Monday, March 19, 2012

Diabetes- knowing the risk is our advantage

  I just read an article abstract , Duration of Diabetes and risk of ischemic stroke: Manhattan Study. They concluded that people with diabetes were at increased risk compared to those without diabetes.
This is not an unexpected finding and I did not put this in todays blog to increase any ones anxiety about their health.

                                     we know 

Those of us with pre diabetes and diabetes already know that we are at increased risk of vascular  disease. We have heard about this from our doctors, diabetes educators, friends and relatives.

                  We know the enemy

The fact of knowing about the risk is our advantage. We know the enemy.
We know the names and faces of the risk factors .

          We know we can defeat the enemy

Blood pressure control
* for every 10mmhg decrease in systolic BP reduces the risk of any diabetes complication by 12%

* BP control reduces the risk of heart disease and stroke 33 to 55%

* UKPDS study demonstrate in people with Type 2 Diabetes that reducing BP from 154/87 to144/82
    produced a- 24% reduction in any adverse  diabetes outcome
                      - 34% reduction in death related to diabetes
                      - 37% reduction in eye, nerve and kidney damage
                      - 44% reduction in stroke
                      - 56 % reduction in heart failure

LDL Cholesterol control
*  CARDS study  - taking lipitor  ( Atorvastatin10 mg /day)  resulted in:
                        - a 36% reduction in acute coronary events
                        - a 31% reduction in coronary bypass surgary
                        - a 48% reduction in strokes
                        - a 27% reduction in death

Blood Glucose Control
   A1c reduced from 8 to 7 (UKPDS study  in people with type 2 diabetes) resulted  in:
                         - a 16 % reduction in heart disease in people 
                         - a 24 to 33 % reduction in kidney damage
                         - a 17 to 21 % reduction in eye damage

  A1c reduced from 9 to 7 ( DCCT study in people with Type 1 Diabetes) resulted in:
                         - a  63% reduction in eye damage
                         - a 54%  reduction in kidney damage
                         - a 60%  reduction in nerve damage

                         - a 17 year follow up of patients with treatment A1c's  of 7 found that there was a
                           57 %relative risk reduction of heart attacks , strokes , and cardiovascular death

 UKPDS patients treated with Metformin ( glucophage) resulted in:
                         - 29% reduction eye and kidney damage
                         - 39% reduction in heart attacks
                         -36% reduction in all cause deaths

Don't smoke and don't hang out with people who smoke

                                                                             Have Fun, Be Smart and Defeat Diabetes
                                                                             David Calder, MD

Stroke. 2012 Mar 1. [Epub ahead of print]

Duration of Diabetes and Risk of Ischemic Stroke: The Northern Manhattan Study.


From the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY; Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY; Departments of Public Health and Epidemiology and Human Genetics, Miller School of Medicine, University of Miami, Miami, FL.



Diabetes increases stroke risk, but whether diabetes status immediately before stroke improves prediction and whether duration is important are less clear. We hypothesized that diabetes duration independently predicts ischemic stroke.


Among 3298 stroke-free participants in the Northern Manhattan Study, baseline diabetes and age at diagnosis were determined. Incident diabetes was assessed annually (median, 9 years). Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% CI for incident ischemic stroke using baseline diabetes, diabetes as a time-dependent covariate, and duration of diabetes as a time-varying covariate; models were adjusted for demographic and cardiovascular risk factors.


Mean age was 69±10 years (52% Hispanic, 21% white, and 24% black); 22% had diabetes at baseline and 10% had development of diabetes. There were 244 ischemic strokes, and both baseline diabetes (HR, 2.5; 95% CI, 1.9-3.3) and diabetes considered as a time-dependent covariate (HR, 2.4; 95% CI, 1.8-3.2) were similarly associated with stroke risk. Duration of diabetes was associated with ischemic stroke (adjusted HR, 1.03 per year with diabetes; 95% CI, 1.02-1.04). Compared to nondiabetic participants, those with diabetes for 0 to 5 years (adjusted HR, 1.7; 95% CI, 1.1-2.7), 5 to 10 years (adjusted HR, 1.8; 95% CI, 1.1-3.0), and ≥10 years (adjusted HR, 3.2; 95% CI, 2.4-4.5) were at increased risk.


Duration of diabetes is independently associated with ischemic stroke risk adjusting for risk factors. The risk increases 3% each year, and triples with diabetes ≥10 years.
[PubMed - as supplied by publisher]


  1. You have shared great awareness tips on diabetes. Thank you for sharing such type healthy information.

  2. Allied health workers comprise the greatest part of the medical industry, and include trained workers who provide support to doctors and nurses through specialized knowledge. Jobs such as dental assisting, ultrasound technician, physical therapist assistant, surgical technician and medical assistant all fall into this category. Thanks a lot.


Your comments and questions are appreciated. David Calder,MD