Protecting kidney and heart health vital for people with type 2 diabetes

John Harvey recalls being concerned over the years that he was at risk of developing type 2 diabetes, heart disease or both because of his family history.

His mother had heart disease and eventually underwent quadruple bypass surgery, and his father developed both type 2 diabetes and cardiovascular problems. His grandfather had diabetes, and later on, his younger brother was also diagnosed.

“I was first exposed to diabetes when I was a young child, seeing my grandfather with a small stainless-steel bowl that held a needle and a bottle of insulin and finding out he had to inject himself,” he says. “It made a strong impression on me, and I thought to myself, ‘I hope I never get that.’”

Concerns about his health risks remained at the back of his mind for some time, but Mr. Harvey hoped he would defy the odds.

Then, 15 years ago, some concerning symptoms, such as blurred vision and frequent urination, led him to make an appointment with his family doctor. After conducting the relevant testing, his doctor confirmed a diagnosis of type 2 diabetes and explained that steps needed to be taken right away to get his high blood sugar levels under control.

“I was still shocked by the diagnosis even though I had always known it was a possibility,” Harvey says. In his mid-fifties at the time, he remembers thinking, “How can this be happening to me when I’m still quite young? Then I started panicking somewhat, wondering how this was going to affect my life and what I would have to give up.”

Today, at age 71, Harvey is enjoying his life as a retiree in Coquitlam, British Columbia, and feeling optimistic about the future. With the support of his health-care team, including his endocrinologist, he has found the balance that he worried would be hard to achieve when he was first diagnosed. Medications and healthy lifestyle choices are helping him to keep his blood glucose levels within target range – signalling his diabetes is well-managed.

He has come to understand that good management of his disease is critical to reducing the risk of serious cardiac and kidney complications.

Interconnectedness of diabetes and cardiac and kidney disease

Type 2 diabetes does not occur in isolation. High blood glucose can damage your blood vessels and many organs in the body, which means you could be at an increased risk of developing heart and kidney disease.

The heart, kidneys and metabolism systems are all interconnected, explains Dr. David Cherney, a professor of medicine at the University of Toronto, clinician-scientist at University Health Network, Toronto General Hospital Research Institute, and a specialist in kidney medicine and the relationship between diabetes and kidney and heart disease.

“There is significant crosstalk between the heart, the kidneys and diabetes, and the risk factors amplify each other,” he says. “People with heart disease are at a higher risk of kidney disease, and people with kidney disease are at a higher risk of cardiovascular disease, including heart failure. Part of what ties that all together is type 2 diabetes, which increases the risk for both.”

Kidney disease

“It’s estimated that 30 to 40 per cent of people with type 2 diabetes have evidence of kidney disease,” says Dr. Cherney.

If kidney damage from diabetes isn’t detected and treated early, he says, “patients are at increased risk for developing end-stage kidney disease, known as kidney failure, which requires either dialysis or a kidney transplant.” Diabetes is the leading cause of kidney failure in Canada, he explains, noting that between 40 and 50 per cent of Canadians who end up with kidney damage, including kidney failure, have diabetes.

Cardiovascular disease

One in three people living with type 2 diabetes has heart disease. One common risk is atherosclerosis, narrowing of the blood vessels, which can cause a heart attack or stroke or place patients at risk of insufficient blood supply to the legs and feet, increasing the risk of needing an amputation.

“Under the cardiovascular umbrella, type 2 diabetes can also increase the risk for heart failure,” explains Dr. Cherney. “Heart failure can lead to shortness of breath, fatigue, inability to do exercise and other outcomes, and it’s a common cause of hospitalization for people who have type 2 diabetes.”

Early screening and diagnosis critical for reducing complications

With millions of Canadians affected by cardio-kidney-metabolic conditions, including type 2 diabetes, heart failure, cardiovascular disease and chronic kidney disease, early screening and diagnosis are key to reducing serious complications.

“As treatment providers, we always inform patients about the importance of regular screening to assess the health of their kidneys,” says Dr. Cherney. When physicians see signs of kidney damage, they can provide treatment, such as medications aimed at preserving kidney function.

It is important to step in as early as possible to prevent the situation from getting worse.

“We work towards early detection because we have no way to grow back kidney tissue or to ameliorate kidney function,” Dr. Cherney explains. “All of our strategies are targeted at slowing the rate at which it’s declining year over year. And preserving the function of the kidneys also protects the heart.”

Health-care providers also screen for cardiovascular risks related to measures such as cholesterol and blood pressure. Blood pressure control is crucial, as having both high blood sugar and high blood pressure – which is more likely to develop when you have diabetes – can increase your risk of heart and kidney disease.

Physicians can also conduct testing to determine if a person with type 2 diabetes has an elevated risk of developing heart failure.

All of this screening and monitoring for kidney and cardiac complications sets the foundation for integrated treatment approaches, including the use of medications or combinations of medications that have multiple benefits – helping the patient control their type 2 diabetes and to reach and maintain a healthy body weight, while also reducing the risk of kidney and cardiovascular complications.

Comprehensive treatment including lifestyle modifications

Along with medications, physicians treating people with type 2 diabetes stress the importance of a healthy diet and exercise to help with control of blood glucose levels and reduce the risk of complications.

“When treating our patients, our treatment goals include blood sugar control, blood pressure and cholesterol management, and maintaining a healthy body weight to reduce cardiovascular and renal risks,” says Dr. Cherney.

“Maintenance of a healthy lifestyle is critical. That includes maintenance of a reasonable exercise routine that’s regular and safe for them based on their medical conditions, cutting down on salt in their diet and controlling their caloric intake, which is tied together with maintenance of a healthy body weight.”

Because medications, along with diet and exercise, can lower the risk of complications related to the heart and blood vessels, and can help treat kidney disease, Dr. Cherney encourages people with type 2 diabetes to talk to their health-care provider about the impact it can have on their heart and kidneys.

“The sooner you know the risks, the sooner you can make a change to benefit your health.”

Although he had a sense that diabetes could lead to serious complications, Mr. Harvey says he didn’t grasp the full picture until after he was diagnosed. He started learning more when his physicians explained the risks and began regularly monitoring markers related to heart and kidney health.

“Before a medical problem hits you personally, you don’t pay a lot of attention to all the risks,” he says. “But when I learned about the additional harm that diabetes can cause, I definitely wanted to learn everything I could about protecting myself.”

He has made lifestyle changes to support his diabetes management. It wasn’t easy at first: at work, he had the nickname of “Candyman” because he was always bringing sweet treats to the office.

“After some time, I became more comfortable with bringing moderation to my diet and eating a good balance of different foods,” he says. He also goes on walks several times a week. He says he has received helpful guidance from his physicians and also learned more about healthy eating by attending classes at a diabetes clinic.

Mr. Harvey enjoys collecting and reviewing movies and socializing with friends, and he remains optimistic about his future.

He aims to maintain a healthy lifestyle so he can pursue personal goals, including spending quality time with his daughter and granddaughter, and travelling more.

“I have a good, positive outlook for the coming year and the many years beyond.”

Brought to you by Boehringer Ingelheim (Canada) Ltd. and Eli Lilly Canada Inc. Visit itsconnected.ca to learn more about these connected conditions and how to protect your health.

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