Diabetes Research and New Registry Aim to Improve Outcomes

Diabetes is a growing global health epidemic. According to the American Diabetes Association (ADA), approximately 29.1 million people in the U.S. have diabetes, while an estimated 86 million have prediabetes. Worldwide, nearly 400 million people have diabetes, and it is estimated that one in three people born in the 21st century will develop diabetes mellitus during their lifetime.

Treating diabetes is often complicated in that care is not managed by one type of health provider. Rather, patients with diabetes often receive care across medical specialties for a multitude of related medical conditions, including cardiovascular disease. Data from the ACC’s PINNACLE Registry show that nearly 22 percent of patient office visits submitted to PINNACLE  in 2014 included diabetes as a co-morbidity, along with at least one of hypertension, heart failure, atrial fibrillation and coronary artery disease.  

Two studies being presented as part of ACC.15 could prove beneficial for navigating these challenges and preventing and treating of diabetes. One study by Faraz S. Ahmad, MD, and colleagues from Northwestern University, Chicago, IL, suggests that reduction in hypertension, obesity, and diabetes prevalence by age 45 may substantially prolong heart failure-free survival, reduce heart failure-related morbidity, and reduce the public health impact of heart failure.

The study, which pooled, individual-level survival analysis from the Framingham Heart, Framingham Offspring, Chicago Heart Association Detection Project in Industry, and Atherosclerosis Risk in Communities studies, found that men and women without hypertension, obesity or diabetes at age 45 lived on average 11.3 to 12.7 years longer free of heart failure than those with all three risk factors.

A second study found that people with prediabetes who take part in a comprehensive health program to improve nutrition, exercise, stress and sleep are able to quickly revert to normal blood glucose metabolism without substantial changes in body mass index, thereby, lowering their risk for developing diabetes.

The study, led by researchers at Walter Reed National Military Medical Center in Bethesda, MD, looked at data for 508 consecutive subjects in the Integrative Cardiac Health Project Registry, a 12-month Cardiovascular Disease Risk Reduction Program. Those enrolled completed validated questionnaires and were categorized as prediabetic (glucose > 100 mg/dL and < 140 mg/dL) or reverting prediabetes (glucose < 100 mg/dL). According to data, in just six months, almost half of people with prediabetes participating in the program were able to revert to normal glucose metabolism irrespective of weight loss. On average, they lowered their fasting glucose level by 12 percent, or 13 points (105.4 to 92.4 mg/dL).

“This is a big deal because we know that with each 5 mg/dL drop in blood glucose, there is a significant reduction in cardiovascular risk,” said the study’s lead author Mariam Kashani, chief scientific director, DNP, CRNP, at Walter Reed. “Most importantly, they lowered their glucose levels below the threshold of 100 mg/dL when blood vessels start to become unhealthy.”

Moving forward, the ACC recently partnered with the ADA, the American College of Physicians, the American Association of Clinical Endocrinologists, the Joslin Diabetes Center and AstraZeneca to build up this type of research. The new Diabetes Collaborative Registry is designed to support the generation of new evidence that can reveal new insights, drive decision making, and enable better treatment and improved outcomes for those with diabetes around the world.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Diet, Hypertension

Keywords: Atherosclerosis, Atrial Fibrillation, Blood Glucose, Cardiovascular Diseases, Coronary Artery Disease, Decision Making, Diabetes Mellitus, Fasting, Glucose, Heart Failure, Hypertension, Military Personnel, Morbidity, Obesity, Prediabetic State, Public Health, Registries, Research Personnel, Risk Factors, Risk Reduction Behavior, Survival Analysis, Weight Loss, ACC Annual Scientific Session

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