Cardiologists can help prevent diabetes, USF Health review article suggests

Cardiologists could and should take more action in guiding their patients to interventions aimed at delaying, and even preventing, diabetes, USF Health faculty proposed last month in a review published  in the American Journal of Cardiology.

“We propose cardiologists can play a key role in preventing diabetes and aligning practice patterns with guideline recommendations among endocrinology, cardiology, and primary care stakeholders,” wrote Nicholas W. Carris, PharmD, assistant professor in the USF Health College of Pharmacy.

The review article, which summarizes previously published studies on the topic, presents cohesively for the first time the specific factors contributing to an apparent lack of action by clinicians, and suggests an approach that might better encourage cardiologists to proactively engage their patients who have prediabetes.

“The prediabetes timeframe is an opportunity to act and significantly reduce the likelihood of someone progressing to diabetes,” Dr. Carris said. “It’s an opportune time to help patients at considerable cardiometabolic risk and to have a significant impact on the current diabetes epidemic.”

“Eighty-four million patients in the United States have prediabetes and at least 70 percent will develop diabetes unless they receive an intervention,” he said. “Most of these patients have or are at risk for cardiovascular disease, with recent reports describing significantly increased microvascular and macrovascular risks among patients with prediabetes.”

Central to what Dr. Carris and authors suggest is for cardiologists to actively engage their patients with prediabetes and implement evidence-based methods of diabetes prevention.

“For several key reasons, we believe cardiologists have a responsibility and opportunity to improve the health of their patients with prediabetes by making it a very high priority to prevent progression to diabetes,” Dr. Carris said. “First, we must recognize that multiple cardiovascular medications may increase risk for new-onset diabetes. Second, avoiding or delaying diabetes’ onset can improve quality of life and decrease health-system cost. And third, because heart disease and stroke are the most common causes of death in people with diabetes, we expect that preventing diabetes will improve long term health.”

The authors go on to note how strong an influence cardiologists could have on shifting the diabetes epidemic.

“Cardiologists are increasingly being asked to weigh in on diabetes management as select agents demonstrate cardiovascular benefit… as the mortality risk of patients with a history of myocardial infarction and diabetes is almost double that of patients with a history of myocardial infarction who are free of diabetes, there is even more potential benefit in delaying/avoiding diabetes in patients with cardiovascular disease.”

Current methods of intervention show an impact in reversing prediabetes or slowing progression to diabetes, Dr. Carris said.

“Cardiologists are centrally positioned to help patients adopt a healthier lifestyle and prescribe therapeutic and preventive medications when appropriate,” he said. “Studies have shown that intensive lifestyle intervention, metformin, and other medications reduce the progression to diabetes.

“The bottom line is, it cannot be ignored that avoiding diabetes is an important outcome – at the very least from a humanistic perspective – and cardiologists are pivotal to helping patients avoid diabetes.”