Having diabetes for a decade or more dramatically increases the risk for ischemic stroke 3% each year and triples at 10 years....
Senior investigator Mitchell Elkind, MD, from Columbia University Medical Center in New York, stated that, "We were not surprised to see an increased risk, but we were taken aback by how high the risk was."
Using data from the Northern Manhattan Study, investigators looked at 3298 multi-ethnic participants. They found that 22% had diabetes at baseline and another 10% went on to develop the disease over the course of the study. There were 244 ischemic strokes.
The authors explained, "Our study provides evidence that the risk of ischemic stroke increased continuously with duration of diabetes mellitus." "This was after controlling for other factors such as age, smoking history, physical activity, history of heart disease, blood pressure, and cholesterol."
"The increase is not as much during the second half of the first decade," they noted, "but it increases steeply as the disease enters its second decade."
Duration of Diabetes and Ischemic Stroke Risk
Diabetes (Years) Hazard Ratio 95% Confidence Interval
0 to 5 1.7 1.1 - 2.7
5 to 10 1.8 1.1 - 3.0
>10 3.2 2.4 - 4.5
Among the nearly 26 million Americans with diabetes, more than half are younger than age 65 years, according to the American Diabetes Association. Dr. Elkind said, "We used to think of type 2 diabetes as a disease people get when they are older, after a lifetime of poor dietary habits, but the age at diagnosis is getting younger and younger because of the obesity problem among young people."
The researchers pointed out that diabetes was determined by self-report in this study. "It's possible we missed some cases," Dr. Elkind added during an interview. An estimated one third of diabetes cases may be undiagnosed. It has also been found that true onset of diabetes may be 4 to 7 years earlier than clinical diagnosis.
As the population ages and the elderly live longer, more and more people will live with longer duration of disease, the authors note. "It is important to better understand the dynamics between diabetes, time, and stroke, and to emphasize the importance of interventions to prevent early diabetes. Minimizing the number of years a patient has diabetes would help combat the increase in stroke risk with each year of the disease."
Some of the reasons for increased stroke risk may include an association between longer diabetes duration and thicker plaque in neck arteries and the higher prevalence of hypertension, accelerated vascular complications, and clotting abnormalities.
Showing posts with label heart attack and stroke. Show all posts
Showing posts with label heart attack and stroke. Show all posts
Saturday, June 30, 2012
Thursday, October 20, 2011
6 Emergency Complications of Type 2 Diabetes
Uncontrolled diabetes can control your health. Help prevent these serious diabetes complications by learning the warning signs.
People with type 2 diabetes are at increased risk of many serious health problems, including heart attack, stroke, vision loss, and amputation. But by keeping your diabetes in check — that means maintaining good blood sugar control — and knowing how to recognize a problem and what to do about it should one occur, you can prevent many of these serious complications of diabetes.
Heart Attack
Heart disease and stroke are the top causes of death and disability in people with diabetes. If you experience any of the following heart attack warning signs, call 911 immediately:
-Chest discomfort that feels like pressure, squeezing, fullness, or pain in the center of your chest, lasting for a short time or going away and returning
-Pain elsewhere, including the back, jaw, stomach, or neck; or pain in one or both arms
•Shortness of breath
•Nausea or lightheadedness
Heart attack symptoms may appear suddenly or be subtle, with only mild pain and discomfort.
Stroke
Stroke warning signs may include:
Sudden numbness or weakness in the face, arm, or leg, especially if it occurs on one side of the body
-Feeling confused
-Difficulty walking and talking and lacking coordination
-Developing a severe headache for no apparent reason
If you suddenly experience any of these stroke symptoms, call 911 immediately. As with a heart attack, immediate treatment can be the difference between life and death.
Nerve Damage
People with diabetes are at increased risk of nerve damage, or diabetic neuropathy, due to uncontrolled high blood sugar. As a result, various foot and skin problems can occur, including:
•Foot problems. Nerve damage associated with type 2 diabetes can cause a loss of feeling in your feet, which makes you more vulnerable to injury and infection. You may get a blister or cut on your foot that you don't feel and, unless you check your feet regularly, an infection can develop. Untreated infections can result in gangrene (death of tissue) and ultimately amputation of the affected limb.
•Skin problems. Diabetes can make it more difficult for your body to fight infections, causing skin problems. Various skin conditions are linked to diabetes, and even the most minor cuts or sores can turn serious fast. Any bumps, cuts, or scrapes should be cleaned and treated with an antibiotic cream and monitored carefully.
If you notice any of the following symptoms, see your doctor:
•Inflammation and tenderness anywhere on your body
•Red, itchy rash surrounded by small blisters or scales
•Cuts, sores, or blisters on your feet that are slow to heal and are not as painful as you would expect
•Numbness, tingling, or burning sensations in your hands or feet, including your fingers and toes
•Sharp pain that gets worse at night
•Muscle weakness that makes walking difficult
•Bladder infections and problems with bladder control
•Bloating, stomach pain, constipation, nausea, vomiting, or diarrhea
•Erectile dysfunction in men and vaginal dryness in women
Kidney Disease
Type 2 diabetes increases your risk of kidney disease, or diabetic nephropathy, a condition in which the blood vessels in your kidneys are damaged to the point that they cannot filter out waste properly. If left untreated, dialysis (a treatment to filter out waste products from the blood) and ultimately a kidney transplant may be needed.
Typically, you won’t notice symptoms of kidney disease until it has advanced. However, if you experience any of the following symptoms, tell your doctor:
•Swelling in your ankles and legs
•Leg cramps
•A need to go to the bathroom more often at night
•A reduction in your need for insulin
•Nausea and vomiting
•Weakness and paleness
•Itching
The best way to prevent type 2 diabetes-related kidney problems is to have your urine, blood, and blood pressure monitored regularly and to keep your blood sugar and blood pressure under control.
Eye Problems
People with type 2 diabetes are at risk of several eye conditions, including diabetic retinopathy (which affects the blood vessels in the eye), glaucoma, and cataracts. If left untreated, these conditions can cause vision loss.
Call your doctor if you notice any of these warning signs:
•Blurry vision that lasts for more than two days
•Sudden loss of vision in one or both eyes
•Floaters, black or gray spots, cobwebs, or strings that move when you move your eyes
•A sensation of seeing "flashing lights"
•Pain or pressure in one or both eyes
Hyperglycemia
Hyperglycemia means you have too much sugar in your blood. High blood sugar doesn't always produce symptoms; therefore, it is important to check your blood sugar regularly, as indicated by your doctor. When symptoms of hyperglycemia occur, they may include:
•Frequent urination
•Extreme thirst
•Feeling tired and weak
•Blurry vision Feeling hungry even after eating
If you frequently have high blood sugar, tell your doctor. He or she may need to make changes to your medication and suggest diet and lifestyle modifications to help you gain and maintain better blood sugar control.
The key to preventing many of the complications of diabetes is to keep your blood sugar at a healthy level. To do this, eat right, exercise, monitor your blood sugar as recommended by your doctor, and don't smoke.
Report any unusual signs or symptoms to your doctor. Together you can work to prevent these diabetes-related health complications.
By Hedy Marks, MPH
Medically reviewed by Pat F. Bass III, MD, MPH
People with type 2 diabetes are at increased risk of many serious health problems, including heart attack, stroke, vision loss, and amputation. But by keeping your diabetes in check — that means maintaining good blood sugar control — and knowing how to recognize a problem and what to do about it should one occur, you can prevent many of these serious complications of diabetes.
Heart Attack
Heart disease and stroke are the top causes of death and disability in people with diabetes. If you experience any of the following heart attack warning signs, call 911 immediately:
-Chest discomfort that feels like pressure, squeezing, fullness, or pain in the center of your chest, lasting for a short time or going away and returning
-Pain elsewhere, including the back, jaw, stomach, or neck; or pain in one or both arms
•Shortness of breath
•Nausea or lightheadedness
Heart attack symptoms may appear suddenly or be subtle, with only mild pain and discomfort.
Stroke
Stroke warning signs may include:
Sudden numbness or weakness in the face, arm, or leg, especially if it occurs on one side of the body
-Feeling confused
-Difficulty walking and talking and lacking coordination
-Developing a severe headache for no apparent reason
If you suddenly experience any of these stroke symptoms, call 911 immediately. As with a heart attack, immediate treatment can be the difference between life and death.
Nerve Damage
People with diabetes are at increased risk of nerve damage, or diabetic neuropathy, due to uncontrolled high blood sugar. As a result, various foot and skin problems can occur, including:
•Foot problems. Nerve damage associated with type 2 diabetes can cause a loss of feeling in your feet, which makes you more vulnerable to injury and infection. You may get a blister or cut on your foot that you don't feel and, unless you check your feet regularly, an infection can develop. Untreated infections can result in gangrene (death of tissue) and ultimately amputation of the affected limb.
•Skin problems. Diabetes can make it more difficult for your body to fight infections, causing skin problems. Various skin conditions are linked to diabetes, and even the most minor cuts or sores can turn serious fast. Any bumps, cuts, or scrapes should be cleaned and treated with an antibiotic cream and monitored carefully.
If you notice any of the following symptoms, see your doctor:
•Inflammation and tenderness anywhere on your body
•Red, itchy rash surrounded by small blisters or scales
•Cuts, sores, or blisters on your feet that are slow to heal and are not as painful as you would expect
•Numbness, tingling, or burning sensations in your hands or feet, including your fingers and toes
•Sharp pain that gets worse at night
•Muscle weakness that makes walking difficult
•Bladder infections and problems with bladder control
•Bloating, stomach pain, constipation, nausea, vomiting, or diarrhea
•Erectile dysfunction in men and vaginal dryness in women
Kidney Disease
Type 2 diabetes increases your risk of kidney disease, or diabetic nephropathy, a condition in which the blood vessels in your kidneys are damaged to the point that they cannot filter out waste properly. If left untreated, dialysis (a treatment to filter out waste products from the blood) and ultimately a kidney transplant may be needed.
Typically, you won’t notice symptoms of kidney disease until it has advanced. However, if you experience any of the following symptoms, tell your doctor:
•Swelling in your ankles and legs
•Leg cramps
•A need to go to the bathroom more often at night
•A reduction in your need for insulin
•Nausea and vomiting
•Weakness and paleness
•Itching
The best way to prevent type 2 diabetes-related kidney problems is to have your urine, blood, and blood pressure monitored regularly and to keep your blood sugar and blood pressure under control.
Eye Problems
People with type 2 diabetes are at risk of several eye conditions, including diabetic retinopathy (which affects the blood vessels in the eye), glaucoma, and cataracts. If left untreated, these conditions can cause vision loss.
Call your doctor if you notice any of these warning signs:
•Blurry vision that lasts for more than two days
•Sudden loss of vision in one or both eyes
•Floaters, black or gray spots, cobwebs, or strings that move when you move your eyes
•A sensation of seeing "flashing lights"
•Pain or pressure in one or both eyes
Hyperglycemia
Hyperglycemia means you have too much sugar in your blood. High blood sugar doesn't always produce symptoms; therefore, it is important to check your blood sugar regularly, as indicated by your doctor. When symptoms of hyperglycemia occur, they may include:
•Frequent urination
•Extreme thirst
•Feeling tired and weak
•Blurry vision Feeling hungry even after eating
If you frequently have high blood sugar, tell your doctor. He or she may need to make changes to your medication and suggest diet and lifestyle modifications to help you gain and maintain better blood sugar control.
The key to preventing many of the complications of diabetes is to keep your blood sugar at a healthy level. To do this, eat right, exercise, monitor your blood sugar as recommended by your doctor, and don't smoke.
Report any unusual signs or symptoms to your doctor. Together you can work to prevent these diabetes-related health complications.
By Hedy Marks, MPH
Medically reviewed by Pat F. Bass III, MD, MPH
Wednesday, October 12, 2011
Diabetes Doubles Alzheimer's Risk
People with diabetes are at increased risk of having a heart attack or stroke at an early age. But that’s not the only worry: Diabetes appears to dramatically increase a person’s risk of developing Alzheimer’s disease or other types of dementia later in life, according to a new study conducted in Japan.
In the study, which included more than 1,000 men and women over age 60, researchers found that people with diabetes were twice as likely as the other study participants to develop Alzheimer’s disease within 15 years. They were also 1.75 times more likely to develop dementia of any kind.
“It’s really important for the public health to understand that diabetes is a significant risk factor for all of these types of dementia,”says Rachel Whitmer, PhD, an epidemiologist in the research division of Kaiser Permanente Northern California, a nonprofit health-care organization based in Oakland, Calif.
Whitmer, who studies risk factors for Alzheimer’s but wasn’t involved in the new research, stresses that many questions remain about the link between diabetes and dementia. The new study was “well done” and provides“really good evidence that people with diabetes are at greater risk,” she says,“but we really need to look at other studies to find out why.”
What Factors Increase the Risk?
Diabetes could contribute to dementia in several ways, which researchers are still sorting out. Insulin resistance, which causes high blood sugar and in some cases leads to type 2 diabetes, may interfere with the body’s ability to break down a protein (amyloid) that forms brain plaques that have been linked to Alzheimer’s. High blood sugar (glucose) also produces certain oxygen-containing molecules that can damage cells, in a process known as oxidative stress.
In addition, high blood sugar—along with high cholesterol—plays a role in the hardening and narrowing of arteries in the brain. This condition, known as atherosclerosis, can bring about vascular dementia, which occurs when artery blockages (including strokes) kill brain tissue.
“Having high glucose is a stressor to the nervous system and to the blood vessels,” says David Geldmacher, MD, a professor of neurology at the University of Alabama at Birmingham. “The emerging information on Alzheimer’s disease and glucose shows us that we do need to remain vigilant on blood sugar levels as we get older.”
New and Improved Research
Studies dating back to the late 1990s have suggested that people with diabetes are more likely to develop Alzheimer’s disease and other types of dementia, but the research has been marred by inconsistent definitions of both diabetes and dementia.
The authors of the new study, led by Yutaka Kiyohara, MD, an environmental medicine researcher at Kyushu University, in Fukuoka, sought to address this weakness by using the gold standard of diabetes diagnosis, an oral glucose tolerance test. This involves giving a person a sugar-loaded drink after they have fasted for at least 12 hours, and then measuring how much glucose remains in their blood two hours later.
At the beginning of the study, the tests showed that 15% of the participants had full-fledged diabetes, while 23% had prediabetes, also known as impaired glucose tolerance.
During the next 15 years, 23% of the participants received a dementia diagnosis. Slightly less than half of those cases were deemed to be Alzheimer’s disease, with the remainder roughly split between vascular dementia and dementia due to other causes. (The diagnoses were confirmed with brain scans of living patients and brain autopsies in deceased patients.)
The link between diabetes and dementia risk persisted even after the researchers took into account several factors associated with both diabetes and dementia risk, such as age, sex, blood pressure, and body mass index.
The next step in the research, Whitmer says, will be to understand whether controlling blood sugar and reducing risk factors for type 2 diabetes also reduces dementia risk. She and her colleagues have several studies underway investigating these questions.
In the study, which included more than 1,000 men and women over age 60, researchers found that people with diabetes were twice as likely as the other study participants to develop Alzheimer’s disease within 15 years. They were also 1.75 times more likely to develop dementia of any kind.
“It’s really important for the public health to understand that diabetes is a significant risk factor for all of these types of dementia,”says Rachel Whitmer, PhD, an epidemiologist in the research division of Kaiser Permanente Northern California, a nonprofit health-care organization based in Oakland, Calif.
Whitmer, who studies risk factors for Alzheimer’s but wasn’t involved in the new research, stresses that many questions remain about the link between diabetes and dementia. The new study was “well done” and provides“really good evidence that people with diabetes are at greater risk,” she says,“but we really need to look at other studies to find out why.”
What Factors Increase the Risk?
Diabetes could contribute to dementia in several ways, which researchers are still sorting out. Insulin resistance, which causes high blood sugar and in some cases leads to type 2 diabetes, may interfere with the body’s ability to break down a protein (amyloid) that forms brain plaques that have been linked to Alzheimer’s. High blood sugar (glucose) also produces certain oxygen-containing molecules that can damage cells, in a process known as oxidative stress.
In addition, high blood sugar—along with high cholesterol—plays a role in the hardening and narrowing of arteries in the brain. This condition, known as atherosclerosis, can bring about vascular dementia, which occurs when artery blockages (including strokes) kill brain tissue.
“Having high glucose is a stressor to the nervous system and to the blood vessels,” says David Geldmacher, MD, a professor of neurology at the University of Alabama at Birmingham. “The emerging information on Alzheimer’s disease and glucose shows us that we do need to remain vigilant on blood sugar levels as we get older.”
New and Improved Research
Studies dating back to the late 1990s have suggested that people with diabetes are more likely to develop Alzheimer’s disease and other types of dementia, but the research has been marred by inconsistent definitions of both diabetes and dementia.
The authors of the new study, led by Yutaka Kiyohara, MD, an environmental medicine researcher at Kyushu University, in Fukuoka, sought to address this weakness by using the gold standard of diabetes diagnosis, an oral glucose tolerance test. This involves giving a person a sugar-loaded drink after they have fasted for at least 12 hours, and then measuring how much glucose remains in their blood two hours later.
At the beginning of the study, the tests showed that 15% of the participants had full-fledged diabetes, while 23% had prediabetes, also known as impaired glucose tolerance.
During the next 15 years, 23% of the participants received a dementia diagnosis. Slightly less than half of those cases were deemed to be Alzheimer’s disease, with the remainder roughly split between vascular dementia and dementia due to other causes. (The diagnoses were confirmed with brain scans of living patients and brain autopsies in deceased patients.)
The link between diabetes and dementia risk persisted even after the researchers took into account several factors associated with both diabetes and dementia risk, such as age, sex, blood pressure, and body mass index.
The next step in the research, Whitmer says, will be to understand whether controlling blood sugar and reducing risk factors for type 2 diabetes also reduces dementia risk. She and her colleagues have several studies underway investigating these questions.
Subscribe to:
Posts (Atom)
