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Promoting diabetes care, prevention and a cure worldwide

Diabetes and cardiovascular disease

Diabetes and cardiovascular disease (CVD) are both global epidemics. They are currently among the leading causes of morbidity and mortality worldwide, particularly affecting populations in low- and middle-income populations. Their negative effects are accelerated by globalization, rapid unplanned urbanization and increasingly sedentary lifestyles.

People with diabetes are two to three times more likely to have cardiovascular disease than people without diabetes. High levels of blood glucose can make the blood coagulation system more active, increasing the risk of blood clots. Diabetes is also associated with high blood pressure and cholesterol levels, which lead to increased risk of cardiovascular complications such as angina, coronary artery diseases (CADs), myocardial infaction, stroke, peripheral artery disease (PAD), and congestive heart failure.

Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels and include:

• Coronary heart disease: disease of the blood vessels supplying the heart muscle • Cerebrovascular disease: disease of the blood vessels supplying the brain • Peripheral arterial disease: disease of blood vessels supplying the arms and legs • Rheumatic heart disease: damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria • Congenital heart disease: malformations of heart structure existing at birth: deep vein thrombosis and pulmonary embolism - blood clots in the leg veins, which can dislodge and move to the heart and lungs

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The Diabetic Foot

We lead the global advocacy effort for action to prevent, control and reduce the global burden of CVD

High blood glucose can cause damage to the nerves throughout the body. Neuropathy is a frequently encountered complication of diabetes. Nerve damage can be quite significant and allow injuries to go unnoticed, leading to ulceration, serious infections and in some case amputations.

Diabetic neuropathy is an impairment of normal activities of the nerves throughout the body and can alter autonomic, motor and sensory functions. Peripheral neuropathy is the most common form of diabetic neuropathy, affecting the outer nevers of the limbs, particularly those of the feet. It mainly alters sensory function, causing abnormal feelings and progressive numbness which facilitates the development of ulcers (diabetic foot).

Diabetic foot is one of the most common, costly and severe complications of diabetes. Amputation in people with diabetes is 10 to 20 times more common than in people without diabetes and it is estimated that every 30 seconds a lower limb or part of a lower limb is lost somewhere in the world as a consequence of diabetes.

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Diabetes and the kidneys

Kidney disease (nephropathy) is far more common in people with diabetes than in people without diabetes. It is caused by damage to small blood vessels, which can cause the kidneys to be less efficient, or to fail altogether. Diabetes is one of the leading causes of chronic kidney disease (CKD).

Based on data from the UK and USA, up to 40% of people with diabetes will develop chronic kidney disease.1 Pooled data from 54 countries reveal that more than 80% of cases of end-stage renal disease (ESRD) are caused by diabetes, hypertension or a combination of both.

Diabetes, hypertension and kidney failure are highly interlinked. On the one hand, type 2 diabetes is a leading cause of kidney failure, which is a risk for hypertension, and on the other, hypertension can often precede CKD and contribute to the progression of kidney disease.

Both diabetes and CKD are strongly associated with cardiovascular disease (CVD) and therefore, the major component in their management is control of CVD risk factors such as hypertension and high blood glucose (hyperglycaemia). It is important to control blood glucose and blood pressure to reduce the risk of kidney disease. Screening for abnormal quantities of albumin in the urine (albuminuria) and starting treatment with drugs that reduce the activity of the renin-angiotensin-aldosterone system when albuminuria is persistently found, even in the absence of hypertension, is very effective to prevent the development and progression of CKD in people with diabetes.

Diabetes and the eye

We lead the global advocacy effort for action to prevent, control and reduce the global burden of CVD

Everyone with diabetes is at risk of losing vision. As diabetes becomes more prevalent so do associated complications like diabetic retinopathy.

Diabetic retinopathy occurs as a direct result of chronic hyperglycaemia (high blood glucose), causing damage to retinal capillaries, leading to capillary leakage and blockage. It may lead to loss of vision and eventually blindness.

Diabetes may also cause conditions such as cataract, glaucoma, loss of focusing ability and double vision.

Diabetic retinopathy is the leading cause of vision loss in working-age adults (20-65 years). Approximately one in three people with diabetes have diabetic retinopathy and one in ten will will develop a vision threatening form of the disease.

Managing diabetes goes a long way to managing diabetic retinopathy. Diabetes management includes controlling blood pressure, blood glucose and lipid levels. This can be achieved by encouraging a healthy lifestyle and medication as required. Improved control can slow the progession of eye disease, especially when initiated soon after diabetes is diagnosed.

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Prevention of type 2 diabetes

425 million people were living with diabetes in 2017. Most of these cases are type 2 diabetes. Another 352 million people were estimated to be at high risk of developing type 2 diabetes in 2017.

While there are a number of factors that influence the development of type 2 diabetes, it is evident that the most influential are lifestyle behaviours commonly associated with urbanization. These include consumption of unhealthy foods and inactive lifestyles with sedentary behaviour. Randomised controlled trials from different parts of the world, including Finland, USA, China and India, have established the that lifestyle modification with physical activity and/or healthy diet can delay or prevent the onset of type 2 diabetes.

Modern lifestyles are characterised by physical inactivity and long sedentary periods. Community-based interventions can reach individuals and families through campaigns, education, social marketing and encourage physical activity both inside and outside school and the workplace. IDF recommends physical activity at least between three to five days a week, for a minimum of 30-45 minutes.

Taking a life course perspective is essential for preventing type 2 diabetes and its complications. Early in life, when eating and physical activity habits are established and when the long-term regulation of energy balance may be programmed, there is an especially critical window to prevent the development of overweight and reduce the risk of type 2 diabetes. Healthy lifestyles can improve health outcomes at later stages of life as well.

Managing type 2 diabetes in primary care

Diabetes is a global issue. Type 2 Diabetes (T2DM) is the most common form of diabetes. Around 90% of people with diabetes have type 2 diabetes. From the onset of the disease until the symptoms developed, many people with undiagnosed diabetes already have complications such as chronic kidney disease, heart failure, retinopathy and neuropathy. Early detection, diagnosis, and cost-effective treatments can save lives and prevent or significantly delay devastating diabetes-related complications.

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