1 in 5 youth with diabetes has heart risk

With the epidemic of obesity in the United States leading to a greater incidence of diabetes among youth, a new study highlights why Americans cannot afford to ignore this dangerous trend: One in five youth with diabetes has already developed two or more additional risk factors for premature heart disease.

The August issue of Diabetes Care also includes new treatment guidelines developed by the American Diabetes Association to help physicians choose the most appropriate therapies for lowering blood glucose levels in people with type 2 diabetes.

Overall roughly 20 percent of young people with diabetes (92% in those with type 2 and 14% in those with type 1) experience at least two additional cardiovascular disease risk factors, according to a new study sponsored by the Centers for Disease Control and Prevention, and the National Institutes of Health. The study, known as the SEARCH for Diabetes in Youth Study, found that overweight and obesity, high blood pressure and high triglycerides were extremely prevalent among youth with type 2 diabetes and somewhat prevalent among those with type 1 diabetes.

As is the case among adults, CVD risk factors were higher among minority and ethnic groups than they were among non-Hispanic whites. They were also higher among girls. This study adds to a growing body of research revealing a high prevalence of risk factors for diabetes and premature heart disease among American youth.

The researchers recommended better weight, lipid, and blood pressure control in youth with diabetes to prevent or delay the development of cardiovascular disease as they grow up.

Management of hyperglycemia in type 2 diabetes is extremely important, especially given the increased prevalence of this disease. Studies have shown that maintaining blood glucose levels as close to the nondiabetic range as possible helps to prevent the serious complications of type 2 diabetes, such as eye and kidney disease and nerve damage. Lowering blood glucose levels has also been shown to prevent heart disease in people with type 1 diabetes.

To help physicians select the most appropriate and effective therapies for lowering blood glucose levels, the American Diabetes Association has published in this month's Diabetes Care a consensus statement describing the treatment of elevated blood glucose. The guidelines urge physicians to make "normal" glycemic levels a goal for most patients (i.e. an A1C level less than 6.1 percent, with any A1C greater than or equal to 7% a call to adjust therapy); to first attempt to lower blood glucose levels with lifestyle interventions and the drug metformin; to add any one of three classes of medications if glycemic levels are not quickly achieved; to use insulin therapy when other treatment options do not result in patients achieving their target goals; and to initiate and adjust interventions rapidly to lower glycemic levels to target, with adjustments usually no less frequent than every three months.

With the emergence of many different medications for the treatment of type 2 diabetes in recent years, these recommendations set a precedent in the treatment of diabetes by providing health care providers with a specific treatment algorithm to determine the most appropriate intervention for their patients with type 2.

"The consensus panel believes that the algorithm we describe can be easily implemented," said Dr. David M. Nathan, the Chair of the Panel. He added, "We have recommended that clinicians use the generic drug metformin in combination with lifestyle changes immediately upon diagnosis, and that only three other drug classes are necessary for most patients, should metformin plus lifestyle intervention prove insufficient. Also, it's no longer acceptable to delay the initiation and adjustment of glucose-lowering therapy when metabolic goals are not being met."

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