommendation applies to all patients over 55, and younger

> patients with any other risk factors for heart disease.

>

> Studies cited in the guidelines found that diabetics who took statins

> and blood pressure medicine reduced the risk of heart attack or stroke

> by up to a third.

>

> BLOOD SUGAR In Type 1 diabetes, the body fails to produce insulin, the

> hormone that regulates blood sugar. In Type 2, the body's ability to

> respond to insulin is weakened. All Type 1 patients inject insulin.

> Both types of patients must monitor their blood sugar and control their

> diet to keep blood sugar in a target range. Some drugs are available to

> help Type 2 patients control blood sugar. One kind, sulfonylureas,

> helps the pancreas make insulin. Another, thiazolidinediones, makes the

> body more sensitive to insulin. If one pill does not lower blood sugar

> sufficiently, a combination is prescribed.

>

> DIET AND EXERCISE Some patients are able to lower their cardiovascular

> risk by losing weight, eating healthier, exercising and quitting

> smoking. Even with the emphasis on medication, these changes are

> important, said Dr. Eugene Barrett, president of the American Diabetes

> Association. " They're more effective than any drug treatment we have in

> preventing diabetes. "

>