February Blog: Diabetes Heart Connection

Guest Contributor: Amy Tuhlei

BJ, a 68-year-old male, has been living with diabetes for over 20 years.  Recently, BJ was caught off guard when he found out he had developed heart failure and established heart disease. He pondered, how could this have happened? He had been working hard to manage his diabetes and make healthier choices.  BJ is not alone out there.  

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Did you know that diabetes increases risk of developing heart disease? Heart disease is commonly caused by the buildup of cholesterol in the blood vessels that supply oxygen and nutrition to the heart. These cholesterol plaques can break apart or rupture, which the body will then try to repair the plaque by sending platelets to seal it up. However, the artery is small, so the platelets could possibly block the flow of blood and not allow for oxygen delivery and then a heart attack may develop. It could also result in not enough blood to the brain and cause a stroke, or not enough blood to the feet, hands, or arms causing peripheral vascular disease. High blood sugar from diabetes can damage your blood vessels and the nerves that control your heart and blood vessels over time and the longer you have diabetes, the higher the chances for you to develop heart disease.

So what prevention steps can be taken? Remember, the major contributors to heart disease (heart attack and stroke) are high blood pressure, high cholesterol levels (particularly low-density lipoprotein (LDL) (or as I call it, lousy cholesterol), and blood clots. The following are recommended goals and medications for each of these contributors:

  1. Blood pressure management
    1. Goal BP <140/90 mmHg (ADA Guidelines)
    1. Common medications classes for that you may be on for high blood pressure: (don’t let the long names overwhelm you)
      1. Angiotensin Converting Enzyme Inhibitor (ACEI):
        1. i.e. Lisinopril (Zestril) or Enalapril (Vasotec)
      1. Angiotensin Receptor Blocker (ARB):
        1. i.e. Valsartan (Diovan) or Losartan (Cozaar)
      1. Thiazide Diuretic:
        1. i.e. Hydrochlorothiazide (Microzide) or Chlorothiazide (Diuril)
      1. Calcium Channel Blockers:
        1. i.e. Amlodipine (Norvasc) or Nifedipine (Procardia)
  • Controlling Bad Cholesterol, Low Density Lipoprotein (LDL or lousy cholesterol)
    • Goal LDL: if have established cardiovascular (heart) disease, goal LDL < 70 mg/dL
    • Primary medication class for you treating elevated LDL:
      • Statin: Atorvastatin (Lipitor)
      • These drugs lower bad cholesterol levels by blocking an enzyme that the liver uses to make cholesterol
  • Preventing Blood Clots 
    • Blood clots can form and break off and travel through the body and cause blockage of blood vessels
    • If a blockage happens in a blood vessel to the brain, it can result in a stroke
    • Medication to prevent blood clots:
      • Blood thinner: low-dose Aspirin (81mg)

I encourage you to talk with your health care professional if you have questions.

Diabetes medications, in particular some sodium glucose co-transporter 2 (SGLT-2 inhibitors and glucagon-like peptide 1 (GLP-1) agonists, have shown to have particular benefits in prevention of heart disease complications. Below you will find a table with the agents/drugs in class and their indication unique for heart disease.

Drug name                                        Benefits
Heart Failure (HF) (lower hospitalization risk for heart failure) Major adverse cardiovascular event (MACE) reduction (Ex. Heart attack and stroke)
Sodium Glucose Co-transporter 2 Inhibitors (SGLT2 inhibitors)
Canaglifozin (Invokana) X X
Dapagliflozin (Farxiga) X  
Empagliflozin (Jardiance) X X
Glucagon-Like Peptide 1 Agonists (GLP-1 Agonists)
Liraglutide (Victoza)   X
Dulaglutide (Trulicity)   X
Semaglutide (Ozempic)   X
Semaglutide (Rybelsus)   X
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Along with treatment, it is always important to implement non-drug treatment such as your diet, physical activity, and smoking cessation.

 For your diet, multiple options for healthy eating plans are described below and are proven to work for persons with diabetes.  Food is medicine, so what and how much we eat really matters.  

  • Dietary Approach to Stop Hypertension (DASH) diet:
    • Eating plan rich in fruits and vegetables, low-fat and nonfat dairy, whole grains, along with nuts, beans, and seeds
    • Also includes some
    • Cut back on foods high in saturated fat, such as fatty meats, full-fat dairy foods and tropical oils, as well as sugar-sweetened beverages and sweets
    • Limiting salt to less than 2,300 mg per day or less than 1,500 mg per day
  • Carbohydrate counting
    • Working with diabetes care and education specialist (formerly diabetes educator) learn how to count carbohydrates
    • Typically recommend 30 – 45 grams of carbohydrates per meal, and 15 grams of carbohydrates per snack
  • Healthy Eating Behaviors
    • Learning portion control
    • Plate Method: ½ plate nonstarchy veggies, ¼ plate protein, ¼ plate of starch (carbohydrate), diary product (i.e. milk or yogurt) and fruit
  • Mediterranean diet
    • High in vegetables, fruits, whole grains, beans, nuts, seeds, and olive oil
    • Plant based, not meat based
    • Main components:
      • Daily intake of vegetables, fruits, whole grains and healthy fats
      • Weekly intake of fish, poultry, beans and eggs
      • Moderate portions of dairy products
      • Limited intake of red met

Along with diet, moving your body each day is key for keeping the heart healthy.  The 2020 ADA Standards of Care Guidelines recommends at least 150 minutes a week, that’s less than 22 minutes each day, of moderate-intensity physical activity such as brisk walking. This will not only help you manage your weight, but also help lower your blood sugars, blood pressure, and cholesterol which will essentially help reduce your risk for heart disease and many other potential complications.

Last but not least, it is important to stop smoking. Smoking can lead to so many illnesses including lung cancer, chronic pulmonary disease (COPD) or progressive disease of the lungs, and atherosclerotic cardiovascular disease or Heart disease.

Lifestyle modifications along with your treatment therapy will help reduce your risk of heart disease and also improve your quality of life so you can live out the best possible life!

Back to BJ, he recently met with this primary care provider who placed him on empagliflozin (Jardiance) 25 mg once daily and semaglutide (Ozempic) 0.5 mg once weekly because he has diabetes, heart failure and heart disease.  He is relieved that his diabetes medications will help both manage his diabetes and protect his heart. 

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#diabetes #heart #connection

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Tuesday’s Daily Piece: New Heart Indication for dulaglutide

Dulaglutide, Trulicity, has received a new FDA indication for prevention of primary (person has no established heart disease, or history of heart attack or stroke) AND secondary (person has established heart disease, or history of heart attack or stroke) reduction of major adverse cardiovascular (heart) events (i.e. heart attack or stroke) in adults with type 2 diabetes. Adults with type 2 diabetes have an elevated risk for heart attacks and strokes so proactive prevention is vital. What makes this new indication particularly important is that it is for prevention in person with or without established heart disease.

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https://www.healio.com/endocrinology/diabetes/news/online/%7Ba3e6dcf7-baa1-48e3-bbfa-cde2d3ba9a20%7D/fda-grants-dulaglutide-cv-indication-for-diabetes-with-or-without-established-cvd?utm_source=selligent&utm_medium=email&utm_campaign=endocrinology%20news&m_bt=4557970002905

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#Dulaglutide #primary #secondary #prevention #heart

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Saturday’s Daily Piece: Important FDA Recalls This Week

Unfortunately, we have two recalls this week. FDA has issues a class I recall (most serious) for certain Medtronic MiniMed 600 series (please click on link below for specifics) due to incorrect insulin dosing which has caused 2,175 injuries and one death.

https://www.fda.gov/medical-devices/medical-device-recalls/medtronic-recalls-minimed-insulin-pumps-incorrect-insulin-dosing

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Secondly, Eisai manufacturer of weight loss medication, lorcaserin (Belviq), has agreed to voluntarily withdrawal lorcaserin from the market due to concerns of cancer risk.

https://www.fda.gov/drugs/drug-safety-and-availability/fda-requests-withdrawal-weight-loss-drug-belviq-belviq-xr-lorcaserin-market

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#FDA #recall #Medtronic #Belviq

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Saturday: It’s Official…FDA Not Recommending Recall of Metformin

As a person with prediabetes who takes metformin, I am excited to share that the FDA recommends no recall on metformin. This is a follow up from Tuesday’s Daily Piece regarding the testing of metformin for NDMA. Please share this good news.

https://www.medscape.com/viewarticle/924866

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#metformin #no #recall #FDA

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Tuesday’s Daily Piece: Good News Regarding NDMA in Metformin

If you recall in 2019, several generic medications were pulled from the market due to having unacceptable levels of N-Nitrosodimethylamine (NDMA) impurity as NDMA increases risk of cancer. Concerns regarding the level of NDMA in generic metformin surfaced in late 2019. Good news came out earlier this week that the FDA found no tested samples of generic metformin contained unacceptable levels of NDMA important. Please click below to found additional details regarding the tested samples of metformin.

https://www.raps.org/news-and-articles/news-articles/2020/2/ndma-in-metformin-fda-finds-low-levels-in-only-2

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#metformin #NDMA #FDA

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Thursday’s Daily Piece: Real World Case of “If Sounds Too Good to Be True, Then It Probably Is”

CVS Health announced a new program, RxZERO, which sounds amazing. It promises to eliminate out of pocket expenses for diabetes medications. Wow!!! Oh exciting until you read closely that it requires employees with diabetes to use only approved generic diabetes medications – no branded medications. So this “amazing” program does not eliminate copays for SGLT-2 inhibitors, GLP-1 agonists, most DPP-IV inhibitors, branded insulin.

https://www.benefitnews.com/news/cvs-health-eliminates-out-of-pocket-costs-for-diabetes-medications

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#RxZERO #disappointed #generic #drugs

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Tuesday’s Daily Piece: New 3-in-1 Medication Combination Available

I don’t know about you but I like the idea of 3 meds in 1 pill. Well we now have a new 3 in 1 diabetes combination medication on the market. Trijardy XR contains empagliflozin (Jardiance) (SGLT2 inhibitor with additional indication to reduce risk of cardiovascular (heart related) death in adults with type 2 diabetes and established cardiovascular disease), linagliptin (Tradjenta) (DPP-IV inhibitor) and metformin XR (backbone of treatment for type 2 diabetes).

https://investor.lilly.com/news-releases/news-release-details/us-fda-approves-only-triple-combination-tablet-jardiancer-adults

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#3-in-1 #combination #TrijardyXR

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Saturday’s Daily Piece: Diabetes Educators are Now Diabetes Care and Education Specialists

I am thrilled to share the exciting new name of diabetes care and education specialists for the specialty formerly known as diabetes educators. This new title for the specialty more accurately captures the role of the specialty. Certified diabetes educators are now certified diabetes care and education specialists. As a diabetes care and education specialists myself, I do more than simply educate. American Association of Diabetes Educators (AADE) is now the Association of Diabetes Care and Education Specialist (ADCES). Having served on the Board of Directors of AADE during the process of changing name of specialty and association, I confidentiality say that the research backs the name change as well as input from key stakeholders. For more information on the timely and essential name change, please click below.

https://www.diabeteseducator.org/practice/new-name-title

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#ACDES #new #name #specialty

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Tuesday’s Daily Piece: Gout Reduction Benefit with SGLT-2 Inhibitors

In a recent study published in Annals of Internal Medicine, sodium glucose cotransporter-2 (SGLT2) inhibitors were found to have a reduced risk for gout as compared to glucagon like peptide 1 (GLP-1) agonist. In this study patient taking SGLT2 inhibitor had 36% reduced risk of developing gout. The study design, population-based cohort study, is not the most robust study design as well as gout risk factors were not accessed in the study. While this is promising, more studies are needed.

https://annals.org/aim/article-abstract/2758844/assessing-risk-gout-sodium-glucose-cotransporter-2-inhibitors-patients-type

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#gout #reduction #SGLT-2 inhibitors

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Saturday’s Daily Piece: Ozempic and Cardiovascular Benefit

The benefits or harms of diabetes medications on cardiovascular health matters in a major way. In recent years, medications particularly select GLP-1 agonists and SGLT-2 inhibitors have shown major cardiovascular benefits. Ozempic, a GLP-1 agonist, now has a FDA indication for reduction of major adverse cardiovascular events (i.e. heart attack, stroke) in adults with type 2 diabetes and known (diagnosed) heart disease. Please click more for details.

https://www.prnewswire.com/news-releases/fda-approves-ozempic-for-cardiovascular-risk-reduction-in-adults-with-type-2-diabetes-and-known-heart-disease-updates-rybelsus-label-300988672.html

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#heart #reduction #Ozempic #indication

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