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Managing Cardiovascular Disease In Patients With Diabetes

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Cardiovascular disease CVD is a leading cause of death among adults with type 2 diabetes mellitus T2D. We recently reported that glycemic control in patients with T2D can be significantly improved through a continuous care intervention CCI including nutritional ketosis. The purpose of this study was to examine CVD risk factors in this cohort. Circulating biomarkers of cholesterol metabolism and inflammation, blood pressure BPcarotid intima media thickness cIMTmulti-factorial risk scores and medication use were examined. Antihypertensive medication use was discontinued in Despite advances in the prevention and treatment of cardiovascular disease CVDit remains the leading cause of death in adults across the world [ 1 ].

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Intensive lifestyle interventions with dietary carbohydrate restriction [ 567 Cardiovascular Diseases Among Diabetic Patients, 8 ], including the recently described continuous remote care model, which helps patients with T2D sustain nutritional ketosis [ 910 ], have demonstrated improved glycemic control concurrent with medication reduction. However, the long-term sustainability and impact of these interventions on CVD risk and lipid profiles remains a subject of debate [ 1112 ]. Atherogenic dyslipidemia, a known risk factor for CVD [ 13 ], is highly prevalent in patients with T2D [ 14 ] and tightly linked to high-carbohydrate diets [ 15 ].

The condition is characterized by increased triglycerides, decreased high-density lipoprotein cholesterol concentration HDL-C and increased small low-density lipoprotein particle number small LDL-P. Evidence suggests that increased very low-density lipoprotein particle number VLDL-Pand in particular large VLDL-P, may be one of the key underlying abnormalities in atherogenic dyslipidemia [ 14161718 ]. Previous studies of carbohydrate restriction of up to 1-year found a consistent decrease in triglycerides and increase in HDL-C, while LDL-C slightly increased or decreased [ 15262728 ]. Inflammation, as assessed by elevated high-sensitivity C-reactive protein hsCRP or white blood cell count WBC [ visit web page303132 ], is an independent CVD risk factor and is Cardiovascular Diseases Among Diabetic Patients in all stages of atherogenesis [ 33 ].

Inflammation is often observed in T2D concurrent with atherogenic dyslipidemia [ 34 ] and represents an additional CVD risk even in individuals with low to normal LDL-C [ 3536 ]. Hypertension is an additive risk factor in this patient population. Tighter blood pressure control has been associated with reduction in the risk of deaths related to diabetes. This included decreased CVD, stroke and microvascular complications [ 37 ]. For this open label, non-randomized, controlled, before-and-after study, we investigated the effects of a continuous care intervention CCI on CVD risk factors. The CCI included individualized digital support with telemedicine, health coaching, education in nutritional ketosis, biometric Cardiovascular Diseases Among Diabetic Patients, and an online peer-support community.

Given the multi-faceted pathophysiology of CVD, we assessed the 1-year responses in several biomarkers related to cholesterol and lipoprotein metabolism, blood pressure, and inflammation, as well as carotid intima media thickness cIMT and medication use. Some results were previously Duabetic in relation to glycemic control Tragical History Of Faustus 10 ] and are presented here as they pertain to source effectiveness of the intervention and CVD risk i. Diseaees previously described [ 910 ], we utilized a prospective, longitudinal study design with a cohort of patients with T2D from the greater Lafayette, Indiana, USA, region who self-selected to participate in the CCI Clinicaltrials.

Participants in the CCI were provided Cardiovascular Diseases Among Diabetic Patients to a web-based software application app for biomarker reporting and monitoring including body weight, blood glucose and blood betahydroxybutyrate BHB; a marker of ketosis.

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The remote care team consisted of a health coach and physician or nurse practitioner who provided nutritional advice and medication management, respectively. Participants were guided by individualized nutrition recommendations to achieve and sustain nutritional ketosis. Notably, if participants reported headaches, constipation or lightheadedness, the remote care team recommended individualized adjustments to sodium and fluid intake [ 10 ].

There were no instructions given Cardiovascular Diseases Among Diabetic Patients the CCI group on counting or restricting calories. The CCI participants were instructed to restrict carbohydrate, eat protein in moderation, and consume fat to satiety from the start of the study. Due to the well-known link errors associated with dietary records in an obese population [ 38 ], we chose not to collect diet records. Social support was provided via an online peer community.

Inclusion and exclusion criteria were previously described [ 10 ]. This study was approved by the Franciscan Health Lafayette Institutional Review Board, and participants provided written informed consent. The frequency of glucose and BHB monitoring, along with glycemic control medication management, were previously described in detail [ 910 ]. Briefly, glucose and BHB levels were initially obtained daily using a blood glucose and ketone Cardiovaecular Precision Xtra, Abbott; Alameda, CA, USA to personalize nutrition recommendations and also provide a marker of adherence. The frequency of measurement was modified by the care team Cardiovascular Diseases Among Diabetic Patients each participant based on individual care needs and preferences. For participants with a history of hypertension, a home automatic sphygmomanometer was supplied.]