Heart problems triggered by poor blood glucose control in diabetes mellitus: from etiology to treatment

Abstract

The persistence of hyperglycemia in diabetes is associated with chronic micro- and macrovascular complications, resulting in increased morbidity, decreased quality of life and a higher mortality rate. The disease is directly linked to problems such as kidney failure, heart attacks, stroke and lower limb amputation, representing a significant social burden by limiting the efficiency and autonomy in the daily routine of many patients (WHO, 2018).

Type 1 diabetes is caused by an autoimmune process that destroys the beta cells of the pancreas, leading to a total lack of insulin. Symptoms include polyuria, polyphagia, polydipsia, weight loss and visual changes. There are risks of chronic complications, such as atherosclerosis and myocardial infarction, as well as greater susceptibility to infections. Insulin administration is crucial to prevent ketoacidosis, coma and death (FIGUEIREDO; RABELO, 2009).

Patients with type 2 diabetes may present similar symptoms, being influenced by hereditary factors and obesity. Despite producing insulin normally, they face insulin resistance, resulting in high levels in the blood (FIGUEIREDO; RABELO, 2009).

In relation to cardiovascular problems, individuals with diabetes face a significantly increased risk of developing cardiovascular diseases. Given this scenario, the Brazilian Societies of Diabetes, Cardiology and Endocrinology and Metabolism joined forces to develop strategies aimed at preventing cardiovascular diseases in this population. It is noteworthy that the cardiovascular prevention plan needs to be personalized for each patient, taking into account their cardiovascular risk profile.

Regarding treatment, it is highlighted that the DM approach has evolved beyond a simple management focused on glucose, acquiring a comprehensive metabolic character. The quest for essential glycemic regulation now aims for efficacy, minimizing the risks of hypoglycemia, and optimizing comprehensive care to mitigate other cardiometabolic risk factors. This approach aims to reduce cardiovascular morbidity and mortality associated with DM. The importance of new antihyperglycemic therapies stands out, with proven evidence of benefits in reducing adverse cardiovascular events, as a crucial part of treatment for individuals with DM2.