Diabetes and Cardiovascular Damage: Early Diagnosis and Treatment and Comprehensive Intervention for Glucose Metabolism Disorders

It is estimated that there are currently 60-80 million people in China with diabetes and impaired glycemic regulation. These glucose metabolism disorders play a very detrimental role in the development of hypertension, hyperlipidemia, and cardiovascular and cerebrovascular diseases. At least half of diabetic patients are asymptomatic and are only diagnosed after a blood glucose test, and fasting blood glucose tests miss 80% of early-stage diabetes patients. Abnormal glucose metabolism can cause acute and chronic complications, especially chronic complications which affect multiple organs, leading to high rates of disability and mortality, seriously impacting patients' health and quality of life.

Diabetes is mainly divided into two types: 95% are type II and 5% are type I. Based on etiology, it can be divided into primary and secondary types. Diabetic patients have a 3-5 times increased risk of stroke and a more than 3 times increased risk of cardiovascular mortality. The presence of abnormal blood glucose significantly exacerbates the harmful effects of other risk factors and accelerates the development of cardiovascular and cerebrovascular diseases; therefore, guidelines for controlling other risk factors are more stringent when patients have diabetes. When diabetes is diagnosed, the cardiovascular system is already severely damaged. The risk of cardiovascular events is similar to that of patients after a myocardial infarction, approximately 20% per 10 years. If diabetes and myocardial infarction coexist, the probability of cardiovascular events rises to 40% per 10 years. Based on this, the American Heart Association considers diabetes a cardiovascular disease. Current guidelines in various countries classify diabetes as an equivalent risk factor for coronary heart disease. Aggressive treatment and blood sugar control in diabetes can prevent the continued deterioration of vascular damage and reduce cardiovascular events by 30%.

It is now known that prediabetes has a serious impact on the cardiovascular system, with damage almost equivalent to that of diabetes. Therefore, it should be given special attention in clinical practice. If a patient has multiple risk factors or cardiovascular disease, medication can be administered to reduce or delay the development of diabetes and lower the risk of cardiovascular disease by 30%–40%.

Diagnosis of diabetes and prediabetes. The most concerning clinical problem is missed diagnosis. Multiple large-scale clinical studies in China and Western countries have demonstrated that fasting blood glucose levels can miss 60%–80% of patients with diabetes and prediabetes. Therefore, glucose tolerance testing is recommended for high-risk groups. Among patients with atherosclerotic cardiovascular, cerebrovascular, renal, or other peripheral vascular diseases, 60%–80% also have diabetes or prediabetes. Glucose tolerance testing is recommended for patients with risk factors for diabetes, especially those with cardiovascular or cerebrovascular diseases. Multiple evidence-based medicine studies in 2005 demonstrated that, compared to intensive intervention and routine treatment for patients with diabetes or hyperglycemia, intensive intervention for cardiovascular and cerebrovascular diseases further reduced cardiovascular and cerebrovascular events and mortality by 40%–50%.

Diagnostic criteria for diabetes. Symptoms of diabetes are characterized by polydipsia, polyphagia, and polyuria. In mild cases, these three symptoms may not be obvious, or there may be no symptoms, but patients often have a large appetite, or a habit of eating sweets or late-night snacks, leading to overweight or obesity and reduced physical activity. In severe cases, weight loss may occur. Other accompanying symptoms include frequent skin infections, periodontal disease, urinary tract infections, sexual dysfunction, and cataracts. Diabetes mellitus is diagnosed when the patient presents with the three major symptoms of diabetes (polyuria, polydipsia, polyphagia) and a random plasma glucose concentration ≥200 mg/dL (11.1 mmol/L), or a fasting plasma glucose concentration ≥126 mg/dL (7.0 mmol/L), or a 2-hour post-OGTT plasma glucose concentration ≥200 mg/dL (11.1 mmol/L). If there are no clinical manifestations of diabetes, the above results need to be verified on another day for a diagnosis.

Prediabetes. 1. Impaired fasting glucose (IFG): Fasting venous glucose ≥6.1 mmol/L (110 mg/dL) — <7.0 mmol/L (126 mg/dL). 2. Impaired glucose tolerance (IGT): 2-hour post-load glucose ≥7.8 mmol/L (140 mg/dL) — <11.1 mmol/L (200 mg/dL). Early diagnosis and prevention can reduce myocardial infarction and stroke by 20%–40%. Without active intervention, approximately 10% of prediabetic patients will develop diabetes each year. Therefore, the guidelines recommend glucose tolerance tests for high-risk individuals and patients with cardiovascular and cerebrovascular diseases. Timely detection and early intervention can reduce the occurrence of cardiovascular and cerebrovascular events by 20%–40%.

Treatment Focus: Beyond Blood Sugar Control – Comprehensive Treatment to Prevent the Development of Cardiovascular and Cerebrovascular Damage. Diabetes is a significant risk factor for arteriosclerosis, and blood sugar management recommendations occupy a considerable portion of the guidelines. Since most deaths in diabetic patients are due to cardiovascular and cerebrovascular complications, the fundamental principle of diabetes treatment is to quickly stop the damage of high blood sugar to blood vessels, protect the cardiovascular and cerebrovascular systems, and slow down, stop, and reverse the pathological process of atherosclerosis. Recent results show that for every 1% reduction in glycated hemoglobin (HbA1c), diabetes-related mortality decreases by 20%, and myocardial infarction decreases by 14%. Blood sugar control should begin as early as possible for diabetic patients. This is the most significant change in domestic and international guidelines for diabetes. It is now believed that once diabetes is diagnosed, drug treatment should begin immediately.

For prediabetes, treatment is determined based on risk level. Recently, treatment for prediabetes has become more aggressive. This is because it is now clear that prediabetes has already caused severe and irreversible damage to the cardiovascular and cerebrovascular systems. The incidence of cardiovascular and cerebrovascular events in prediabetic patients is significantly higher, 2-3 times that of normal individuals. When diabetes is diagnosed, the damage to large blood vessels caused by diabetes is comparable to that of a patient who has had a myocardial infarction, with a 20% risk of cardiovascular and cerebrovascular events every 10 years. This indicates that diabetes treatment must begin early to prevent and treat cardiovascular and cerebrovascular diseases. Furthermore, numerous recent studies have demonstrated that aggressive blood sugar-lowering treatment for diabetic or prediabetic patients can reduce the incidence of cardiovascular events by 35%-40%. Comprehensive treatment is crucial for protecting blood vessels. Diabetic patients require comprehensive treatment, actively correcting various risk factors such as glucose and lipid metabolism, improving insulin resistance, controlling blood pressure, and controlling weight. The goal of treatment is to protect and strive to reverse pancreatic function damage by correcting unhealthy lifestyles and metabolic disorders in diabetic patients, so as to prevent the risk of acute and chronic complications, especially damage to the heart, brain, kidneys, eyes, and lower limbs.