The Life Threatening Link Between Diabetes and Heart Disease [transcript] [audio]

Guest: Ty J. Gluckman, MD, FACC, FAHA

Presenter: Neal Howard

Guest Bio: Ty J. Gluckman, MD, FACC, FAHA is Medical Director of Clinical Transformation at the Providence Heart and Vascular Institute in Portland, Oregon and an adjunct faculty member of the Ciccarone Center for the Prevention of Heart Disease at The Johns Hopkins Hospital in Baltimore, Maryland.  Dr. Gluckman graduated summa cum laude with highest honors from Brandeis University and received his medical degree from Northwestern University Medical School in Chicago, Illinois. He completed his internal medicine training at McGaw Medical Center of Northwestern University, where he remained for additional years as chief resident and an Instructor of Medicine. He completed his cardiology fellowship training at The Johns Hopkins Hospital and served as chief fellow during his final year there.

Segment Overview: A nationwide movement called “For Your Sweetheart” aims to educate the public about the deadly link between Type 2 diabetes and heart disease.

Transcript – Diabetes and Heart Disease

Neal Howard: Hello and welcome to the program. I’m your host Neal Howard. Diabetes Alert Day takes place every March to urge people to understand their risk for diabetes. However, millions of folks already diagnosed with diabetes are unaware of another risk. The risk of heart disease is the leading cause of death for people with type 2 diabetes. There’s a nationwide movement called “For Your Sweetheart” and here with more is Dr. Ty Gluckman. He’s a Cardiologist and Medical Director of Clinical Transformation at Providence Heart and Vascular Institute. Welcome to the program Dr. Gluckman.

Dr. Ty Gluckman: Thanks for having me.

N: When it comes to an increased risk of heart disease, why is it that people with diabetes are at that increased risk?

G: So they’re probably a number of reasons that individuals with diabetes face increased risk for cardiovascular disease and that includes heart attack, stroke and other forms of cardiovascular disease. Individuals with diabetes are commonly have higher blood pressure, high cholesterol, excess weight and each of those can likely play a role but even when you adjust for all of those risk factors, having diabetes alone increases one’s risk for heart attack and stroke. And in fact, cardiovascular disease is the leading cause of death amongst those with type 2 diabetes.

N: Is there any risk when it comes type 1 diabetes as far as risk of heart disease?

G: Unfortunately, the risk for those with type 1 diabetes and type 2 diabetes in terms of increased cardiovascular risk is somewhat similar. There are different conditions and the factors that contribute to those conditions developing is different. But unfortunately amongst those with type 1 diabetes and type 2 diabetes, they both face increased risks for cardiovascular events including heart attack and stroke.

N: Why do you think that when someone is diagnosed with type 1 or type 2 diabetes there isn’t more awareness made about this risk of cardiovascular disease? It would seem that that would be the number one thing that people with this condition would be alerted to?

G: As a cardiologist, I couldn’t agree more and I see a lot of patients with diabetes who are unaware of that link. And a survey found millions of people living with diabetes and loved ones that were of those individuals that had diabetes were unaware of the increased risk that exists. I think many people who have in particular type 2 diabetes are aware of the potential risks of vision, foot problems, kidney problems, we just as a profession for whatever reason haven’t talked about that link between cardiovascular disease and diabetes to the extent that we should have and it underscores the reason for the movement “For Your Sweetheart”, a national campaign to raise awareness of the link between type 2 diabetes and heart disease why it actually came into existence and why I joined that national movement.

N: So what types of things are happening within this “For Your Sweetheart Movement”?

G: Well, one of the key things is that there is a website foryoursweetheart.com and again, this was intended to enlighten individuals with diabetes and those individuals, relatives, family members, loved ones of those with diabetes to better understand that link between type 2 diabetes and heart disease. On the website, there is a “Heart You Quiz” that allows individuals to take a brief quiz to better understand their individual risk. But it also provides a number of resources including a patient discussion guide that really is meant to empower and engage those with diabetes to ask questions of their healthcare providers when they meet with them about what they can better do to reduce their cardiovascular risk going forward.

N: As a physician, when you’re in conversations with other physicians who may or may not be cardiologist, someone whose has patients with diabetes or maybe some other issues that can become heart related, when you’re talking with them, what is the consensus as to why we’re not being told? I mean we’re talking about millions of people and we’re just focusing in on those traditional effects of type 2 diabetes, the feet, the vision and things. What is it that’s preventing this awareness?

G: I’m not certain that there’s one uniform explanation for why awareness has not been as prominent as otherwise would be. I will tell you as an example, cardiovascular disease continues to be the number one killer for women and that is not as well understood by many patients and healthcare providers as well. So I would say as a healthcare provider myself, we clearly have opportunities to improve our messaging not only amongst the medical community but also to our patients. And that’s what got me so excited about this national movement. It was really aimed at moving beyond where we’ve been and going forward how do we educate, enlighten, inform individuals with diabetes, their loved ones and to your point, those individuals who provide healthcare to these patients to make them aware of the link between diabetes and cardiovascular disease. The fact that it’s the number one killer for those individuals and that there’s a lot that we can do to help reduce their risks going forward.

N: I find that there I guess from a layman’s and a patient’s standpoint, some very important things that just simply aren’t touched on in med school. Is this one of those things that is maybe not touched on or something that is touched on but as a person’s career progresses, something that’s kind of pushed to the backburner in favor of the more traditional information that’s given to patients for certain types of ailments?

G: I think as a healthcare provider, the amount of information that’s coming out daily. Not even just monthly or yearly, but daily is staggering. And so I think it’s sometimes a challenge to stay on top of all of those things. I think this is partly why the campaign is engaging not only healthcare providers but also patients and their loved ones to encourage and ask those questions that are important, as a diabetic, “What can I do to reduce my cardiovascular risk?”. Now importantly, there are a number of traditional interventions that are pretty straightforward that can help in diabetes including weight reduction through diet and exercise, quitting tobacco, controlling blood pressure, controlling cholesterol. But for diabetics, risks still persist above and beyond that and so individuals should be pushing their healthcare providers prodding them to ask the questions, “What more can I do as an individual to further reduce my risk?”.

N: Would you say that simply asking what’s the the next best thing to do is the first step or what would that first step be in someone who’s diagnosed with diabetes to manage their disease risk on a daily basis?

G: So briefly, I think there are two important things setting down a path of lifestyle intervention which forms the bedrock for all of our interventions and diabetes. And secondly is understanding your personal risk and going to foryoursweetheart.com, taking the “Heart You Quiz,” downloading the patient discussion guide and going in arm to understand your risk and then asking those questions to what can I do next of my healthcare provider.

N: Dr. Gluckman, it’s been a pleasure. Thank you so much for joining us today here on Health Professional Radio. Great information. I’m hoping you’ll return.

G: My pleasure. I’d welcome the opportunity.

N: You’ve been listening to Health Professional Radio. I’m your host Neal Howard. Transcripts and audio of the program are available at healthprofessionalradio.com.au and also at hpr.fm.

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