Prevention of cardioglycometabolic diseases

Prevention of cardio-glyco-metabolic diseases

Cardiovascular and cardiocirculatory diseases are the leading cause of death and invalidity in Italy and in the entire Western World.
Being affected by a metabolic disease – the most frequent types being obesity and diabetes mellitus – contributes greatly to one’s risk of suffering a cardiovascular event.
Therefore, it’s clear how important it is to frame a metabolic disease or a potential one as early as possible and to calculate the cardiovascular risk in order to implement an important preventive action that prevents such a disease developing and increasing the risk of cardiovascular problems (heart attack and/or stroke).

Primary prevention means the beginning of a shared path with the patient in order to eliminate the greatest number of risk factors that increase the chances of developing a metabolic and/or cardiovascular disease.

The main changeable risk factors that can be controlled are:

There still are non-changeable risk factors which are useful to consider to assess the cardiovascular risk and decide the subsequent preventive action:

Analyzing the presence of one or more of these factors it is possible to do a rather precise calculation of the patient’s risk.Primary prevention is that discipline which intervenes before such a risk significantly increases and prevents the development of one or more of these risk factors.

The approach to this path is behavioral: modifying life styles which in the Western world tend towards hyper-technology, incorrect food choices and unbalanced use of our time whereby increasing precedence is given to work or significant sources of stress to the detriment of rest (physical and mental) and care of our bodies.

Should this approach be insufficient, then it is also possible to use drugs, which in this phase often have not a mere curative purpose but a preventive one and are therefore not used to modify a value but to keep it stable over time.

Primary prevention (a fundamental and too often underestimated tool) differs from secondary prevention since it intervenes when there are risk factors without the presence of a disease or of a confirmed illness, while secondary prevention has a mere curative action rather than a preventive one since it intervenes in the case of an already established disease or in cases of one or more cardiovascular events that have already occurred.

Type 1 Diabetes

Type 1 Diabetes is a metabolic disease caused by the absence of natural insulin production by pancreas. Insulin is the hormone responsible for transporting glucose from the circulation into the cells. Insulin absence causes an important rise (hyperglycemia) of the glucose with a subsequent glucotoxicity and cellular damage.

Type 2 Diabetes is a metabolic condition in which glucose is not properly metabolized because of abnormal insulin production by the pancreas, or because of peripheral malfunction of the insulin which is not carrying out its normal activities; or because of a rather common phenomenon called peripheral insulin resistance that develops due to excessive accumulation of visceral fat.

In any case the final result is a deficient glucose transportation within the cells with consequent hyperglycemia.

The constant hyperglycemia results in chronic complications affecting any organs and apparatus since the systemic arterial damage caused by the DURATION in time of high glucose values results in poor oxygenation of all organs causing their suffering.

The TIME FACTOR (the length of time a severe hyperglycemia state lasts) is the one to be most closely monitored, since the damage is not mainly caused by the ENTITY of the glycemic value (as long as it is of relatively short duration) but by how much TIME a state of glycemic disorder lasts.

A strict control of glycemic value for type 1 and type 2 diabetic patients is strictly necessary to obtain a proper prevention of diabetes complications.
Continuous monitoring of metabolic compensation through the evaluation of GLYCATED HEMOGLOBIN values and home self-monitoring of glycemia is a fundamental step (this allows to precisely spot intensity and time in which the metabolic disorder appears, thus allowing the improvement of the therapeutic approach).

Complications

The main chronic complications of diabetes are:

MACROANGIOPATHY

Diabetic macroangiopathy is an event linked to damage to the large vessels with cardiovascular consequences that can lead to hypertensive disease, Ischemic heart disease and Stroke. Cardiovascular damage with subsequent heart attack is the leading cause of death and disability for a diabetic patient.
There also is a silent form of heart attack which is totally asymptomatic, especially when there is the simultaneous presence of a sensory neuropathy.
On the other hand, hypertension is also the main cause of kidney failure and retinal damage, organs which are already targeted by diabetic disease.

NEUROPATHY

Diabetic Neuropathy depends on nerve damage, caused both by a direct mechanism of the glycation of nerve cells and/or by an indirect mechanism depending on damage of vessels supplying blood to the nerves with subsequent poor oxygenation of the peripheric nervous system.
Neuropathy might be sensory, and in such a case it presents symptoms like numbness, tingling, and in the most severe cases with cramps of the calves, often occurring nocturnally, and pains in lower limbs untill the appearance of neuropathic ulceration on the sole of the foot.
Diabetic Neuropathy also presents a motor variant, in which the deficit is a more or less severe impairment of movement, often affecting lower limbs. The Diabetic patient normally presents a mixed variant called: Sensory Motor Neuropathy.

RETINOPATHY

Diabetic retinopathy is a clinical condition characterized by the damage of the retinal arterioles resulting in poor oxygenation of the retina itself. The worst variant is the hemorrhagic-exudative form which can cause a loss of vision up to a complete blindness. There are also less severe variants, called proliferative forms. The Fundus Oculi examination is the exam that allows us to diagnose and correctly frame the problem.

NEPHROPATHY

Diabetic Nephropathy is a clinical condition characterized by damage of the renal afferent arterioles with subsequent alteration of the glomerular filtrate up to the evolution in chronic renal failure. The worst variant is severe renal failure called fourth stage which can lead to dialysis and in the most severe cases even to the need of kidney transplant. There are less severe variants of kidney failure called first, second and third stadium. The dosage of microalbuminuria is a test that can predict renal failure with a huge anticipation thus allowing us to understand that a very early kidney suffering is already in place.

DIABETIC FOOT

Diabetic food is a condition in which due to a vascular and/or neurological compromise of one or both feet are experiencing ischemic or nerves transmission pain leading finally to ulcers formations which if not promptly treated, can became infected and cause severe complications such as gangrene or osteomyelitis (bone infection). Any small ulcer or callus must be treated by skilled personnel to prevent the complications described as they can develop and evolve negatively in a very short time.

Obesity is a medical condition characterized by an excessive accumulation of body fat leading to severe health damages. In visceral obesity fat is deposited around organs and it is revealed by an excessive deposition of fat in the abdominal area. This is the most dangerous condition and is the one more easily predisposing to chronic diseases mainly of the cardiovascular, metabolic (diabetes), respiratory and motor types.

There also is a subcutaneous variant whereby fat is distributed more superficially and less so around organs. This variant is less dangerous, and is mainly unaesthetic, is revealed by a cluttered accumulation of fat mass in the whole body and is clearly visible.

It is mainly caused by disordered lifestyles; incorrect diet (more from a qualitative rather than quantitative point of view) and a reduced energy expenditure due to little or no physical activity.
There are also forms depending on hormonal disorders (hypothyroidism or hypercorticosadrenalism) as well as rarer genetic forms.

Obesity is a major public health problem and is a major risk factor for chronic diseases such as Type2 Diabetes, cardiovascular diseases and cancer. Obesity and overweight are an important risk factor for the most common chronic and cancer diseases, such as: