/publications/issue/2002/2002-10/2002-10-6989

The Heart of Diabetes: Understanding Insulin Resistance

Author: Robert Talbert, PharmD, American Heart Association

The chances are good that most patients with diabetes do not know that heart disease is the number-1 cause of death among diabetics. An American Heart Association (AHA) survey conducted in 2001 revealed the following:

? Only 33% of people with type 2 diabetes named heart disease among their ?most serious? diabetes-related problems
? Only 57% knew that insulin resistance is related to heart disease
? 63%, however, had 1 or more cardiovascular disease (CVD) problems

Clearly, a vast difference exists between what patients believe and the reality of how diabetes is related to heart disease, and that difference is regrettable. ?Type 2 diabetes is nearing epidemic proportions in the United States,? said Richard W. Nesto, MD, chair of the cardiovascular medicine department at Lahey Clinic Medical Center in Burlington, Mass. ?That means more and more people have heart disease.? About 17 million people in the United States have diabetes, said Dr. Nesto, who is also an associate professor of medicine at Harvard Medical School, Boston, Mass. Two thirds of people with diabetes die from some form of heart or blood vessel disease. Diabetes also is related to other heart disease risk factors, such as high blood pressure, cholesterol disorders, and obesity. In addition, most people with type 2 diabetes have insulin resistance, a condition in which the body does not respond efficiently to the insulin it produces. This condition seems to predispose a person to both diabetes and CVD.

?Research from the past few years has helped us to better understand the link between diabetes and heart disease,? said Sidney C. Smith, Jr, MD, chief science officer of the AHA. ?We?ve also learned more about the role insulin resistance plays in both. In fact, diabetes is a major risk factor for CVD. But diabetes patients still tend to treat heart disease as a separate concern.?

Fortunately, pharmacists can help patients or those at risk to control or prevent diabetes. The AHA also has a new program that can help. It is called ?The Heart of Diabetes: Understanding Insulin Resistance.? The free program gives information to people with diabetes and prediabetes on how to reduce their risk for heart disease and stroke. The guide takes them through steps whereby they apply what they have learned. Then they assess their health risk. Finally, they enroll as Heart of Diabetes ?Thrivers? and receive the following:

? A journal that includes tips on managing diabetes and reducing risk
? A ledger to track progress concerning (hemoglobin A)1c(, glucose, and choles-)terol levels
? A free 1-year subscription to Diabetes Positive magazine
? Incentives to help them stay motivated
? Tips on managing cholesterol, increasing physical activity, and improving nutrition
? Profiles of other Thrivers and their successes

At the end of their first year, Thrivers complete a survey to measure how much they have learned about type 2 diabetes, heart disease, and insulin resistance. They also record the progress they have made in managing these diseases.
The AHA also wants to reach the ?most-at-risk? minority populations. That is why the association is tailoring the Heart of Diabetes program to the Hispanic community and will offer the program materials in Spanish. It is hoped that pharmacists will encourage their patients to enroll in the program and to work with them when they do. To get started, they can call 800-AHA-USA1 (800-242-8721) or visit americanheart.org/diabetes on the World Wide

The AHA?s Heart of Diabetes: Understanding Insulin Resistance program is sponsored by Takeda Pharmaceuticals North America Inc and Eli Lilly and Company.