Diabetics Lax in Caring for Heart Health

Blood sugar levels, blood pressure fail to improve, study finds

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HealthDay Reporter

TUESDAY, Jan. 20, 2004 (HealthDayNews) -- Despite years of efforts to convince people with diabetes to take better care of themselves, a new survey suggests only 7 percent of American diabetics are properly controlling their blood sugar, blood pressure and cholesterol levels.

One expert says the findings paint a bleak picture of both diabetics and their doctors, especially considering that lifestyle change and medication can greatly reduce risks of early death.

"There's a real gap between our knowledge of what will benefit our diabetic patients and the realities of where their health care is today," says Dr. R. James Dudl, an endocrinologist with the Kaiser Permanente Health Plan in San Diego.

An estimated 7 percent of Americans are diabetics, meaning their bodies cannot adequately process blood sugar, and as many as a third of children born in 2000 are expected to develop the disease. Diabetes often contributes to cardiovascular disease, and researchers suspect diabetics face the same risk of future heart disease as people who just had a heart attack.

Researchers at the U.S. Centers for Disease Control and Prevention examined the results of two federal health surveys, one from 1998-1994 and the other from 1999-2000. The researchers focused on 1,706 diabetics who answered questionnaires and had physical exams.

The findings appear in the Jan. 21 issue of the Journal of the American Medical Association.

Of the three health measurements studied, diabetics only managed to improve their cholesterol levels over the several years between the studies. Blood sugar and blood pressure levels remained about the same in both time periods.

In the 1999-2000 survey, only about 37 percent of diabetics effectively controlled their blood sugar levels. Another 37 percent had dangerously high blood sugar levels.

Meanwhile, only 36 percent of the patients had blood pressure levels in the range considered healthy -- 130/80 or below. Four of every 10 had potentially dangerous high blood pressure levels of greater than 140/90, despite the growing use of drugs that lower blood pressure over the past several years.

The good news is that about half of the patients in the 1999-2000 study had potentially dangerous blood cholesterol levels of 200 milligrams per deciliter or higher, compared to about two-thirds in the earlier study.

It's not entirely clear why the health of diabetics didn't improve over the 1990s, says study author Catherine Cowie, a federal epidemiologist. One factor could be the fact that more patients are being diagnosed with diabetes at an earlier age, she says.

Who's at fault, patients or doctors? Or both? "It's a combination," Cowie says. "I can't ferret out where exactly the breakdown is, but somewhere there is a breakdown. Most likely it's coming from a number of levels."

Dudl says part of the problem is the health-care industry's focus on immediate medical problems at the expense of long-term prevention: "The message that patients could make a significant difference toward living longer is just not being delivered."

On the other side, patients "need to take responsibility and start acting proactively," Dudl adds.

"If you're a diabetic over 55, you should be on an aspirin a day, a lipid-lowering agent [to lower cholesterol], and a medication to prevent heart attacks, like an ACE inhibitor," he says. "Heart attacks kill 80 percent of diabetics, and you can drop that by 70 percent by taking those three medications. You should therefore see your provider and discuss getting on them. Simple three pills, very safe and very simple, with almost no side effects. It could add years to your life."

More information

Visit the American Diabetes Association or the National Diabetes Information Clearinghouse.

SOURCES: R. James Dudl, M.D., endocrinologist, Kaiser Permanente Health Plan, San Diego; Catherine Cowie, Ph.D., director, Diabetes Epidemiology Program, National Institute of Diabetes & Digestive & Kidney Diseases, Bethesda, Md.; Jan. 21, 2004, Journal of the American Medical Association

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