How People With Type 2 Diabetes Can Lower Their Risk of Health Problems

A growing number of studies suggest that getting a handle on a few key risk factors can bring type 2 diabetes under control. Lowering blood sugar, for instance, reduces the risk of additional health problems, such as heart disease and stroke related to the disease.

But most of these studies have focused on studying one risk factor — like blood sugar, cholesterol or blood pressure — at a time. In a new study published in the New England Journal of Medicine, researchers analyzed what happens to death rates and other health problems when people control up to five known risk factors for type 2 diabetes.

The study reviewed the health of more than 1.6 million people in Sweden, nearly 300,000 of whom had type 2 diabetes. The database included information on the levels of five risk factors linked to the condition: blood sugar, LDL cholesterol, kidney proteins, smoking and blood pressure. The researchers compared health outcomes, including early death, heart attack and stroke, among people with type 2 diabetes to those without the chronic disease.

They team, led by Dr. Aidin Rawshani, from the department of molecular and clinical medicine at the University of Gothenburg in Sweden, found that people with type 2 diabetes who successfully followed current health guidelines for keeping their risk factors under control were less likely to have a heart attack than even people without type 2 diabetes; their risk was 16% lower compared to the general population after 5.7 years. Their risk of dying during the study period of any cause was only slightly higher — 6% — than among the control group.

“These results show that we may actually be able to substantially reduce, and in some cases even possibly eliminate, excess health risk by treating these risk factors,” says Rawshani.

The results aren’t a guarantee that following doctor’s orders — bringing blood sugar, blood pressure and cholesterol levels to normal ranges, not smoking and keeping kidneys healthy — will protect people with type 2 diabetes from heart attacks, stroke or early death. But they are an encouraging sign that controlling the disease can improve health.

Rawshani and his colleagues also found from the data that people who lowered three factors — blood sugar, cholesterol and blood pressure — to below currently recommended levels lowered their risk of dying early or having heart events even further.

The risk doesn’t completely disappear when people stick to recommended guidelines; the study also found that people who had all five risk factors within recommended levels had a higher rate of hospitalization for heart failure, although they did not have a higher risk of dying or having a heart attack.

The benefit was especially notable for younger people with type 2 diabetes, says the study’s senior author, Dr. Soffia Gudbjornsdottir, professor of molecular and clinical medicine at the University of Gothenburg. That suggests that younger people with type 2 diabetes and their doctors should pay even more attention to this panel of risk factors, rather than focusing on just a few of them. “There seems to be a tendency to wait and see a little bit with younger people when it comes to blood pressure and high blood lipids,” she says. “But the results show that we may be waiting and seeing a little bit too long.”

The researchers hope the findings prompt more doctors to look at all five risk factors in people with type 2 diabetes; addressing all of them can significantly lower risk of future health problems associate with the disease. “This is fantastic news for patients with type 2 diabetes: that just by bringing these five selected risk factors to within contemporary guideline levels, they can actually reduce their excess risk of early death, and possibly eliminate their excess risk of heart attack,” says Rawshani. “It’s absolutely positive news for patients with type 2 diabetes.”

He also notes that the study only investigated what would happen if people controlled five risk factors, mostly with medications. “We have not included lifestyle changes, such as an improved diet and more physical activity,” he says. “One can only imagine what a patient with type 2 diabetes could achieve by looking at more than just these five risk factors.”