Treating diabetes and heart disease holistically, not separately

Diabetics are four times more likely to develop heart disease than non-diabetics.

Likewise, more than half of all people who suffer from heart disease also have diabetes.

Dr Nandakumar Ramasami, senior consultant interventional cardiologist, and endocrinologist Ben Ng share why it makes more sense to treat diabetic heart disease (DHD) - referring to heart disease that develops in people who have diabetes - holistically rather than separately.

They are from the Arden Cardio-Metabolic Clinic, which provides an integrated and comprehensive one-stop assessment for both conditions - even when symptoms may be masked or undetected for a long time.

What is the likelihood of heart disease patients also suffering from diabetes?

Dr Nandakumar: About 25 per cent of patients suffering from heart disease referred for a coronary angiogram have diabetes because over time, high blood sugar in diabetics damages the blood vessels' inner walls.

When the lining of the blood vessels does not function properly, the vessels constrict and stiffen. Fatty plaques develop as fat enters the damaged vessel walls from the blood stream.

This may develop into heart disease, hypertension, kidney disease or stroke.

In fact, two-thirds of those with diabetes have hypertension. In diabetes, there is also a characteristic increase in bad cholesterol and a lower level of good cholesterol.

Likewise, 75 per cent of all diabetics will have an underlying heart disease.

Diabetics have a two- to four-fold risk of developing coronary heart disease, and up to 68 per cent of deaths in diabetics is due to cardiovascular disease.

What is the mode of treatment for patients with both heart disease and diabetes?

Dr Nandakumar: Compared with non-diabetics, diabetics are at a higher risk for heart disease, tend to have additional risk factors, develop heart disease at a younger age, and have more severe forms of heart disease.

Those with DHD respond less favourably to treatments such as stents (coronary angioplasty) and bypass surgery than non-diabetics.

The current mode of therapy for DHD is the same as for those who do not have diabetes.

However, the emphasis is on controlling blood sugar levels, as poorly controlled hyperglycemia damages the various organs in diabetics.

Usually, multiple risk factors are present; poor lifestyle and stress (with a genetic predisposition) often lead to metabolic disorders like abdominal obesity, fatty liver, hypertension, diabetes and raised lipids.

Therapy is generally directed at these risk factors, as even a moderate elevation of multiple risk factors can prove more dangerous than a single elevated risk factor.

What are some challenges faced when managing heart disease and diabetes?

Dr Ng: Treating both diabetes and heart disease in a single patient can be complicated.

Patients often require several different kinds of medication to keep blood sugars under control and to treat blood pressure and cholesterol.

The main challenge that patients face is to integrate all this information.

For example, patients with diabetes are encouraged to exercise more regularly and reduce overall sugar intake.

In contrast, patients who have heart disease may be asked to restrict the amount of physical activity they can do (particularly following a recent heart attack) and foods that may be low in sugar but high in fat and cholesterol.

This confuses patients as they may receive advice from different doctors who are dealing with different parts of the body and different diseases.

What are the benefits of patients having their heart disease and diabetes treated holistically?

Dr Nandakumar: An integrative model ensures investigations of a patient's condition are tailored to the cardio-metabolic syndrome as a whole as the effects produced by these related diseases are closely interlinked.

All screenings for the various organs are performed in the clinic along with blood tests, urinalysis and other tests. This one-stop approach makes it more convenient for the patient and enhances compliance to regular screening in the long term.

This is followed by a combined assessment by the endocrinologist, cardiologist and nephrologist working together to form a single integrated care plan that aims to achieve the best possible therapeutic goal for the patient as a single entity.

Combined with education by the appropriate supporting personnel such as optometrist, podiatrist, dietitian and physiotherapist, the patient can be armed with the right tools to ensure they can make the right treatment choices for their future.