32 VOLUME 19 NUMBER 2 • November 2022 Diabetes and heart disease Dr Gita Makan Why people with diabetes should regularly assess their cardiac risks While COVID-19 dominated headlines in 2021 another more insidious plague continued unabated. At that time, there were 24 million adults between the ages of 20 and 79 years in Africa living with diabetes. Worryingly that figure continues to rise. By 2030, an estimated 33 million people on the continent will be affected by this disease. In many ways, diabetes can be considered to be the dark horse of non-infectious diseases. It is not as widely discussed as HIV, cancer or malaria in the African context, however in 2021 it was responsible for 416 000 African deaths.1 Diabetes is not selective and the diagnosis has been attached to such famous names as Johnny Cash, Tom Hanks and Patti LaBelle. The famous singer, LaBelle jokingly referred to herself as a ‘divabetic’. Diabetes can lead to severe morbidity from chronic kidney disease, nerve damage, and vision and hearing impairment. However, a potentially deadly complication is cardiovascular disease (CVD). Following the commemoration of World Diabetes Day on November 14, it is fitting to remind those at risk that heart disease is prevalent among people with type 2 diabetes.2 In 2019 alone, more than one million deaths were attributed to CVD in subSaharan Africa. In the broader context, that constitutes 5.4% of all global CVD-related fatalities and 13% of all deaths in Africa.3 People with diabetes are twice as likely to have heart disease or a stroke than people without diabetes.4 Thirty per cent of type 2 diabetes patients will develop heart failure in their lifetime.5 Prevention begins with assessing your risk As diabetes grows its footprint across the continent, so does the burden of heart failure. And people with heart failure in type 2 diabetes have an increased risk of death compared with type 2 diabetes without heart failure.6 But while the statistics may seem alarming, prevention is possible. A simple assessment from a healthcare professional can help diabetic patients at risk of CVD take life-saving preventative measures – even if they are asymptomatic when they are assessed.7 Why testing matters: even if there aren’t any symptoms If you are assessed by a healthcare professional as having a high risk for developing heart failure, there are effective and safe interventions that can be provided to prevent the development of CVD.7 Early assessment: the ultimate line of defense There is now a straightforward science to assessing your risk of CVD. It all begins with a simple, relatively non-invasive blood test. Having provided a blood sample to a clinician, your test will present biomarkers that can diagnose your risk of CVD.7 Your healthcare provider will order anNT-proBNP test to assess your risk or deliver a diagnosis.8 A visit to your healthcare professional who helps you treat your diabetes can result in him/her recommending this test to assess your risk of developing heart failure. Your healthcare professional will test or refer you for testing based on their risk assessment. Once you know your risk, documented treatment options such as ACE inhibitors and betablockers can reduce your risk of developing heart failure.7 Ultimately, if you or a family member has diabetes – with specific emphasis on type 2 – getting an early assessment can drastically reduce your risk of heart failure or provide the data your healthcare professional needs to treat you.9 The value of diagnostics in practice Before assessing your risk of diabetes-related cardiovascular conditions, a healthcare professional must test for diabetes and advise you on treatment options. According to the International Diabetes Federation, around 13 million adults living with diabetes in Africa remain undiagnosed. That is an astonishing 54% of the total number of adults with diabetes on the continent.1 Diabetes is a multifaceted disease that is increasing its reach in Africa. Together with CVD and other complications associated with it, it is a significant contributor to Africa’s burden of noncommunicable diseases.10 While diabetes may be a disease that is managed rather than cured, modern diagnostics and treatments can be the catalysts for better quality of life in the long term. As celebrity chef Alvin Leung suggests, ‘Diabetes is not curable. It’s sustainable’. If you have diabetes, take a moment to consider your risks and get an early assessment for CVD. And if you suspect that you have any symptoms associated with diabetes, consult a healthcare professional sooner rather than later. For a list of the symptoms related to diabetes, visit: https://www.rochediabetescaremea.com/en/diabetes-basics/world-diabetes-day-what-diabetes References 1. idf.org [Internet]: International Diabetes Federation; c2021 [cited 2021]. Available from: https://www.idf.org/our-network/regions-members/africa/diabetesin-africa.html#:~:text=52%20million%20adults%20(20%2D79,and%20 117%20million%20by%202045 2. cdc.gov [Internet]:WorldHeart Federation; c2022 [cited 2022Nov 3]. Available from: https://www.cdc.gov/diabetes/managing/problems.html#:~:text=Common%20 diabetes%20health%20complications%20include,how%20to%20improve%20 overall%20health 3. world-heart-federation.org [Internet]. Johannesburg: World Heart Federation; c2019 [cited 2019]. Available from: https://world-heart-federation.org/where-wework/africa/ 4. cdc.gov [Internet]:WorldHeart Federation; c2022 [cited 2022Nov 3]. Available from: https://www.cdc.gov/diabetes/managing/problems.html#:~:text=Common%20 diabetes%20health%20complications%20include,how%20to%20improve%20 overall%20health. 5. Bertoni AG, et al. Diabetes Care 2004; 27: 699–703. 6. Ml-eu.globenewswire.com [Internet]: Globe News Wire; c2021 [cited 2021 Apr 28]. Available from: https://ml-eu.globenewswire.com/Resource/Download/1f4fa4001186-4791-8da7-b1c24a959e9c 7. Huelsmann M, et al. J Am Coll Cardiol 2013;62:1365–72. 8. cdc.gov [Internet]: Centers for Disease Control; c2021 [cited 2021]. Available from: https://www.cdc.gov/diabetes/library/features/prevent-complications.html 9. academic.oup.com [Internet]. European Heart Journal; c2009 [cited 2009 Jan]. Available from: https://academic.oup.com/eurheartj/article/30/1/66/2398330 10. Rosano GM, et al. Card Fail Rev 2017. doi: 10.15420/cfr.2016:20:2. opinion piece SA JOURNAL OF DIABETES & VASCULAR DISEASE Correspondence to: Dr Gita Makan Endocrinologist and specialist physician, Life Wilgeheuwel Hospital, Johannesburg S Afr J Diabetes Vasc Dis 2022; 19: 32
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