Treating Diabetes: Beyond Glucose Control
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Treating Diabetes: Beyond Glucose Control

Blood pressure control is important for heart disease prevention in people with diabetes.

There are four major potential complications of poorly controlled diabetes, eye damage (retinopathy), kidney damage (nephropathy), nerve damage (neuropathy), and heart disease. The control of glucose is vitally important for the prevention of diabetes related microvascular complications (retinopathy and nephropathy) as well as neuropathy. However, studies have now shown that in order to prevent heart disease, the leading cause of death in people with diabetes, treatment of hypertension and hyperlipidemia are as important or more important than glucose control. 

The American Diabetes Association, the American Heart Association, the National Kidney Foundation, and the Joint National Committee on Prevention, Detection, and Treatment of High Blood Pressure all agree that people with diabetes need to maintain a blood pressure less than 130/80 millimeters of Mercury (mm Hg) in order to prevent not only kidney disease but also heart disease. These societies also recommend the use of one of two classes of blood pressure medications, Ace Inhibitors or Angiotensin Receptor Blockers, as the first-line agent for blood pressure management. However, in my experience, most patients require two or three different medications for adequate blood pressure control (130/80 mm Hg).

Lipid management is also of crucial importance with regard to heart disease prevention and there are strict guidelines outlining HDL (good cholesterol), LDL (bad cholesterol), and Triglyceride treatment goals from the the National Cholesterol Education Program, the American Diabetes Association, and the American Heart Association. Triglycerides should be maintained less than 150 mg/dl, HDL more than 40 mg/dl in men and 50 mg/dl in woman, and LDL below 100 mg/dl. However, for individuals with multiple heart disease risk factors or known heart disease an LDL goal of less than 70 mg/dl is desirable. '

Other conditions can contribute to elevated blood pressure and high blood glucoses.  One condition in particular that is very common in people with diabetes is sleep apnea. I would advocate screening all people with diabetes for sleep apnea with at least a questionnaire as it is very common and once again effects both blood pressure and glucose control. We use the Epworth Sleepiness Scale as a screening tool at the Diabetes Care Center where I serve as the diabetologist and medical director. The Epworth Sleepiness Scale can be taken online at www.stanford.edu/~dement/epworth.html.

In order to prevent the potential long term complications associated with diabetes be sure you are not only achieving glucose control but also blood pressure and cholesterol control. Be advised that sleep apnea is common in people with diabetes and can lead to difficult to control glucoses and blood pressure as well as heart and lung disease if left untreated.  

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