Whenever we hear about diabetes, we usually think of sugar and sweets. But, did you know that diabetes is more than just that? More than just sugar, an unhealthy level of cholesterol is also a factor that makes diabetics prone to cardiovascular diseases (CVDs).
In fact, CVDs such as heart attacks and strokes account for 50 percent of deaths among persons with diabetes. While limiting one’s sugar intake is important, a diabetic should manage cholesterol levels, too.
What can we do health-wise to be there for the sweeter things in life so that we can still enjoy the moments that matter most?
To further shed insight on why tackling diabetes is important, Dr. Jermaine Lim, country medical lead of Viatris Philippines, defined cholesterol as a waxy, fat-like substance found in all cells of the body. It is needed to make hormones, vitamin D, and substances to help digest food. Most cholesterol is made in the liver and the rest is obtained from food.
Cholesterol travels through the bloodstream in small packages called lipoproteins. “We have the high-density lipoprotein (HDL) or the good cholesterol which helps remove cholesterol from the arteries and back to the liver, and the low-density lipoprotein (LDL) or the bad cholesterol and high levels lead to build-up in arteries,” Lim explained.
Globally, based on the data from the International Diabetes Federation (IDF), diabetes prevalence is rising at alarming rates. “There is a 46 percent increase from 2021 (537 million adults) to 2045 (783 million adults),” she stressed.
The Philippines is among the top countries for diabetes prevalence in the region. Based on the local prevalence data from the Food and Nutrition Research Institute, “we can see the similar trend; it is also rising fast,” she also said. This increase in prevalence rate can be seen across all age groups and sex.
According to Lim, diabetes is the fourth leading cause of death in the Philippines as of 2020 based on the data from Philippine Statistics Authority. Lim underscored that ischemic heart diseases and cerebrovascular diseases are the first and third leading causes of death in the country.
This is why, Viatris recently launched the “be there” campaign, which aims to remind Filipinos that diabetes is not just about sugar. By limiting its intake, diabetics can reduce the risk of untimely death and really be there with their family and loved ones to celebrate and enjoy life’s important milestones.
Definitely, there is no better time to take care of our health than now, especially for many among us who may have family members suffering from diabetes. It truly is a frightening thought losing your mom, dad, wife, or husband to a disease that can be treated and managed.
Fortunately, for patients with diabetes, there are steps that can be taken to manage their cholesterol levels. To better understand the topic at hand, Dr. Bien Matawaran, past president of Philippine Society of Endocrinology, Diabetes and Metabolism, discussed cholesterol management in diabetes — why it is essential and what should be done.
The current chief of the Section of Endocrinology, Diabetes and Metabolism at the University of Santo Tomas Hospital said that diabetes may shorten life expectancy; the most common deaths in diabetes are of vascular origin across different ages and sex; vascular disease occur more in persons with diabetes than in those without diabetes; diabetes more than doubles one’s risk for cardiovascular death.
The IDF Diabetes Atlas in 2019 mentioned that collectively, cardiovascular diseases account for between one-third and one-half of all deaths among persons with diabetes. Matawaran also said that the multiple risk factors in diabetes increase risk for heart disease — glucose intolerance (1.8 times), high cholesterol (2.3 times), high blood pressure (1.5 times).
“If you are diabetic with high cholesterol and high blood pressure, your risk for having a heart disease is as much as 6.2 times,” he stressed, which goes to show the deadly combination of the three risk factors. The main reason for this, Matawaran said, is because of atherosclerosis, the condition where there is a build-up of plaque — composed of fat, cholesterol, calcium, and other substances in the blood — inside the arteries, causing them to narrow. This leads to a decrease in blood supply in organs.
Multifactorial (pharmacologic and non-pharmacologic) interventions yield greater cardiovascular disease risk reduction: aspirin (-10 percent), statin (-21 percent), blood pressure (-11 percent), nutrition (-29 percent), lifestyle treatment (-5 percent), and lifestyle and medical treatment (-53 percent).
Besides the healthy food plate for Filipino adults, there are lifestyle therapy for patients with diabetes mellitus such as nutrition (maintain optimal weight, calorie restriction, plant-based diet), physical activity (150 minute per week moderate exertion), sleep (about six to eight hours per night), behavioral support (community engagement, alcohol moderation), and smoking cessation (no tobacco products).
Matawaran also mentioned the comprehensive anti-atherosclerotic therapy in diabetes where they give anti-cholesterol drugs for high cholesterol, anti-diabetic drugs for high blood sugar, antihypertensive drugs for high blood pressure, and antiplatelet drugs for platelet activations.
Diabetics are never at low risk for cardiovascular disease, according to Matawaran. Those at very high risk and high risk must lower their LDL by more than 50 percent of baseline.
Patients with diabetes must consult their doctor so they may be prescribed with an anti-cholesterol medication (statins, fibrates, fish oil) that can provide the desired LDL-C reduction, he said.
Medical adherence is important. According to the World Health Organization, improving adherence to medical therapy for conditions of hypertension, hyperlipidemia, and diabetics would yield very substantial health and economic benefits.
The longer LDL-C treatment is maintained, the greater is the reduction in cardiovascular risk, Matawaran pointed out.
