The better diabetes is managed, the lower the risks of heart issues in the future.
Diabetes itself may not kill you but the complications associated with it - particularly heart disease - may.
This is why a nationwide movement was launched last week to encourage people with diabetes to know their risks and speak to their doctors about managing those risks.
Called For Your SweetHeart, this year-long campaign is run by the Singapore Heart Foundation, Diabetes Singapore and pharmaceutical firm Boehringer Ingelheim.
Worldwide, about two out of three diabetics die from some form of heart disease or stroke.
In Singapore, about half of the patients who had a heart attack between 2007 and 2016 have diabetes, according to the Singapore Myocardial Infarction Registry, a registry of all the heart attacks reported here.
And about two in five stroke patients here also have diabetes, pointed out Assistant Professor Chin Chee Tang, a senior consultant at the cardiology department of the National Heart Centre Singapore.
The strongest association between diabetes and heart disease is in the most common form of cardiac affliction - ischaemic heart disease or coronary artery disease, he said.
"Patients with diabetes have a tendency to develop coronary atherosclerosis (thickening of the wall of the blood vessels that supply blood to the heart muscles) at an earlier age," said Prof Chin.
"This places them at a higher risk of heart attacks compared to non-diabetics of the same age."
Heart attacks in turn may lead to heart failure, or even death, he added.
So the better the diabetes is managed, the lower the risks of heart issues in the future, he said.
Diabetes, apart from high blood pressure and high cholesterol, is a major factor that increases the risk of heart disease and stroke, said Dr Alvin Ng Chee Keong, a cardiologist at Mount Elizabeth Novena Hospital. "When you have diabetes and heart disease, you have to take more pills, and you will have more potential side effects...And also, mentally, you have more stress about your condition."
Yet "there is widespread lack of awareness of the link between diabetes and heart disease," said Dr Low Lip Ping, emeritus chairman of the Singapore Heart Foundation.
As the diagnosis of diabetes and its treatment are based on the level of blood sugar in the body, it is not surprising to find patients and the public associating the health risks of diabetes with only blood sugar, he said.
"Doctors in concentrating on the treatment of high blood sugar levels may also not emphasise the high cardiovascular risks of diabetes."
Dr Low said a recent multi-country survey on cardiovascular risk awareness and knowledge among people living with Type 2 diabetes showed that one third of respondents with Type 2 diabetes consider their cardiovascular disease risk to be low.
The survey, conducted by the International Diabetes Federation in partnership with a pharmaceutical company Novo Nordisk, also showed that about a quarter of the respondents had either never learnt about cardiovascular disease or received information on this disease several years following their Type 2 diabetes diagnosis.
"Cardiovascular disease is in fact the leading cause of disability and death of people with Type 2 diabetes," said Dr Low.
"These cardiovascular complications include coronary heart disease, stroke, ischaemia and gangrene of the lower limbs. Adults with diabetes are two to four times more likely to die from cardiovascular disease than adults without diabetes."
Apart from the harmful effects of high levels of blood sugar, people with diabetes are more likely to have other risk factors for developing cardiovascular disease, he said.
These include high blood pressure, high levels of bad cholestrol and triglycerides as well as obesity.
Dr Low said that the blood vessels in patients with diabetes are more susceptible to these risk factors.
The blood vessels of diabetics also seem to have an increased level of low-grade inflammation, which may predispose them to vascular disease.
These complications may be silent until they reach an advanced stage at which time serious disability may already be present, he said.
"All diabetics should be assessed at the time of diagnosis for the presence of these risk factors as well as for cardiovascular disease which may already be present," said Dr Low.
"Early treatment can reduce the risk of more advanced cardiovascular complications and death."
The good news is that over the last few years, medications from two new classse of drugs - GLP-1 receptor agonists and SGLT2 inhibitors - have been shown in international randomised trials to reduced the risk of death, heart attacks and strokes for diabetics with ischaemic heart disease, said Prof Chin.
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