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Blood glucose regulation important for prevention of CVD
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Effective prevention of CVD requires integrating approaches and interventions also used for diabetes management, with the regulation of blood glucose a key component of both, according to a study published in the Journal of the American College of Cardiology.
“Hyperglycemia is a key modifiable risk factor for the development of CVD, with prediabetes being a major risk factor for the progression to type 2 diabetes mellitus, which, in turn, increases CVD risk,” Peter. E.H. Schwarz, MD, MBA, of the department for prevention and care of diabetes at the Technical University Dresden in Germany, and colleagues wrote. “As a part of a multifactorial risk factor intervention, effective reduction of hyperglycemia has a positive effect on CVD risk.”
To synthesize recent evidence related to how blood glucose regulation can influence CV health and disease prevention, researchers analyzed 44 systematic reviews of randomized controlled trials and meta-analyses published from 2016 to 2017. Results were categorized into one of four types of interventions: pathophysiological, individual-level for behavior change, population-level for behavior change and health promotion care pathways. From these findings, researchers then compiled a set of practical recommendations for health care professionals involved with CVD prevention.
Pathophysiological mechanisms
The evidence related to pathophysiological mechanisms of blood glucose regulation on CVD risk suggests that pharmacological interventions that improve glycemic control in people with type 2 diabetes can also improve CV outcomes, with BP regulation providing a mediating effect, according to the researchers. Insulin does not reduce risk for CV events, but meta-analyses found that glucagon-like peptide-1 agonists and sodium-glucose cotransporter 2 inhibitors are associated with reduced risk for all-cause and CV mortality, and both lower BP.
The researchers recommended that health care professionals consider baseline BP before initiating intensive BP lowering with intensive glucose lowering.
The studies reviewed related to individual-level interventions that support behavior change demonstrate a need for interventions that promote changes in both diet and physical activity for weight loss and blood glucose reduction. Interventions should encourage the use of “self-regulation” techniques, including individualized goal-setting, self-monitoring and review of behavioral-goals, according to the researchers. In addition, digital interventions such as mobile phone apps are effective for increasing physical activity, reducing weight and reducing HbA1c, they wrote. Due to evidence that suggests in-person support aids in weight loss, researchers recommend that health care providers consider a “blended” intervention where patients collect and share data on target behaviors/health outcomes.
Workplace programs help
The population-level intervention studies demonstrated that changes to the workplace focusing on increased physical activity and diet alterations can reduce blood glucose (–0.18 mmol/L; 95% CI, –0.29 to –0.07), HbA1c (–0.18%; 95% CI, –0.29 to –0.06) and fasting plasma glucose (–2.6 mg/dL; 95% CI, –5.27 to 0.08). The workplace setting is especially good for population-interventions because it incorporates social support in a stable environment, according to the researchers. Intervention types included individual or group-based education, medical testing, online programs, educational materials and active workstations.
Health care should integrate existing CVD prevention and diabetes prevention or management programs, according to the researchers, and multidisciplinary teams (including community pharmacists and nurses) were effective at reducing the burden of CVD and type 2 diabetes with improvements in HbA1c, BP, glycemic and lipid control and all-cause mortality. The effectiveness of these interventions relies on how patient-centered and attuned the health care providers are to the individuals’ health beliefs and goals.
“CV prevention services should consider the regulation of blood glucose as a key target for intervention and adopt recommendations for effective intervention and service delivery described in this review as well as in existing evidence-based practice guidelines,” the researchers wrote. “Addressing the individual needs of patients is key for CV prevention programs and should take into account pathophysiological mechanisms and aspects influencing individual behavior change, both on the individual as well as the environmental level. Multidisciplinary teams (including pharmacists, nurses or community health workers) should be formed to deliver multicomponent interventions in community-based settings.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.
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