22Nov

Symptoms of Adult Diabetes – Information That You Should Know

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Diabetes is a disease associated with the body’s inability to produce the required amount of insulin or the inability of the body cells to use the produced insulin. In either case glucose level builds up in our blood leading to diabetes. The hormone insulin secreted by the pancreas is actually a glucose regulator. It activates the cells to burn down the glucose, absorb it and convert it in to energy required by the body for day to day acts. If insulin produced falls short of the required amount, as in the case of Type 1 diabetes, one has to inject insulin to combat the disease. Type 1 diabetes is also known as juvenile diabetes. Type 2 diabetes occurs when cells grow non-reactive to insulin. This is the commonest type of diabetes attacking adults. Poor nutritional habits, inactive lifestyle, obesity are factors leading to Type 2 diabetes. Gestational diabetes is another type affecting pregnant women.

Major Symptoms of Adult Diabetes

1. Frequent urination is a prominent symptom of adult diabetes. One feels a fullness of bladder even after excreting urine. This happens because the body of a patient of diabetes tries to flush out fluids through kidneys in order to balance and dilute the high levels of glucose in the patient’s urine.

2. Constant thirst is usually felt by a diabetic. Due to increased urination, the body needs to replace the lost fluids and the result is feeling thirsty frequently. Not taking water may lead to dehydration and further complications.

3. Feeling extremely hungry frequently is another major symptom. The body cells become inert to insulin, and the cells do not get glucose to convert into cells. The starved cells make the feel a persistent hunger.

4. Excessive loss of fluids, reversed metabolism of body fats and proteins lead to loss of weight drastically. Thus weight loss is another symptom.

5. Muscles cells are deprived of enough fuel to convert it in to energy in a diabetic. Often body fat is consumed due to a reverse calorie effect, leading to much fatigue. Fatigue is common symptom of diabetes.

6. Vomiting and nausea is a symptom that occurs when ketone acid builds up in blood due to the reverse calorie effect.

7. Irritability is common in a diabetic. Inadequate glucose supply to brain may make the patient suffer from excessive mood swings or feel cranky.

8. A diabetic also suffers from blurry vision. Excessive glucose may get in to eyes changing the shape and create problems in focusing.

9. Poor wound healing is also a symptom. Excess glucose in blood lowers the production of white blood cells and thereby weakens the immune system. This leads to very slow healing of wounds.

10. A diabetic is more prone to any infections due to the suppression of the immune system.

11. A diabetic may feel an itching sensation on the skin around genitals.

12. A feeling of numbness or a tingling sensation on legs, feet and finger is another symptom a diabetic may suffer from.

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16Nov

Fifty Percent Of Us Are On The Road To Diabetes

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One of the harmful affects on our bodies of living our modern sedentary lifestyle that no longer has enough physical activity to keep our muscles strong is that our muscle cells become less responsive to the hormone insulin.

Insulin is the ‘key’ that tells the muscle cells to unlock the door and ‘open up’ to take in glucose from the blood stream that has been converted from the food we eat to be used for energy. But our muscles have grown flabby and weak from our inactive lifestyles so they cannot use the glucose.

So, with the cell door closed glucose remains in the blood stream circulating around with nowhere to go but eventually into the fat stores. But the levels are consistently higher than they should be so more and more insulin is produced to try and get the levels down. Then there are not only high blood sugar levels but high insulin levels as well hanging around where they should not be doing major damage to cells, tissue and organs.

You may be wondering why this is important but this is a condition called ‘Insulin Resistance’ which if you have it will lead you down a path to full blown diabetes. This devastating disease does major damage to sensitive organs like the brain, eyes and kidneys and that is what leads to a shortened life if you are unfortunate enough to go on to develop diabetes.

This condition is becoming more common and is affecting up to 50 percent of adults who either have this condition or are in the process of developing it and one third of all children. As we get older we become more prone to develop it as the combination o our no-exercise lifestyles together with a diet of refined foods takes it toll on our health.

It can easily be reversed though but it will take some action to restore good health. Firstly a strength training program done just 2-3 times a week will get those muscles toned back up so they can soak up excess sugar from the blood stream and burn it up harmlessly for energy. Muscle tissue is highly active and has high energy demands so taking this step alone will go a long way to getting a healthy body back.

The next thing is to get rid of as much refined and processed foods as possible as the more of them we eat the more insulin is required to metabolize them. The more insulin needed and present in our blood the less the cells can take it up and the more damage is caused to other organs and tissues.

Women especially around mid-life are especially prone to this condition. A waist measurement of over 35 inches (40 for men) is one sign, fatigue, climbing blood pressure and blood fats are all other indicators.

In essence our lifestyles along with our environment have all evolved and changed too rapidly for our bodies to keep up the pace. We still have the same genetic blue-print of our ancestors who thrived on a diet of natural, nutrient rich foods low in carbohydrates. They were also highly active on a day-to-day basis with much greater levels of vigorous movement and exercise than our modern sedentary lifestyles.

But we can put some of these things back into our life and make some changes that will keep us healthy and well. It will not be easy though as we are surrounded by mountains of processed ‘junk’ food and leisure activities that involve no more activity than sitting.

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11Nov

Decreasing the Risk of Diabetic Retinopathy in a Type 2 Diabetes Study: Part 4

FILED IN Type 2 Diabetes No Comments

Mexican pharmacy

Case management may also have played a role in attendance at sessions when the photographs were taken and the immediate feedback that nonmydriatic photography can give to the health care team and thus facilitate the follow-up of patients with documented retinopathy. Whether it is the support associated with case management and the resultant adherence to nonglycemic targets such as hypertension that led to the improved retinal status, independent of improved glycemic control, cannot be addressed by this study. However, perhaps because case management clearly improves glucose control in a Medi-Cal–type population and is associated with decreased risk of new-onset retinopathy, comprehensive case management may be justified in similar health care settings.

Limitations of this study include the fact that it was not of sufficient duration to address whether case management may have also prevented progression of previously recognized retinopathy, which may have required more time or larger numbers to see an effect. Another limitation is the fact that we only used a single field for evaluation of the retina rather than the seven fields used in other studies of retinopathy, although in previous reports, this technique for diabetic retinopathy screening has been shown to be effective. In this way, minimal retinopathy may have been missed in the periphery at baseline and at the follow-up study. However, since both baseline and follow-up retinal fields were identical, it is most likely that our findings reflect a clinically meaningful decrease in the development of retinopathy over the 2-year time span that was tested. Furthermore, seven-field photography was not practical in this case management setting. Although all participants were urged to visit an ophthalmologist, those subjects with evidence of any retinopathy on the photograph were personally followed by the case management team to facilitate the consultation.

Although other studies show that improved glycemic control decreases the risk of retinopathy, this study is the first to show that even a relatively short duration of improved control (?2 years) instituted before the onset of clinically identifiable retinopathy can decrease the risk of developing new retinopathy. This study also underscores the risk of retinal disease in type 2 diabetes in that progression of retinopathy occurred within a relatively short time when glycemic control was not achieved. Further studies are necessary to determine whether early intervention to achieve glycemic control in established diabetes has a greater effect to reduce diabetic retinopathy than its introduction at a later stage of the disease.

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11Nov

Decreasing the Risk of Diabetic Retinopathy in a Type 2 Diabetes Study: Part 3

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This report is the first evidence that intensive case management reduces risk of new-onset retinopathy in people with established type 2 diabetes. The U.K. Prospective Diabetes Study first demonstrated the effects of improved glycemic control on retinopathy in type 2 diabetes, but the subjects who participated in that landmark study were all newly diagnosed, whereas the patients without retinopathy in this study had a mean duration of diabetes of 7.5 years by the time the case management intervention was begun. Although the number of subjects with established retinopathy in this study was not sufficient to draw conclusions about progression of retinopathy compared with those who had none at baseline, the response observed in the latter suggests that early intervention with case management is an effective approach to reducing the burden of retinopathy in patients with type 2 diabetes. This conclusion is reinforced by the finding that even when case management is maintained for a short duration (mean <2 years), it is sufficient to diminish the risk of retinopathy.

The mechanisms for the effect of case management on reduction in the development of new-onset retinopathy may be related to any of the different facets of the case management process, although the major factor is likely to be improved glycemic control. Although A1C concentrations were not consistently evaluated at the time the follow-up photographs were taken, in the main trial the case management group showed a persistent improvement in the A1C that was greater than in the standard care group (6), suggesting that the decreased risk of retinopathy is likely due to improvement in glycemia. This study, therefore, confirms the necessity of providing adequate education and follow-up support, as delivered in this trial that utilized case management and frequent intervention, in order to achieve and maintain an A1C improvement over and above the standard care given to this county clinic Medi-Cal population.

However, other elements of the case management approach may well have contributed to the reduction in development of new-onset retinopathy. With adequate surveillance and support, glycemia improves, but, as demonstrated in our primary report, this improvement was associated with significant decreases from baseline to end of study in diastolic blood pressure, LDL cholesterol, and total cholesterol and an increase in HDL cholesterol in the intervention group. Thus, case management not only resulted in improvement of glycemic control but also had an effect on diminishing the risk of microvascular disease, as measured by retinopathy.

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08Nov

Decreasing the Risk of Diabetic Retinopathy in a Type 2 Diabetes Study: Part 1

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Between 1 July 1995 and 30 June 1999, a randomized, controlled study of subjects aged ?18 years who had type 2 diabetes of at least 1-year duration was conducted in southern California. Detailed information about the methods used in this study was presented in an earlier publication and will be briefly summarized here. Subjects with type 2 diabetes, as defined by the American Diabetes Association, were recruited at clinical sites in Santa Barbara, Los Angeles, and San Diego counties, three California counties serving predominantly ethnic minority, low-income Medicaid (called Medi-Cal in California) populations. Although specific income data were not collected as part of this study, overall 93.9% of the Medi-Cal–eligible population is classified as medically indigent or needy or is eligible for public assistance. Two of these sites, in Santa Barbara and Los Angeles counties, had access to fundus cameras and participated in the retinal photograph component of the study, and the data provided in this manuscript are limited to those two sites. Signed, witnessed, informed consent was obtained from all prospective participants using forms approved by local institutional review boards.

As previously described, the main trial recruited participants with HbA1c (A1C) levels >7.5%. At the two participating sites, 121 subjects were randomized to the intervention group and 119 to the control group. Intensive diabetes case management was provided to the intervention group in addition to the standard care that was received by both groups from a primary physician not connected with the trial. In the intervention group, subjects were seen or contacted by the case management staff at varying intervals according to the need (at least monthly) to lower A1C. In the control group, blood for A1C determination was collected at 6-month intervals, and contact between study staff and participants was generally limited to that needed to assure collection of A1C samples or to obtain retinal photographs. All subjects, in both the intervention and control groups, were referred for retinal photographs at baseline and then at least yearly. Two hundred subjects (98 control and 102 intervention subjects) had at least one photograph and 149 (70 control and 79 intervention subjects) had least two sets of retinal photographs that could be analyzed in this study. For subjects with more than two sets of photographs, only the first and last were used in this analysis. Only the main study had sufficient power to see differences in metabolic variables. Thus, for this small ancillary study of retinopathy, which utilized only two of three original participating centers, follow-up analyses of A1C, blood pressure, and lipids were not planned. Photographs were obtained at a separate case management visit, and, after baseline, photographs were not necessarily scheduled to coincide with the laboratory tests or physical examinations.

The study staff at each site, consisting of registered nurses and registered dietitians working in close collaboration with an endocrinologist, provided diabetes case management to the intervention group only. Evidence-based practice guidelines and algorithms for oral medicines and insulin initiation and adjustment were used in a collaborative practice model with the primary care provider. Treatment goals and targets for therapy were uniform across sites, with flexibility to utilize individualized treatment algorithms and strategies at each site. Interactions between the participant and study staff occurred in person at the clinic site and via telephone between visits as needed. The need for ancillary medical evaluations and/or services such as ophthalmologic examinations was monitored, with subsequent follow-up to ensure receipt of services, results retrieval, and communication of results to the primary care provider.

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02Nov

Type 2 Diabetes – Chocolate and Cholesterol!

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Finally there is good news for chocolate-loving Type 2 diabetics. Eating chocolate with high polyphenol content might help prevent heart attacks! The results of a study designed to discover the affect of chocolate consumption on cholesterol, inflammation, weight and blood sugar control in diabetics will be published in November, 2010 in the journal Diabetes Medicine.

Researchers at the University of Hull in the United Kingdom enrolled 12 Type 2 diabetics into the study. The volunteers were randomly assigned to receive 45 grams of chocolate either with or without polyphenols. After 16 weeks, Type 2 diabetics consuming chocolate with polyphenols showed:

  • an increase in high-density lipoproteins
  • the good cholesterol, and
  • a decrease in total cholesterol, meaning that low-density cholesterol, or LDL, was decreased

Weight, C-reactive protein (associated with inflammation), and blood sugar control stayed the same in these Type 2 diabetics. The volunteers who ate chocolate without polyphenols remained the same also. The researchers then concluded that weight, inflammation, and blood sugar were unaffected by the high-polyphenol chocolate, but cholesterol was lowered.

According to the Hershey’s people, chocolate, and specifically, the cocoa, or non-fat portion of chocolate, is high in the same anti-oxidants found in many fruits, vegetables, tea and wine. This is not surprising when you realize that it comes from a plant. The anti-oxidants are the polyphenols mentioned in the study above. While consuming unlimited amounts of chocolate products, especially those high in added fats and sugar, is clearly not healthy chocolate or cocoa can help the body to repair itself and heal the damage from molecules called free radicals.

The National Institute of Health in Washington DC, United States, defines a free radical as a molecule or ion with a free electron, which makes it highly reactive and capable of stealing electrons from other molecules. Most free radicals contain at least one atom of oxygen.They are implicated in tissue damage callused by radiation, environmental chemicals and aging. Anti-oxidants such as polyphenols receive the extra oxygen with its extra electron, preventing the free radical from doing damage to the body’s other molecules.

When buying chocolate products, check the label for the polyphenol content. Again, according to Hersheys.com:

  • dark chocolate has a slightly higher antioxidant content than blueberries
  • cocoa has slightly less anti-oxidant content than blueberries but rates higher than pecans, cranberries, cherries,
  • walnuts, raspberries and prunes
  • milk chocolate ranks lower than those foods already mentioned, but is still higher in anti-oxidants than
  • red grapes, almonds and raisins

Discuss with your doctor or nutritionist how to make a moderate consumption of chocolate or cocoa a part of a healthy diet that will help to keep bad cholesterol levels down.

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21Oct

What Is Insulin and How Do We Produce It?

FILED IN Insulin Levels No Comments

Insulin is a hormone produced by the pancreas to battle rising blood sugar levels caused by normal carbohydrate intake. A diabetic person is unable to produce Insulin at all so must take injections to keep blood sugar levels at an acceptable level.

Insulin causes cells in the liver, muscle, and fat tissue to absorb glucose from the blood. Recombinant DNA technology is used to synthetically create Insulin for medical use. A type 1 diabetic can take insulin in the form of injections in a Multiple Daily Injections scheme or with the use of an insulin pump which closely mimics the action of a real pancreas.

The cause of type 1 diabetes is not yet understood fully which makes finding a cure very difficult. Usually children and young adults are diagnosed and most continue to live a normal healthy life by learning to manage and control the condition

Insulin contains two separate amino acid chains bonded together. Proteins are all made up of amino acids, the basic building blocks. The two chains have slightly different amounts of amino acids.

Preproinsulin is required to be produced before an active insulin protein can be made. Preproinsulin is a single protein chain containing both of the separate chains, a section in the middle links the chains together and stimulates the proteins to secret. An evolution then occurs developing proinsulin and finally an active insulin protein is formed which does not have the linking section between the individual chains.

Specific enzymes are required by the protein at each step of evolution to ensure the next step is accurately generated.

Insulin production is a lengthy and complicated process but the millions of type one diabetics rely on it every day to keep well and healthy.

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19Oct

How Can You Cure Diabetes?

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Trying to find the best treatment for diabetes is quite difficult since the disease itself is difficult to diagnose. This is one such ailment which must be handled with proper care. However, the condition can be easily controlled with proper diet and lifestyle changes. The complexities that lie in trying to find the best treatment for diabetes can sometimes be an infuriating experience. It takes time to find out the treatment that will be effective on the diabetes and at the same time have minimum impact on their lifestyle. An idea about how the various types of treatments work on the disease will be helpful in finding an effective form of treatment for you.

There are various treatments available that contributes towards the treatment of the disease. Insulin injections and oral medications are some of the forms of treatment that are available. For the treatment of diabetes, you can use both insulin and the oral medication. However, it is not always necessary to use insulin injections. Besides, there are also a number of other methods that can be used to keep the condition in check. And since there are a wide variety of medications available, trying to find suitable medications for you is a time consuming task.

Regular exercise also can keep your health in check. Being overweight is one of the major factors of diabetes. So keeping your weight in check may also be helpful in curbing the issue. Most of the people find trying to fight against diabetes pathetic and annoying. Your eating habits and your lifestyle play a major role in keeping diabetes in control. In trying to combat diabetes, most people have had to endure many failed treatment methods and regimes. But this must not let you deter your spirit. With a little care and prevention you can still lead the life you use to.

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16Sep

Diabetes, Glycemic Control: Research Design and Methods

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The Heart and Soul Study is a prospective cohort study of psychosocial factors and health outcomes in patients with stable CAD. Design of the study has been published previously. In summary, patients were recruited from outpatient clinics of 12 different centers in the San Francisco Bay area if they met one or more of the following inclusion criteria: prior myocardial infarction, angiographic evidence of ≥50% stenosis in one of the coronary arteries, prior coronary revascularization, and exercise-induced ischemia (treadmill or nuclear scintigraphy). Exclusion criteria were acute coronary syndrome within the past 6 months, the inability to walk one block, and plans to move out of the area within 3 years.

Between September 2000 and December 2002, 1,024 patients were enrolled in the study. For the current investigation, 185 patients (18.1%) were excluded because they had a history of heart failure (n = 179) or heart failure status was unknown (n = 6).

Baseline study variables

All patients completed a daylong baseline study visit that included a medical history interview, physical examination, questionnaire, laboratory analysis, exercise test, and echocardiogram. Diabetes was defined as self-reported diabetes or the use of antidiabetes medication. Alcohol use was determined by questionnaire. Participants rated their physical activity during the previous month using a 6-point Likert scale. Those responding “not at all active” or “a little active” were classified as physically inactive. An estimate of chronic glycemia was provided by serum A1C measurement. Serum glucose level, A1C, LDL cholesterol, and C-reactive protein (CRP) were assessed by standard routine biochemistry analysis after an overnight fast (except for taking their regularly prescribed medication with water) using a venous blood sample, drawn via a 21-gauge butterfly needle. Subjects were considered to have metabolic syndrome if they met the criteria of the National Cholesterol Education Program. Echocardiography was performed with an Acuson Sequoia Ultrasound System (Siemens Medical Solutions USA, Malvern, PA), with a 3.5-MHz transducer. Left ventricular ejection fraction (LVEF) was calculated using the modified Simpson rule as recommended by the American Society of Echocardiography. In addition, a full description of diastolic function was performed according to predefined established criteria (normal, impaired, pseudonormal, or restrictive diastolic function). An exercise treadmill test (standard Bruce protocol) was performed. Immediately after exercise, echocardiographic analysis was performed to investigate exercise-induced wall motion abnormalities, which served as an indicator of myocardial ischemia. Details pertaining to acquisition and analyses of echocardiographic data were reported elsewhere. The institutional review board at each of the sites approved the study protocol, and all participants provided written informed consent.

End points

The main study outcome was time to hospitalization for heart failure, as was previously reported for the whole cohort in detail. Heart failure was diagnosed according to established criteria using clinical and radiological evaluation. Potential events were recorded annually by telephonic interviews. Additional information (e.g., medical records and death certificates) was collected and reviewed by two independent and blinded adjudicators. Discrepancies were discussed, and decisions were made by unanimity. In case of disagreement, a third blinded adjudicator was consulted. Follow-up was completed for all patients.

Statistical analysis

The study sample comprised 839 patients. Baseline differences between participants with diabetes and without were compared using t tests for continuous variables and χ2 tests for dichotomous variables.

In addition to the association of diabetes per se with hospitalization for heart failure, we investigated the role of glycemic control in the development of heart failure. A1C was used as a proxy measure for glycemic control (both dichotomized and continuous, per 1% change). For the former categorization, a cutoff of ≥6.5% and <6.5% was used because this cutoff was recently used to redefine the diagnosis of diabetes. The following analyses were conducted with diabetes and A1C as independent variables. First, Kaplan-Meier analysis was used to estimate the time from baseline to heart failure hospitalization in patients with or without diabetes and in patients with low or high A1C. The log-rank test was used for bivariate significance testing. In addition, given the influence of antidiabetes medication on A1C levels, we compared the effect of glycohemoglobin on heart failure in patients taking antidiabetes medication. Second, Cox proportional hazard regression analyses were performed to investigate the impact of diabetes and A1C level, respectively, on the time to first hospitalization for heart failure. To study the impact of diabetes and A1C on heart failure in the context of several potential confounders, we made a selection of the most important risk factors for heart failure based on recent guidelines. We then applied the following series of a priori determined Cox regression models in which we sequentially controlled for the following groups of confounders: model 1: age, sex, and race; model 2: smoking, physical inactivity, BMI, LDL cholesterol, and systolic blood pressure; model 3: myocardial infarction during follow-up; model 4: LVEF; model 5: exercise-induced wall motion abnormalities (i.e., ischemia); model 6: diastolic dysfunction; model 7: logCRP; and model 8: ACE inhibitor/angiotensin receptor blocker (ARB) and β-blocker-use. All models included age, sex, and race. In the final model (model 9) we include all the variables that were used in models 1–8. Finally, in sensitivity analyses, the relationship between several other definitions of diabetes and time to onset of heart failure were tested.

These definitions were 1) self-reported diagnosis of diabetes (irrespective of antidiabetes medication use, 2) fasting blood glucose >126 mg/dl, and 3) fasting blood glucose >126 mg/dl or use of antidiabetes medication. Moreover, the presence of metabolic syndrome was tested in sensitivity analyses. P < 0.05 was used for all tests to indicate statistical significance. Hazard ratios (HRs) with 95% CIs are reported. All statistical analyses were performed using SPSS (version 17.0 for Windows; SPSS, Chicago, IL).

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15Sep

Diabetes, Glycemic Control, and New-Onset Heart Failure

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OBJECTIVE

Diabetes is a predictor of both coronary artery disease (CAD) and heart failure. It is unknown to what extent the association between diabetes and heart failure is influenced by other risk factors for heart failure.

RESEARCH DESIGN AND METHODS

We evaluated the association of diabetes and A1C with incident heart failure in outpatients with stable CAD and no history of heart failure (average follow-up 4.1 years).

RESULTS

Of 839 participants, 200 had diabetes (23.8%). Compared with patients who did not have diabetes, those with diabetes had an increased risk of heart failure (hazard ratio [HR] 2.17 [95% CI 1.37–3.44]). Adjustment for risk factors for CAD (age, sex, race, smoking, physical inactivity, obesity, blood pressure, and LDL cholesterol), interim myocardial infarction, and myocardial ischemia did not alter the strength of the association between diabetes and heart failure. After inclusion also of other risk factors for heart failure (left ventricular ejection fraction, diastolic dysfunction, and C-reactive protein) and medication use, diabetes remained an independent predictor of heart failure (HR 3.34 [95% CI 1.65–6.76]; P = 0.001). Each 1% increase in A1C concentration was associated with a 36% increased HR of heart failure hospitalization (HR 1.36 [95% CI 1.17–1.58]).

CONCLUSIONS

In patients with stable CAD who are free from heart failure at baseline, diabetes and glycemic control are independent risk factors for new-onset heart failure. The mechanisms by which diabetes and hyperglycemia lead to heart failure deserve further study, as the association is independent of baseline functional assessment of ischemia, systolic and diastolic function, and interim myocardial infarction.

Heart failure is an enormous burden of disease, leading to substantial health care costs. Despite advances in treatment, the number of heart failure hospitalizations has increased steadily. The 2005 Heart Failure Guidelines of the American College of Cardiology/American Heart Association and European Society of Cardiology emphasized the importance of identification and treatment of risk factors. Among the patients classified in the highest risk group are patients with diabetes. Diabetes is associated with incident heart failure in the general population  and with adverse outcomes among patients with already existing heart failure. Diabetes also predicts heart failure in patients with acute coronary syndromes. Whether diabetes predicts heart failure in patients with stable coronary artery disease (CAD) has not been evaluated in detail.

The precise underlying mechanism by which diabetes portends heart failure is unclear. In fact, it remains to be elucidated whether in this context the diagnosis of diabetes per se is more important than just the presence of inadequate glycemic control. CAD is the number one risk factor for heart failure in the developed world. Because diabetes is strongly associated with CAD, it is plausible to attribute the risk of heart failure associated with diabetes to the effects of CAD. However, although it is known that hyperglycemia predicts heart failure among diabetic patients with CAD (7), it is not known whether this risk is independent of CAD severity, CAD progression, or the presence of myocardial ischemia. Even in the absence of CAD, patients with diabetes show changes in myocardial performance that put them at risk for heart failure (diabetic cardiomyopathy).

To determine to what extent the association between diabetes and heart failure is influenced by other risk factors for heart failure (including interim myocardial infarction and the presence of baseline myocardial ischemia), we evaluated the risk of heart failure associated with diabetes in a cohort of outpatients with stable CAD. The cohort is derived from the Heart and Soul Study, which allows thorough investigation of the strength of the association between diabetes (both the diagnosis per se and the level of glycemic control) and future heart failure episodes, while taking into account the above-mentioned established and presumed risk factors.

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