In the ongoing fight against diabetes, researchers from the University of Gothenburg have discovered a significant shift in the battlefield.
While the risk of major heart attacks and strokes for those with type 1 and 2 diabetes has seen a welcome decline, the war against arterial disease is far from over.
Now, the skirmishes are increasingly occurring in the more peripheral vessels of the body, according to recent studies.
For a long time, the link between diabetes and an elevated risk of heart attack and stroke has been well documented, highlighting the dangerous duo of diabetes and cardiometabolic risk factors like obesity, high cholesterol, and high blood pressure.
However, less attention has been paid to how diabetes affects the arteries outside the heart and brain—until now. Two groundbreaking articles published in The Lancet Regional Health—Europe are shedding light on this less explored territory.
The research delves into two decades of trends concerning virtually all peripheral arterial diseases, investigating long-term trends, the impact of controlling modifiable risk factors, ideal levels for these factors, and the relative significance of various risks.
Data gathered from the Swedish National Diabetes Register, encompassing 34,263 individuals with type 1 diabetes and 655,250 with type 2 diabetes from 2001 to 2020, served as the foundation for this extensive study.
This was compared against data from 2,676,227 non-diabetic individuals, offering a broad perspective on disease trends.
The findings revealed an overall decrease in complications related to peripheral arterial diseases over time among diabetics.
However, a noticeable shift has occurred, with diseases in peripheral vessels gaining relative importance as risks of heart attack and stroke have diminished.
Particularly for those with type 1 diabetes, the study underscores the importance of vigilant monitoring of blood sugar and blood pressure.
Doing so can significantly reduce the risk of several peripheral arterial complications by 30–50%. These include conditions like carotid artery calcification and diseases affecting the abdominal aorta and vessels in the lower extremities.
Interestingly, the study suggests that patients with type 1 diabetes have limited benefits from further lowering levels of BMI, cholesterol, triglycerides, or improving kidney function beyond current guidelines.
For individuals with type 2 diabetes, the research highlights the significant role of bad cholesterol in the calcification of the carotid artery and shows that lower triglyceride levels can substantially reduce the risk of peripheral arterial disease.
The findings also indicate that maintaining triglyceride levels just above the guideline values does not necessarily increase risk, underscoring the nuanced nature of these risk factors.
Across both types of diabetes, long-term blood sugar control emerges as a crucial factor, especially for peripheral arterial diseases. This contrasts with its effects on central arterial diseases and points to the varied impacts of long-term blood sugar on different parts of the vascular system.
Aidin Rawshani, the researcher leading these studies, emphasizes the potential for further reducing the risk of future complications through early and intensive control of cardiometabolic risk factors, especially long-term blood sugar.
The research not only illuminates the shifting landscape of diabetic arterial disease but also highlights the differing biological effects that risk factors have on the arterial tree’s central and peripheral parts.
As the fight against diabetes continues, these findings open new fronts in the quest to protect the health and well-being of those living with diabetes, pointing the way toward more targeted and effective treatments for peripheral arterial disease.
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The research findings can be found in The Lancet Regional Health – Europe.
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