Fine&Clear
Confronting chronic disease in the
community
Confronting chronic disease in the
community
Public Health Program The purpose of this Public Health Program
is
to describe the association between poor glycemic control, oxidative
stress, insulin resistance and of low-grade inflammation that have been
suggested as alleged factors linking diabetes and cardiovascular disease. Dr. Rimsha Ismail
Cardiovascular diseases are the most prevalent cause of illness and
mortality among patients with Type 1 or Type 2 diabetes. The proposed
mechanisms that can link enhanced atherosclerosis and increased cardiovascular
risk in our society are poorly understood. It has been suggested that an
association between hypo/hyper glycemia and intracellular metabolic changes can
result in oxidative stress(a disturbance in the balance between the production
of reactive oxygen species (free radicals) and antioxidant defenses, is
discussed in relation to its possible role in the production of tissue damage
in diabetes mellitus), low-grade inflammation, and endothelial dysfunction (in
which the endothelial layer of the small arteries fails to perform all of its
important functions normally. As a result, several bad things can happen to the
tissues supplied by those arteries).The impact of clinical factors that may
coexist with diabetes such as obesity, dyslipidemia, and hypertension are also
discussed.
INTRODUCTION:
Diabetes is an important chronic disease which incidence is globally
increasing and though considered as an epidemic. Individuals with diabetes and
with chronically poor metabolic control can experience micro-vascular and macro-vascular
complications.
Cardiovascular
diseases (CVD) are the most prevalent cause of mortality and morbidity among
people with T2D and T1D. Adult people with diabetes present rates of
mortality due to heart disease and stroke from two to four times higher than
those without diabetes.
Figure:
Pathogenesis of cardiovascular disease
in diabetes. The mechanisms involved in the pathogenesis of cardiovascular
disease in diabetes comprehend epigenetic changes and intracellular metabolic
changes that result in oxidative stress, low-grade inflammation, and
endothelial dysfunction. CRP: C-reactive protein; FFA: free fatty acids; INOS:
inducible nitric oxide synthase; IL-1: interleukin 1; IL-6: interleukin 6;
MCP-1: monocyte chemo attractant molecule 1; MMP: matrix metalloproteinase;
NF-κB: nuclear factor kappa-β; PAI-1: plasminogen activator inhibitor-1;
VCAM-1; vascular cell adhesion molecule-1; VEFG: vascular endothelial growth
factor; TNF-α: Tumor necrosis factor-α; INF-γ: Interferon-γ.
Obesity:
Obesity,
which prevalence is also increasing worldwide is becoming a major public health
issue due to its association with chronic diseases such as diabetes mellitus,
hypertension, dyslipidemia, sleep apnea, osteoarticular disease, and cardio and
cerebrovascular diseases. Obesity,
especially with visceral fat deposition, is associated with low-grade
inflammation, which plays a role in the pathogenesis of diabetes, and both
diseases are associated with significant increase in morbidity and mortality
due to cardio vascular disease.
Dyslipidemia:
Dyslipidemia
in T2D worsens cardiovascular risk due to the peculiar atherogenic profile
composed by increased very low-density lipoprotein (VLDL) cholesterol,
triglycerides and small and dense LDL cholesterol levels and decreased
high-density lipoprotein (HDL) cholesterol levels.
Hypertension:
Hypertension
is a highly prevalent disease worldwide and very common among patients with
diabetes. Approximately from 10 to 30% of T1D and 60% of T2D (According to
sources) patients have hypertension.
The
coexistence of these two conditions increase the risk of developing macro-vascular
complications (myocardial infarction, stroke) and also micro-vascular
complications.
Oxidative Stress:
Increased
intracellular glucose concentrations result in the activation of alternative
pathways of metabolism such as the hexosamine and the aldose reductase pathways,
both involved in the pathophysiology of chronic complications of diabetes.
Conclusions:
The
incidence of diabetes is sharply increasing worldwide which represents an
important burden for patients and for the society as well due to micro- and
macro vascular complications that people with this condition may experience and
consequently cardiovascular diseases that are the most prevalent causes of
morbidity and mortality among patients with diabetes.
The
classical risk factors for the development of cardio vascular disease in
subjects with diabetes are the presence of poor glycemic control, obesity,
dyslipidemia, and hypertension. In recent decades, several clinical trials have
investigated the effect of intensive treatment of hyperglycemia on cardiovascular
risk reduction, in both T1D and T2D.
Assessment of behavioral changes
and lifestyle modification:
The
population knowledge, perception and awareness of the impact of cardiovascular
risk factors on their global health, are essential components of behavioral
changes and lifestyle modification. The
lack of knowledge, misconceptions, and the poor level of risk factor control
are attributed to ineffective prevention programs. In
most of countries, diverse prevention programs and health promotion campaigns,
aiming to endorse population and individual healthy lifestyles, were planned
and organized, to various extents. However,
the challenge is not merely to monitor the cardiovascular risk factors, but to
evaluate the current risk perception and management from population's
standpoint, in order to bridge the knowledge-practice gaps and to suggest
evidence-based recommendations. The findings will enable the decision-makers
and health professionals to implement effective and target prevention
strategies. At medium to long term, the outcome may have an impact on the
global health.
The
information below outlines four stages you may go through when changing your
health habits or behavior. You will also find tips to help you improve your
eating, physical activity habits, and overall health. The four stages of
changing a health behavior are
Contemplation
Preparation
Action
Maintenance
Contemplation: “I’m thinking about it.”
In
this first stage, you are thinking about change and becoming motivated to get
started.
You
might be in this stage if you
·
have been considering change but are
not quite ready to start
·
believe that your health, energy level,
or overall well-being will improve if you develop new habits
·
are not sure how you will overcome the
roadblocks that may keep you from starting to change
Preparation: “I have made up my mind to take action.”
In
this next stage, you are making plans and thinking of specific ideas that will
work for you.
You
might be in this stage if you
·
have decided that you are going to
change and are ready to take action
·
have set some specific goals that you
would like to meet
·
are getting ready to put your plan into
action
Action: “I
have started to make changes.”
In
this third stage, you are acting on your plan and making the changes you set
out to achieve.
You
might be in this stage if you
·
have been making eating, physical
activity, and other behavior changes in the last 6 months or so
·
are adjusting to how it feels to eat healthier,
be more active, and make other changes such as getting more sleep or reducing
screen time
·
have been trying to overcome things
that sometimes block your success
Maintenance: “I have a new routine.”
In
this final stage, you have become used to your changes and have kept them up
for more than 6 months.
You
might be in this stage if
·
your changes have become a normal part
of your routine
·
you have found creative ways to stick
with your routine
·
you have had slip-ups and setbacks but
have been able to get past them and make progress.
Contemplation: Are you thinking of making changes?
Making
the leap from thinking about change to taking action can be hard and may take
time. Asking yourself about the pros (benefits) and cons (things that get in
the way) of changing your habits may be helpful. How would life be better if
you made some changes?
Think
about how the benefits of healthy eating or regular physical activity might
relate to your overall health. For example, suppose your blood glucose, also
called blood sugar, is a bit high and you have a parent, brother, or sister who
has type 2 diabetes. This means you also may develop type 2 diabetes. You may
find that it is easier to be physically active and eat healthy knowing that it
may help control blood glucose and protect you from a serious disease.
Author information:
Dr. Rimsha Ismail
www.tabbaheart.org
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