Learn your diabetic ABCs

by Elizabeth Smoots, MD

If you've ever taken a class to learn CPR, or cardiopulmonary resuscitation, you probably remember the ABCs: A is for airway, B for breathing, C for carotid pulse and chest compressions. Now, the National Diabetes Education Program (NDEP) has come up with its own ABCs.

The NDEP recently launched a campaign called "Be Smart About Your Heart: Control the ABCs of Diabetes." The goal of the program is to make people with diabetes aware of their high risk for heart disease and stroke. In my opinion, it's high time to take action. Here's why.

Diabetics at risk for heart disease

People with diabetes have a two- to four-fold greater chance of developing heart disease, stroke, or hardening of the arteries compared to people without diabetes. And deaths from these diseases have not fallen in recent years among diabetics the way they have among people without diabetes.

When the time comes, about 80% of patients with diabetes die from cardiovascular causes. If you have diabetes—even if you have no known heart disease—you've got the same high risk of having a heart attack as someone who has already had a first heart attack. And your odds of dying from a first heart attack are the same as someone without diabetes who has had a second heart attack. It's that serious.

Heart disease results from diabetes when high blood-sugar levels lead to premature hardening of arteries throughout the body. The widespread buildup of plaque contributes to a life expectancy in diabetics that is shortened by an average of about 10 years.

Scope of the diabetes problem

What are the ABCs?

In order to reduce the risk of heart attack and stroke in people with diabetes, we need better management of three critical factors. The National Diabetes Education Program (NDEP) has nicknamed these the ABCs:

"A" is for the A1C test to measure blood sugar

Short for hemoglobin A1C, the A1C test is a blood test that measures how your blood sugar levels have been averaging over the past couple months. Depending on the severity of your disease, your A1C level should be checked about three to four times a year.

"B" is for blood pressure

In people with diabetes the threshold for starting high blood pressure therapy is 130/85. Results from a study of 1,100 patients with diabetes showed that patients with the best blood pressure control had a 34% reduction in cardiovascular disease risk compared to those with poorer control.

"C" is for cholesterol

Guidelines from the National Cholesterol Education Program say that LDL (bad) cholesterol levels should be less than 100, the same level recommended for patients with coronary heart disease. People with diabetes should also try to raise HDL (good) cholesterol and lower triglyceride levels.

Steps to lower heart disease risk

A recent government report found the majority of people with diabetes in this country are not getting the kind of care they need to prevent heart disease. But NDEP's new campaign urges people with diabetes to gain control of their A1C, blood pressure, and cholesterol. A good place to begin is by asking your health care provider three important questions about your ABCs:

• What are my A1C, blood pressure, and cholesterol numbers?
• What are my personal treatment goals?
• What do I need to do to reach these goals?

Just because you have diabetes does not mean you have to die prematurely from heart disease or stroke. I've seen that managing the diabetic ABCs can make a real difference.