This content material initially appeared on diaTribe. Republished with permission.
By April Hopcroft
Consultants in diabetes care not too long ago shared invaluable insights for managing kidney well being, lipid ranges, glucose, and physique weight on a current diaTribe panel. Panelists emphasised the significance of schooling and self-advocacy, plus newer therapies like SGLT-2 inhibitors and PCSK9 inhibitors.
The American Coronary heart Affiliation not too long ago coined the phrase cardiovascular-kidney-metabolic (CKM) syndrome – however what does this smorgasbord of phrases imply for individuals with diabetes?
The time period CKM syndrome describes the sturdy connections between coronary heart illness, kidney illness, and metabolic circumstances like kind 2 diabetes and weight problems. Having one in all these circumstances usually makes the danger larger danger for the others.
As an example, individuals with diabetes have an elevated danger of coronary heart illness. Research present that an individual with diabetes has the identical cardiovascular danger as somebody with out diabetes who’s skilled a cardiac occasion (reminiscent of a coronary heart assault or stroke).
Likewise, when you have kidney illness, you’re additionally at larger danger of creating coronary heart illness. Many CKM circumstances have related underlying causes, particularly, diabetes and hypertension.
diaTribe not too long ago hosted a digital roundtable dialogue, the place consultants shared sensible recommendation for optimizing metabolic, lipid, and kidney well being. Panelists highlighted the significance of screening, proactive remedy, and self-advocacy to handle these interconnected circumstances.
The panel was moderated by Dr. Diana Isaacs, an endocrine medical pharmacy specialist and director of schooling and coaching in diabetes expertise on the Cleveland Clinic, and included:
- Dr. Roopa Mehta, an endocrinologist and researcher within the division of endocrinology and metabolism on the Nationwide Institute of Medical Sciences and Vitamin Salvador Zubrian in Mexico Metropolis.
- Daniel Newman, kind 1 diabetes advocate, continual kidney illness survivor, and host of The Speaking Type1 podcast.
- Dr. Ted Okerson, a specialist in medical hypertension and senior discipline doctor at AstraZeneca.
- Dr. Robert Eckel, professor of drugs, emeritus, on the College of Colorado Anschutz Medical Campus.
Know your danger for continual kidney illness
Years of excessive blood sugar ranges can enhance the danger of continual kidney illness (CKD) for individuals with diabetes. Growing old additionally performs a task, no matter whether or not you’ve got diabetes or different well being circumstances. After age 30 to 40, you start to lose nephrons, that are the filtering models of the kidney – even in case you are in any other case wholesome.
“Everybody with diabetes has to concentrate to kidney operate and get correct screening assessments to allow them to be handled early,” mentioned Dr. Eckel.
Whereas anybody with diabetes can develop kidney illness, individuals with kind 1 diabetes have a better danger in comparison with these with kind 2 diabetes. CKD additionally progresses extra quickly in kind 1 diabetes. There are presently few therapies obtainable for individuals with kind 1 diabetes and CKD, however analysis is underway to develop remedy choices.
As Eckel famous, early detection is essential. Everybody with diabetes ought to obtain two screening assessments every year to verify kidney operate:
- Estimated glomerular filtration charge (eGFR): This can be a blood check used to calculate how effectively the kidneys are working.
- Urinary albumin creatinine ratio (uACR): This check makes use of a urine pattern to measure how a lot protein has leaked from the kidneys. When the kidneys are broken, they usually leak protein into the urine.
Whereas most healthcare suppliers are aware of conducting yearly eGFR assessments, Eckel acknowledged that typically they skip the uACR check.
“Healthcare suppliers typically overlook that protein within the urine is a vital marker of diabetic kidney illness and may relate to ongoing kidney injury,” he mentioned.
Certainly, current analysis by the Nationwide Kidney Basis exhibits that over half of individuals with diabetes aren’t receiving these screenings. For these causes, Dr. Isaacs mentioned it’s necessary to advocate for your self if you happen to haven’t obtained the right screenings.
SGLT-2 inhibitors are important for coronary heart and kidney safety
When SGLT-2 inhibitors – reminiscent of Jardiance (empagliflozin), Farxiga (dapagliflozin), and Invokana (canagliflozin) – had been first authorized in 2014, they had been primarily used for glycemic management advantages.
Since then, many giant trials have documented the center and kidney advantages of those medicine, resulting in their approvals for coronary heart failure and continual kidney illness in individuals with and with out diabetes.
Dr. Okerson emphasised that SGLT-2 inhibitors have been proven to scale back demise from any trigger (not simply coronary heart illness) in medical trials. Primarily based on these findings, tips now suggest that folks with diabetes who’ve or are in danger for cardiovascular or kidney illness ought to take an SGLT-2 inhibitor and/or a GLP-1 receptor agonist.
Okerson famous that many individuals expertise a minor drop in eGFR after beginning an SGLT-2 inhibitor, however this dip is completely regular, usually non permanent, and customarily not a trigger for concern.
One other problem in using SGLT-2 inhibitors is their excessive price, which is about $600 for a one month provide. In July 2023, the FDA authorized a brand new SGLT-2 inhibitor, Brenzavvy, which is offered at a decrease price with no insurance coverage via Value Plus Medication. Nonetheless, there isn’t a cardiovascular or kidney consequence knowledge but on this SGLT-2 inhibitor.
What are triglycerides and why are excessive ranges dangerous?
Past coronary heart and kidney illness, it’s additionally necessary to contemplate lipid ranges.
Triglycerides are a sort of fats that flow into within the blood together with ldl cholesterol; they’re additionally present in excessive concentrations in fats (adipose) tissue. Excessive blood sugar ranges trigger extra triglycerides to be launched from the liver, which may result in insulin resistance.
Whereas proof means that triglycerides don’t instantly trigger coronary heart illness, Eckel defined that prime triglyceride ranges are “a clue that one thing in metabolism has gone awry.” This could alert healthcare suppliers to seek out the underlying reason for excessive triglycerides – whether or not it’s genetics, extra physique weight, elevated blood sugar, or one thing else.
Usually, somebody is taken into account to have what’s referred to as hypertriglyceridemia when triglyceride ranges are above 150 mg/dL. When triglycerides are above 500 mg/dL, that is labeled as extreme hypertriglyceridemia, which elevates the danger of acute pancreatitis (irritation of the pancreas).
So, what are you able to do to decrease triglycerides?
1. Weight reduction
Usually, when individuals shed extra pounds, excessive triglycerides are diminished. Eckel highlighted the significance of sustaining weight reduction via bodily exercise and dietary modifications.
He defined that with weight reduction and bodily exercise, physique composition modifications. Particularly, individuals usually lose fats and construct lean tissue together with muscle, which helps with decreasing triglycerides. Sustaining weight reduction additionally contributes to total cardiovascular well being.
2. Restrict alcohol
The extra you drink, the better the affect on triglyceride metabolism and total triglyceride ranges, Eckel defined. Basically, he beneficial avoiding alcohol altogether when triglyceride ranges are over 500 mg/dL.
In case your triglyceride ranges are above 300 mg/dL, Eckel steered limiting your self to 1 drink sometimes. When you do select to drink, you should definitely follow reasonable quantities and be taught to determine carb-filled drinks forward of time.
3. Keep away from easy sugars and reduce carbohydrates
Vitamin tips suggest that folks with diabetes ought to get lower than 10% of their energy from easy sugars, that are essentially the most fundamental type of sugar. Easy sugars are present in meals like soda, sweet, muffins, and different baked items.
In accordance with the American Coronary heart Affiliation, ladies ought to restrict themselves to not more than 100 energy per day from added sugars and males shouldn’t have any greater than 150 energy per day from added sugars.
Lowering consumption of easy sugars is simpler mentioned than executed, Dr. Mehta famous. Usually, household preferences or cultural norms can affect consuming patterns, and it may be exhausting to make main modifications.
Behavior stacking is usually a good method to hyperlink new, wholesome consuming habits to current components of your routine. When you’re nonetheless struggling to observe a nutritious weight loss program, your healthcare supplier can refer you to a nutritionist or dietitian for additional help.
Newer remedy choices for managing ldl cholesterol
Along with triglycerides, it’s necessary to know your levels of cholesterol via an annual lipid panel check.
Ldl cholesterol is one other type of fats that circulates within the bloodstream. LDL ldl cholesterol (“dangerous” ldl cholesterol) is instantly linked to coronary heart illness, as it will possibly accumulate on the partitions of your blood vessels, blocking the circulate of blood, oxygen, and vitamins to the center and mind, which may result in a coronary heart assault or stroke.
To scale back the quantity of LDL ldl cholesterol, it’s necessary to keep away from meals which can be excessive in saturated or trans fat. Statins are often the primary course of remedy for prime ldl cholesterol and are extremely efficient in lowering levels of cholesterol and danger of coronary heart illness, Mehta mentioned.
Past statins, there are newer medicine that may assist individuals additional scale back their LDL ldl cholesterol. These drugs embrace oral medicine like Zetia (ezetimibe) and Nexletol (bempedoic acid). There are additionally injectable choices, such because the PCSK9 inhibitors like Praluent (alirocumab), Repatha (evolocumab), and a more recent remedy referred to as Leqvio (inclisiran).
“Lipids are a pillar of diabetes care that should be managed with weight loss program, statins, and newer medicine coming in with even better profit that can assist sufferers higher attain their targets,” mentioned Mehta.
Managing diabetes misery, letting go of perfectionism, and self-advocacy are additionally key
Dan Newman has lived with kind 1 diabetes for over 27 years. Throughout that point, he has skilled the ups and downs of diabetes, together with being recognized with continual kidney illness and diabetic retinopathy.
As a young person, Newman struggled with diabetes misery and burnout. At one level, he determined he would solely take insulin, however wouldn’t have interaction in different diabetes administration, reminiscent of checking his blood glucose ranges.
A prognosis of CKD in his mid-20s offered a much-needed wake-up name. Newman had excessive ranges of albuminuria – which means his kidneys had been leaking protein into his urine – and finally obtained a kidney transplant from a member of the family in 2018, narrowly avoiding the necessity for dialysis.
“The transplant has been transformational for me by way of high quality of life. I’m very lucky to have had a member of the family who was a match,” Newman mentioned.
Newman burdened the significance of educating and advocating for your self.
“When you’re an individual with diabetes as we speak, studying to advocate for your self is so necessary. Additionally educate your self on kidney well being, what your blood stress readings are, ldl cholesterol, glucose ranges, and the long run affect of diabetes,” he mentioned.
As an example, Newman mentioned that he was unaware that there was a lot hidden salt within the African and Caribbean meals he grew up consuming.
“I needed to actually change the sort and quantity of seasoning I used to be utilizing, which meant altering my cultural id too. That is one other oblique price of diabetes,” Newman mentioned.
Regardless of dealing with many challenges in his diabetes administration, Newman mentioned he stays constructive by letting go of perfectionism and the purpose of being the “ideally suited” affected person with kind 1 diabetes. It’s necessary to acknowledge that some days will probably be higher than others, and that’s okay.
Newman mentioned he views small steps towards wholesome dwelling as equally necessary as main targets. As an example, he mentioned any time he spends exercising is value it for his bodily and psychological well being.
“Don’t be terrified of what can occur sooner or later with diabetes. It’s higher to know now and have that information,” he mentioned.
