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Statins and quitting smoking are traditional methods that have helped reduce the risk of cardiovascular disease for years. Now, within the scope of diabetology alone, we have drugs that have a spectacular effect that extends the life of our patients.
- Cardiovascular complications are the most serious for patients with diabetes. Almost 1/3 of them have coronary heart disease
- Modern drugs for diabetics include those that, in addition to lowering blood sugar, have a beneficial effect on the cardiovascular system and reduce the risk of developing cardiovascular disease.
- You can find more up-to-date information on the TvoiLokony home page
Chronically high levels of glucose in the blood damage blood vessels and peripheral nerves. For this reason, people with diabetes have a 3-5 times greater risk of heart attack, stroke and cardiovascular diseases – explains Prof. Leszek Czupryniak.
Cardiovascular complications most effectively shorten the life of diabetics
The most common complication of diabetes is so-called microangiopathic complications involving small vessels. The resulting retinopathy is dangerous, and it affects 60-70 percent. patients. In type 1 diabetes, after about 30 years of the disease, almost all patients develop eye fundus changes. Complications are also neuropathies.
The most dangerous, however, as they lead to a shortening of the life expectancy of patients with diabetes, are complications related to the circulatory system. We observe that about 1/3 of patients with type 2 diabetes have ischemic heart disease, or coronary artery disease. It is the most common cause of death in patients with type 2 diabetes.
If a person in their 40s and 50s develops type 2 diabetes, the disease can shorten their life by up to 12 years – not as diabetes itself, but with complications such as ischemic heart disease, heart attacks and strokes.
Two steps to avoiding cardiovascular complications in diabetes
There are two steps in preventing cardiovascular complications in diabetes: by reducing the risk of their occurrence or, if they do occur, by inhibiting their progression. We strive to ensure optimal treatment of diabetes by maintaining the best possible blood sugar levels, but also by preventing hypoglycaemia. We are able to achieve better and better results in this field.
We also have more and more drugs that normalize blood sugar levels and do not cause hypoglycaemia. We are also interested in any other disorders that damage the cardiovascular system, such as high blood pressure, high cholesterol, and smoking. This is one therapeutic focus that we focus on, i.e. optimizing various metabolic disorders that can damage the circulatory system.
The second direction that has emerged in the last few years is the possibility of using such antidiabetic drugs, which – in addition to lowering sugar levels – also have a positive effect on the cardiovascular system and reduce the risk of both developing cardiovascular disease and cardiological deaths – on average from 30 to 40 percent in 3-4 years. This is a very effective action that significantly reduces the risk of our patients dying.
Medicines, the effectiveness of which surprised both doctors and manufacturers
The first study that showed the beneficial effect of a drug from the group of SGLT-2 inhibitors (flozyn), empagliflozin, on the risk of death from cardiovascular causes – its use reduced it by as much as 38%. – the EMPA-REG OUTCOME study – was published 5 years ago, in September 2015 to be exact. In 2016, another study was published confirming the effectiveness of the drug from the group of GLP-1 receptor agonists in reducing cardiovascular risk – liraglutide. Drugs from both groups also inhibit the development of renal complications and reduce the rate of worsening of renal function in diabetes. Since then, we doctors have been learning to use drugs that were originally only intended to lower blood sugar, but have been shown to have far more benefits. In addition, they do not cause hypoglycaemia – which in itself is very beneficial for the body of a diabetic patient, and additionally reduces the risk of cardiovascular complications in diabetes in a surprisingly effective way. Nobody expected such research results – neither the producers nor the doctors.
What is the mechanism of action of these drugs, we do not yet fully know – studies are underway to clarify this issue. However, we know for sure that these drugs are completely safe and bring patients a measurable benefit.
There is a refund – from 2019.
Over the last 20 years, there have been no positive decisions regarding the reimbursement of any modern drugs used in the treatment of type 2 diabetes. This changed in November 2019, when SGLT-2 inhibitors were reimbursed, and later in January 2020, when drugs from the group of GLP-1 receptor agonists have been added to the reimbursement list. Both reimbursements apply to specific groups of patients, in whom the benefit from the use of these drugs is the greatest in terms of reducing the risk of cardiac death. So even if the Ministry of Health, usually very skeptical, decided that these drugs work so well, no one should have the slightest doubt as to their effectiveness.
We, doctors, are boring to repeat that the overriding goal of diabetes treatment is to reduce the risk of cardiovascular complications and extend the life of our patients. Now it has become even more real – thanks to modern anti-diabetes drugs. Previously, we used (and still use them extensively) to achieve this goal, incl. statins, which radically reduce the risk of cardiovascular complications, and we have recommended and consistently recommended that the patient should stop smoking.
Thus, a very big change has taken place in the treatment of diabetes since 2015. So much so that in patients who are already at a very high risk of cardiovascular complications, after introducing a drug from one of these groups, it is possible to both control diabetes well and reduce the risk of vascular complications at the same time. And if the patients are already after a heart attack, for example, then a modern drug belonging to one of two groups should absolutely be introduced to their treatment, because the reduction of the risk of death in this group of patients is best proven.
Author: prof. dr hab. n. med. Leszek Czupryniak, specialist in internal diseases, specialist in diabetes, head of the Department of Diabetology and Internal Diseases at the Medical University of Warsaw
The article comes from the “Diabetes under control” campaign prepared by Warsaw Press, whose media partner is MedTvoiLokony. All materials can be found on http://chorobycywilizacyjne.warsawpress.com/
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