Blood glucose regulation is an important aspect of cardiovascular disease prevention and should be addressed on an individual basis tailored to the needs of the patient, according to a review paper published Oct. 1 in the Journal of the American College of Cardiology.

Peter E.H. Schwarz, MD, MBA, et al., reviewed recent evidence on medical and lifestyle interventions targeting blood sugar regulation. Forty-four studies were included analysis. They looked to 1) Outline likely pathophysiological mechanisms by which blood glucose regulation affects cardiovascular disease risk and evidence on pharmacological interventions targeting these pathways; 2) Identify evidence-based individual-level interventions for supporting effective behavior change to regulate blood sugar and thereby reduce cardiovascular disease risk; 3) Identify evidence-based population-level interventions for supporting effective behavior change to regulate blood sugar and thereby reduce cardiovascular disease risk; and 4) Translate key findings into applicable recommendations highlighting competencies for training for health promotion and for standardizing health promotion care path.

The review found that intensive glucose lowering can reduce microvascular and macrovascular morbidities and cardiovascular mortality, even though doing so was once thought to have no benefit on cardiovascular outcomes. However, the authors add that the baseline blood pressure (BP) of type 2 diabetes (T2D) patients must be considered before beginning therapy as it can counteract the beneficial impact on cardiovascular outcomes. Lifestyle interventions such as diet and exercise can also be effective and have fewer side effects. The authors add that more research is needed to establish both the clinical and cost effectiveness of lifestyle interventions.

The authors also found evidence supporting a shift from treatment by doctors to community health workers and other community-based health practitioners such as nurses and pharmacists, writing this could be of most benefit in rural areas and other settings where resources and services are lacking. Additionally, they observed potential for community-based multidisciplinary teams to increase effectiveness in both individual- and community-level interventions.

According to the authors, their findings support the potential for integrating prevention services.

"Combining the results derived from the single sections [of the review] suggests integrating future services and policy efforts to develop standardized care pathways covering diabetes prevention, diabetes management and cardiovascular disease prevention," they write.

This paper is the final installment in an eight-part cardiovascular health promotion JACC focus seminar, where each paper focuses on a different behavioral consideration that impacts cardiovascular health: nutrition and diet; healthy weight; exercise and physical activity; tobacco-free lifestyle; blood pressure; cholesterol; blood sugar; and psychological health.

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