Heart Involvement in Diabetes

Maturity onset Diabetes also called Type II diabetes is a common medical problem seen with an estimated prevalence of 11.4% as per the recent ICMR-INDIAB-17. The figures are not very different in the population of Jammu and Kashmir. India has an estimated 100 million people formally diagnosed with diabetes, which makes it the second most affected in the world, after China. Furthermore, 700,000 Indians died of diabetes, high blood pressure, kidney disease and other complications of diabetes in 2020.

In order to increase the awareness of this disease in the global audience, world diabetes day (WDD) of over 1 billion people in over 160 countries is observed every year on 14 November, the birthday of Sir Frederick Banting, who co-discovered insulin along with Charles Best in 1922. WDD was created in 1991 by the International Diabetes Federation (IDF) and the World Health Organization and became an official United Nations Day in 2006 with the passage of United Nations Resolution 61/225. This year the theme for World Diabetes Day is 'Empowering Global Health'. This theme not only centers on individual health but also stresses the importance of communities working together to combat this global issue.

 Diabetics and Their Hearts:

 Diabetics are more prone to get heart disease or a stroke and may get this problem at younger ages than their non-diabetic counterparts. The high levels of blood sugar can damage the blood vessels and also nerves of the heart. This can lead to one of the 3 problems alone or in combinations:

1, Coronary artery disease; It is a slowly progressive accumulation of fats and other related material in the walls of the arteries, making them stiffer and blocked to varying degrees. Severe narrowing leads to angina and heart attacks. Inflammation of the walls is an important component leading to sudden catastrophes.

2. Heart Failure: This is because of poor functioning of the heart muscle leading to reduction in its work. This complications present as congestion in the lungs, fatigue, shortness of breath and swelling of body in late stages of disease. It can be due to heart attacks which can at times be silent.

3. Cardiomyopathy: It is a condition where the heart muscle becomes progressively weaker even in absence of blockages in the heart arteries.

Diabetes is often associate with high blood pressure, high LDL cholesterol and high triglycerides and overweight and obesity. These associations make the risks of serious heart involvements more likely.

 Management Issues: Diabetes is treatable, but even when glucose levels are under control it greatly increases the risk of heart disease and stroke. Patients with diabetes face a high risk of heart disease especially a heart attack. Ten years’ risk of getting a heart attack in a patient with uncomplicated diabetes is 20 per cent. “Silent heart attack” is another peculiarity seen in diabetics. This is because of involvement of pain transmitting nerves due to uncontrolled diabetes. These people will not feel many sensations of touch, vibration, heat, cold or pain, and this may also include the expected pain of a heart attack.

 People with diabetes and even pre-diabetes (a term used for the population whose blood sugar is high but not high enough to be Type 2 diabetes)  It is diagnosed when the Hb A1c is between 5.7 -6.4 % and one or more of the risk factors enumerated above are at even greater risk of heart disease or stroke. People with diabetes may avoid or delay heart and blood vessel disease by managing their risk factors, especially high blood pressure and keeping the cholesterol levels very low.

 Recent years have improved the drug treatment with the availability of two group of drugs;

a. SGLT2 (Sodium Glucose Transport Protein 2 inhibitors): Dapagliflozin and Empagliflozin. These agents work by excreting sugar through urine and are very useful in preventing heart failure and also treating all varieties of heart failure. They also prevent and treat kidney related complications leading to chronic kidney disease. 

b.   GLP1 (Glucagon like peptide 1) agonists: Semaglutide (injection and oral), Tirzepatide (Injection). These work by preventing vascular events (heart attacks, strokes) in high-risk patients with multiple risk factors.

Both these agents also reduce blood sugar levels significantly and are usually given as addon’s to traditional drugs like metformin and others.

An early diagnosis and effective treatment of diabetes and its associations like hypertension, high bad cholesterol and obesity goes a long way in preventing heart attacks, strokes, chronic kidney disease and heart failure which can be present even without a heart attack by damaging the heart muscle by several indirect methods.

 Author is a Cardiologist, Recipient of Padma Shri and Dr B C Roy Award and Founder Director Gauri Kaul Foundation