Statement Highlights:
- Fewer than 1 in 5 adults with Type 2 diabetes in the U.S. meet suggested targets to reduce elevated heart disease risk.
- Improving heart health among people with Type 2 diabetes requires incorporating new evidence-based approaches that address social determinants of health and other barriers to effective treatment.
DALLAS, Jan. 10, 2022 — Fewer than 1 in 5 adults with Type 2 diabetes in the U.S. are meeting targets to reduce heart disease risk. Fortunately, available therapies can help when combined with new approaches that address social determinants of health and other barriers to care, according to a new American Heart Association scientific statement published today in the Association's flagship journal Circulation. A scientific statement is an expert analysis of current research and may inform future clinical practice guidelines.
"This new scientific statement is an urgent call to action to follow the latest evidence-based approaches and to develop new best practices to advance Type 2 diabetes treatment and care and reduce CVD risk," said Joshua J. Joseph, M.D., M.P.H., FAHA, chair of the statement writing group and an assistant professor of medicine in the division of endocrinology, diabetes and metabolism at The Ohio State University College of Medicine in Columbus, Ohio. "Far too few people – less than 20% of those with Type 2 diabetes – are successfully managing their heart disease risk, and far too many are struggling to stop smoking and lose weight, two key CVD risk factors. Health care professionals, the health care industry and broader community organizations all have an important role to play in supporting people with Type 2 diabetes."
Type 2 diabetes is the most common form of diabetes, affecting more than 34 million people in the U.S., representing nearly 11% of the U.S. population, according to the U.S. Centers for Disease Control and Prevention's 2020 National Diabetes Statistics Report, and cardiovascular disease (CVD) is the leading cause of death and disability among people with Type 2 diabetes (T2D). Type 2 diabetes occurs when the body is unable to efficiently use the insulin it makes or when the pancreas loses its capacity to produce insulin. People with T2D often have other cardiovascular disease risk factors, including overweight or obesity, high blood pressure or high cholesterol. Adults with T2D are twice as likely to die from CVD — including heart attacks, strokes and heart failure — compared to adults who do not have T2D.
The new scientific statement, based on the writing group's extensive review of clinical trial results through June 2020, addresses the gap between existing evidence on how best to lower cardiovascular risk in people with T2D and the reality for people living with T2D. Targets to reduce CVD risk among people with T2D include managing blood glucose, blood pressure and cholesterol levels; increasing physical activity; healthy nutrition; obesity and weight management; not smoking; not drinking alcohol; and psychosocial care. Greater adherence to an overall healthy lifestyle among people with T2D is associated with a substantially lower risk of CVD and CVD mortality.
"In the United States, less than 1 in 5 adults with T2D not diagnosed with cardiovascular disease are meeting optimal T2D management goals of not smoking and achieving healthy levels of blood sugar, blood pressure and low-density lipoprotein (LDL) cholesterol, also known as 'bad' cholesterol," Joseph said.
A surprisingly large proportion – as high as 90% - of factors to effectively manage CVD with T2D includes modifiable lifestyle and societal factors. "Social determinants of health, which includes health-related behaviors, socioeconomic factors, environmental factors and structural racism, have been recognized to have a profound impact on cardiovascular disease and Type 2 diabetes outcomes," he said. "People with T2D face numerous barriers to health including access to care and equitable care, which must be considered when developing individualized care plans with our patients."
