The ABCs of type 2 Diabetes and your Heart

 The International Diabetes Federation (IDF) reported that in 2024 there were 589 million individuals, worldwide living with diabetes. This figure is expected to reach 853 million by 2050. Of all those living with Diabetes 90-95 % are Type 2 Diabetics.

Being diagnosed with diabetes increases your risk of developing heart related conditions. In fact, adults with diabetes are 2-4 times more likely to die from heart disease when compared to those without the condition.

People with Type 2 Diabetes often have high blood pressure, elevated cholesterol, and obesity, all risk factors for heart disease. Controlling blood sugar and managing these conditions helps lower the risk of heart related complications. This comprehensive approach to diabetes management is referred to as the ABCs of Type 2 Diabetes management.

A for A1c , B for Blood pressure ,C for Cholesterol ,D for Diet , E for Exercise, and S for Smoking cessation.

A1c

A1c also known as glycated haemoglobin (HbA1c) is the golden standard in Type 2 Diabetes diagnoses and management. It measures the amount of haemoglobin that has glucose stuck on it ,and is given as a percentage. When blood sugar levels remain high in the body, glucose binds to haemoglobin.

 Haemoglobin is a substance found in the red blood cells; its main function is to transport oxygen in the body. The body produces new red blood cells every 3 months. A1c tells a story of what has been happening with blood glucose control in the last three months.

All individuals living with diabetes should have their HbA1c test done every 3-6 months. The target for most Diabetics is set at 7%. It is however important to talk to your Doctor about setting your target HbA1c goal, as they may need to consider your specific risk factors. Studies show a link between high HbA1c and danger of developing heart disease.

B- Blood pressure

High blood pressure is one of the most common conditions found in individuals with type 2 diabetes. Some studies suggest that high blood pressure is more common in those with type 2 diabetes when compared to the general population. Those living with Type 2 Diabetes should have their blood pressure checked at every clinic visit.

Individuals with blood pressure readings of more than 140/90 taken on two separate occasions after lifestyle changes, should be started on treatment. Most guidelines agree that the target blood pressure for those with type 2 diabetes should be set at 130/80. If you are over the age of 65 years old, discuss your blood pressure targets with your doctor as they may need to consider your individual risk factors.

C- Cholesterol

Type 2 Diabetes negatively affects cholesterol levels in the body. Those living with the condition often have higher LDL (bad) cholesterol and lower HDL (good) cholesterol, and increased triglyceride levels. Triglycerides are the most common type of fats found in the body.

The combination of high triglycerides and LDL can cause a build-up of fatty deposits in blood vessels that supply oxygen to the heart, increasing the risk of heart disease and strokes.

It is recommended that those living with type 2 diabetes should have their cholesterol and triglyceride levels checked when they are first diagnosed with diabetes, and yearly if results were normal. Those with high levels and on treatment should be monitored every 3- 6 months depending on how well they are doing on treatment.

	Target
Triglycerides	<1.7 mmol/L
HDL	>1.0 mmol/L (men) >1.2mmol/L (women)
LDL	<1.8mmol/L

Diet and Exercise

Diet and exercise remain the most important part of Type 2 diabetes prevention and care. Even after starting treatment nutritional support continues to play a crucial role. Nutritional support and exercise have been shown to improve blood glucose control, promote weight loss and reduce risk of heart related complications.

Dietary recommendations for individuals living with type 2 diabetes emphasize the importance of consuming non-starchy vegetables and eating whole foods while reducing the intake of highly refined and processed foods.

Certain diets have been proposed for individuals with type 2 diabetes, these include the Mediterranean diet, vegetarian or plan based diets. It is always advisable to consult with a dietician or nutritionist ,so they can assess and provide individualized nutritional support and guidance.

People living with diabetes are advised to engage in 150-300 minutes a week of moderate intensity aerobic exercise ,or 75-150 minutes of vigorous intensity aerobic exercise. This can be spread over 3 days a week. Moderate exercise includes activities like cycling and swimming, while jogging and aerobics are considered vigorous.

If you already have diabetes related complications remember to seek medical advise before engaging in vigorous intensity exercise. Exercising may cause hypoglycaemia; it is therefore important to check your blood sugar levels before exercising. If your sugar is below 5mmol/L it is advisable that you have a carbohydrate snack before exercising.

 For those on insulin you may need to adjust your insulin dose. Talk to your Doctor or Pharmacist if you are unsure of how to adjust your insulin dose.

Stop smoking.

Smoking increases risk of type 2 diabetes and heart disease. Studies show that 15-30% of smokers are more likely to develop diabetes when compared to non- smokers. Risk increases with the number of cigarettes smoked per day and period as a smoker.

Chemicals in cigarettes react with oxygen in blood causing damage and swelling in the cells. This damage decreases the effectiveness of insulin in the body, causing disturbances in the body’s ability to manage blood glucose levels. They also cause damage to blood vessels, reducing oxygen supply to the heart increasing risk of strokes and heart disease.

Smokers with diabetes are advice to stop smoking, reducing the number of cigarettes a day has not been shown to reduce risk of developing complications.

Knowing and managing the ABCs of type 2 diabetes can help reduce and prevent risk of developing heart related complication .