Diabetes 2 life expectancy

What to Know About Diabetes and Life Expectancy

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Twenty-nine million Americans and more than 400 million people worldwide have diabetes. There are two main types of diabetes with different underlying causes. But when either type 1 or type 2 diabetes is not well controlled, they lead to a dangerous buildup of glucose (sugar) in the blood. Over time, the damage this does to blood vessels and nerves can lead to serious complications, such as blindness, limb amputation, heart disease, and kidney failure.

Diabetes: a Chronic Disease

Diabetes is a chronic condition that requires consistent, daily care, which makes it more difficult to control than some other conditions. When damage from diabetes takes too heavy a toll on the body, it can shorten lifespan. In the United States, diabetes is the 7th leading cause of death. Thinking about life expectancy is uncomfortable. But, it’s important to know that advances in diabetes care and in how people are taking care of their health can make living a long life with diabetes a reality.

Life Expectancy With Type 1 Diabetes

In type 1 diabetes, the pancreas doesn’t make enough insulin—a hormone that helps carry glucose to the body’s cells to use for energy. Five to 10% of people with diabetes have type 1. Type 1 diabetes is most frequently diagnosed in childhood or adolescence. This means that people with type 1 diabetes can spend a large part of their lives with the condition.

The average person with type 1 diabetes has a shorter lifespan than a person without it—but the life expectancy gap is shrinking. Research in the 1970s estimated that people with type 1 diabetes could expect to live 27 fewer years, on average, than people without the disease. However, a recent study out of Scotland reports that men with type 1 diabetes lose an estimated 11 years and women 13 years of life, on average. A study out of the United States also reports significant improvement in life expectancy: People who were diagnosed in the 1970s have a longer life expectancy compared to people diagnosed in the 1950s. This is most likely due to earlier recognition of disease in children in the last 50 years and better treatment.

Life Expectancy With Type 2 Diabetes

In type 2 diabetes, the body has enough insulin, but cells don’t use it properly—leading to a buildup of blood glucose. More than 90% of people with diabetes have type 2. Type 2 diabetes is more frequently diagnosed in adulthood than childhood.

According to some estimates, having type 2 diabetes can shorten your life by about 10 years. But, it’s hard to determine an exact number. How healthy you are with the condition depends greatly on how long you’ve had diabetes, how well you manage blood glucose levels over time, and whether you have cardiovascular conditions, such as heart attack and stroke. These conditions greatly increase the risk of dying in people with diabetes, according to a recent study in the Journal of the American Medical Association.

Advances in Diabetes Care

Improvements in life expectancy with diabetes could be due, in part, to more accurate information on death rates and causes of death. However, diabetes treatment and management is continuing to improve in many ways including:

  • More effective medications including injectable insulin, intensive insulin therapy (with an insulin pump), inhaled insulin, and oral medications to help regulate insulin and blood glucose.

  • Easier-to-use blood glucose monitoring tools including less painful lancing devices and continuous glucose monitoring.

  • More support for self-management from professionals—such as certified diabetes educators and nurse educators experienced in training patients to effectively self-manage diabetes.

How to Live a Long Life With Diabetes

Eight million of the 29 million people with diabetes don’t know they have condition. The first key to managing diabetes is to confirm a diagnosis for it. If you know you have diabetes, take these steps to live the healthiest—and longest—life possible:

  • Regulate your blood glucose levels. You do this by checking and logging your blood sugar numbers, taking your medication consistently, and eating a healthy diet.

  • Know the complications and accompanying conditions that put you at risk. Do what you can to prevent conditions that, along with diabetes, could potentially affect your lifespan. These include heart disease and kidney disease.

  • Work with healthcare providers experienced in treating people with diabetes. These may include a primary care doctor, endocrinologist, eye doctor, and dentist. These providers can help you avoid complications of diabetes.

Early age of type 1 diabetes diagnosis linked to shorter life expectancy, compared to later diagnosis

Credit: CC0 Public Domain

Life-expectancy for individuals with younger-onset disease is on average 16 years shorter compared to people without diabetes, and 10 years shorter for those diagnosed at an older age

Being diagnosed with type 1 diabetes at a young age is associated with more cardiovascular complications and higher risk of premature death than being diagnosed later in life, independent of disease duration. The findings, published in The Lancet, come from a large observational study in Sweden that followed over 27,000 individuals with type 1 diabetes and more than 135,000 matched controls for an average of 10 years. With around half of individuals with type 1 diabetes diagnosed before the age of 14, the authors stress the need to consider wider and earlier use of cardioprotective measures such as statins and blood pressure lowering drugs in this high-risk population.

“Although the relative risk of cardiovascular disease is increased after an early diabetes diagnosis, the absolute risk is low”, says Dr. Araz Rawshani from the University of Gothenburg in Sweden who co-led the research. “However, age at disease onset appears to be an important determinant of survival as well as cardiovascular outcomes in early adulthood, warranting consideration of earlier treatment with cardioprotective drugs.”

The new estimates suggest that individuals diagnosed before the age of 10 have a 30-times greater risk of serious cardiovascular outcomes like heart attack (0.31 cases per 100,000 person years for participants with diabetes vs 0.02 cases in every 100,000 person-years for controls) and heart disease (0.5 vs 0.03) than those in the general population, whilst risk levels are around six times higher for people diagnosed between ages 26 and 30 (0.87 vs 0.25 and 1.80 vs 0.46 respectively).

People with younger-onset type 1 diabetes are four times as likely to die from any cause (0.61 vs 0.17), and have more than seven times the risk of dying from cardiovascular disease (0.09 vs 0.02) than their diabetes-free counterparts. In contrast, people first diagnosed between ages 26 and 30 face a lower (three-fold) risk of dying from any cause (1.9 vs 0.6) and cardiovascular disease (0.56 vs 0.15) compared to their peers without diabetes.

Professor Naveed Sattar, co-author, University of Glasgow (UK), explains: “While the absolute risk levels are higher in individuals who develop diabetes when older, simply due to age being a strong risk factor, the excess risk compared to healthy controls is much higher in those who developed diabetes when younger. If this higher excess risk persists over time in such individuals, they would be expected to have highest absolute risks at any given subsequent age. Indeed, those who develop type 1 diabetes when under 10 years of age experience the greatest losses in life expectancy, compared to healthy controls. This is something we did not fully appreciate before.”

The impact of type 1 diabetes on younger people should not be underestimated, and there is a need to consider adding recommendations about age of onset in future guidelines, say the authors.

Type 1 diabetes mellitus is the second most common chronic disease in children, accounting for 85% of diabetes in the under 20s. But it’s not unusual to develop the disease as an adult. Worldwide, the incidence of type 1 diabetes in children aged 14 years and younger has risen by 3% a year since the 1980s.

It’s well known that people with type 1 diabetes are at increased risk of health problems and have shorter life expectancies, partly due to premature cardiovascular disease. But, until now, the impact of age of diagnosis on this excess mortality and cardiovascular risk was unclear.

To provide more evidence, the researchers calculated the excess risk of all-cause mortality, cardiovascular mortality, acute heart attack, stroke, cardiovascular disease, coronary heart disease, heart failure, and atrial fibrillation in 27,195 individuals from the Swedish National Diabetes Register compared to 135,178 controls matched for age, sex, and county from the general population (average age 29 years).

Individuals with diabetes, who registered between Jan 1988 and December 2012, were divided into groups by age at diagnosis—0-10 years, 11-15 years, 16-20 years, 21-25 years, and 26-30 years—and followed up for an average of 10 years.

The researchers adjusted for a range of factors that may have influenced the results including age, sex, marital status, income, educational level, region of birth, diabetes duration, and previous history of cardiovascular complications.

Cardiovascular risks and survival were strongly related to age at disease onset, with people diagnosed before the age of 10 having five-times greater risk of heart attack and coronary heart disease than those diagnosed at age 26-30 years. The younger group also had much higher risk of heart failure and stroke than peers without diabetes and those diagnosed at an older age (figure 3).

Excess risks were particularly pronounced in women, with those diagnosed before age 10 facing a 60-fold higher risk of heart disease (0.48 cases per 100,000 person years for participants with diabetes vs 0.02 cases in every 100,000 person-years for controls) and 90-times increased risk of heart attack than matched controls (0.25 vs 0.01). In comparison, men with young-onset diabetes have a 17 times greater risk of developing heart disease and 15 times higher risk of having a heart attack in early adulthood compared to those in the general population (0.53 vs 0.05 and 0.36 vs 0.03).

These estimates for early-onset disease are substantially higher than recent estimates by the American Heart Association and American Diabetes Association, which do not consider age of onset as a risk stratifier, and report that women with type 1 diabetes are at seven times increased risk and men at three times the risk of developing heart disease.

Life expectancy was also markedly shorter for women with type 1 diabetes. Women who develop the condition before 10 years of age die on average around 18 years earlier than their diabetes-free counterparts (average life expectancy 70.9 years vs 88.6 years), whilst men with early onset type 1 diabetes die around 14 years earlier (69.1 years vs 83.3 years). Individuals diagnosed at 26-30 years old lose, on average, about 10 years of life.

The authors speculate that loss of beta cells which contribute to glycaemic load, and is more severe and rapid among those with younger age onset, could be a contributing factor to the increased risk of cardiovascular-related death. Whilst they adjust for duration, longer exposure to higher glucose levels in individuals who develop diabetes when children might also contribute to greater heart disease risks. However, the authors acknowledge that their findings show observational associations rather than cause and effect.

Professor Sattar adds: “People with early onset diabetes should more often be considered for cardioprotective drugs such as statins and blood pressure lowering medication when they reach 30-40 years of age. Currently, only around 10-20% of individuals with type 1 diabetes are taking statins by the age of 40. Also, improving glycaemic control and smoking cessation programmes could meaningfully prolong the lives of these individuals. The good news, however, is that recent technological advances are helping younger patients manage their glucose levels better.”

The authors note some limitations including that they did not have information about patients’ glycaemic control before enrolment in the register. What’s more, they only included patients who had the condition for 20 years or less to provide contemporary comparisons of cardiovascular risk that reflect current diabetes management. Key strengths include the large cohort, individual controls, adjustment for diabetes duration, the range of age subgroups, and variety of cardiovascular outcomes. Life expectancy analyses used the entire cohort, regardless of duration of diabetes.

Writing in a linked Comment, Marina Basina and David M Maahs, Stanford University (USA) say: “These data will increase attention towards cardioprotection at younger ages and specifically for those with an earlier age of type 1 diabetes onset. Practitioners need a stronger evidence base, including confirmatory reports from other registries and clinical trials, to clarify proper therapy and translate research findings to care guidelines and clinical practice to improve mortality and cardiovascular disease outcomes for individuals with type 1 diabetes.”

More information: Araz Rawshani et al. Excess mortality and cardiovascular disease in young adults with type 1 diabetes in relation to age at onset: a nationwide, register-based cohort study, The Lancet (2018). DOI: 10.1016/S0140-6736(18)31506-X Journal information: The Lancet Provided by Lancet Citation: Early age of type 1 diabetes diagnosis linked to shorter life expectancy, compared to later diagnosis (2018, August 10) retrieved 2 February 2020 from https://medicalxpress.com/news/2018-08-early-age-diabetes-diagnosis-linked.html This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.

Diabetes may shorten life expectancy

Men and women with diabetes generally have shorter life expectancy and fewer years without disability than people without diabetes, according to a new study.

“Most individuals with diabetes are familiar with the classical complications affecting eyes, kidneys, feet and cardiovascular system, but this study highlights another impact, especially about the number of disability free years which were lost,” said senior author Dianna J. Magliano of Baker IDI Heart and Diabetes Institute and Monash University in Melbourne.

Based on Australian diabetes studies, disability surveys and the national death index, the researchers estimated that 50-year old men and women with diabetes had a life expectancy of 30 years and almost 34 years, respectively – or about three years less than for men and women without diabetes.

“Disability” meant having at least one of 17 limitations or impairments, for at least six months, that restricts everyday activities like bathing or getting into or out of bed.

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Fifty-year-olds with diabetes could expect an average of about 13 years of disability-free life, eight or nine years less than men and women without diabetes, as reported in Diabetologia.

Women age 50 with diabetes would spend more of their remaining years living with disability than men with diabetes, the researchers estimated.

Diabetes is the fourth most common cause of death in Europe, according to the European Diabetes Leadership Forum (EDLF). Meanwhile, 10-20% die of kidney failure, 10% develop severe visual impairment and 50% suffer from diabetic neuropathy.

“The differential impact of diabetes by sex on life expectancy difference can be explained largely by the fact that women with diabetes had longer life expectancy and significantly higher prevalence of disability, which is consistent with previously reported data for women in general,” Magliano said.

Although people with diabetes are living longer now than in the past, diabetes still carries a large risk of other health problems, said Dr. Ed Gregg of the Division of Diabetes Translation at the Centers for Disease Control and Prevention, who was not part of the new study.

But, he said, there are wide variations among individuals.

“Many people develop diabetes and manage it really successfully, have a life expectancy as long as anyone, based on how well they are able to manage it and work with their health system,” Gregg told Reuters Health by phone.

‘Cook from scratch’ key to battling spread of diabetes, panel told

A healthier diet with meals cooked from scratch instead of sugary, processed foods and drinks is the most cost-effective way of tackling diabetes, said experts as part of a panel discussion on World Diabetes Day (12 November).

“Diabetes shortens life expectancy through the development of diabetes complications such as retinopathy, kidney disease, and cardiovascular disease,” Magliano told Reuters Health by email. “We believe the development of these complications may also influence the development of disability, although the mechanisms are not so clear yet.”

Managing blood sugar, blood pressure and lipids should be reasonable steps to maximize healthy years of life, she said.

“Another important intervention is physical activity, which is of proven value in slowing the decline of physical function, and should be strongly recommended in older people with diabetes, even if obesity and poor glycemic control are not a problem,” Magliano said.

Helping individuals with diabetes meet recommended preventive care guidelines and maintain an active lifestyle should reduce years lived with disability, Gregg said.

“The other thing that we can do in clinical settings is try to identify people at high risk for diabetes and help them make lifestyle changes,” since type 2 diabetes is largely preventable in the first place, he said.

Diabetes: A silent killer that hurts the world’s poorest

Diabetes is on the rise, both in Europe and worldwide. In Nicaragua, 600,000 people, more than 12% of the population, are affected by the chronic disease. EURACTIV’s partner El País – Planeta Futuro reports.

Background

For those with diabetes, controlling blood pressure is crucial, but not urgent

January 9, 2012

A new study suggests that middle-aged adults recently diagnosed with diabetes and hypertension have time to try to learn how to control their high blood pressure without medications, but not too much time.

The consequences of delaying effective hypertension treatment for up to a year were small–a two-day reduction in quality-adjusted life expectancy–according to a study by University of Chicago researchers published online for the Journal of General Internal Medicine. But as the delay gets longer, the damages multiply. A ten-year delay decreased life expectancy by almost five months.

“For newly diagnosed patients, this means we have time,” said study author Neda Laiteerapong, MD, instructor of medicine at the University of Chicago. “Most patients would prefer to control their blood pressure through diet and exercise rather than with medications, and it can take months to learn how to change old habits and master new skills. Our results indicate that it’s OK to spend from six months to a year, perhaps even longer, to make the difficult lifestyle changes that are necessary and will pay off in the long run.”

High blood pressure is especially damaging for people with diabetes, raising their risk of stroke, coronary artery disease, kidney failure, vision loss and amputations. Both the American Diabetes Association (ADA) and the National Institutes of Health recommend a lower blood pressure target for patients with diabetes than for the general public, urging them to keep their pressures below 130/80 mmHg.

Two out of three adults with diabetes, however, never reach that goal. Many patients are hampered by limited access to health care. Others are delayed by what the authors call “clinical inertia,” a disinclination by patients to implement lifestyle changes or reluctance by their doctors to push additional medications. Among those who are prescribed blood pressure drugs, at least 20 percent of patients with diabetes do not stick to their treatments.

Until now, the implications of these delays on patients’ health had not been quantified. Laiteerapong and colleagues built computer models using published data to determine the magnitude of harm caused by different delays in controlling blood pressure in patients from 50-59 years of age with newly diagnosed type 2 diabetes. The damage caused by a one-year delay “may be small,” they concluded but delays of ten years or more were comparable to smoking in patients with cardiovascular disease.

Given time to learn how, many patients would prefer to control blood pressure through diet and exercise rather than with antihypertensive medications. Most guidelines, however, including those of the ADA, recommend at most a three-month trial of medication-free lifestyle therapy for patients with moderately elevated blood pressure. They call for immediate initiation of medication for those with blood pressure more than 10mmHg above the goal.

That is often not enough time for patients to learn the methods, develop good habits and demonstrate improvements.

“We ask patients with diabetes to do a billion things,” Laiteerapong said, “to test their blood sugars, to count carbohydrates, to spend 30 minutes a day doing exercise, including cardio and weight training. Most, if not all, of this is new to them. They need time to adapt. It’s important to do this right, but our results say it’s not that important to do it so fast.”

This study argues that caregivers should work with patients to help them gain the knowledge and develop the necessary skills gradually rather than rushing to drug treatment, especially if their blood pressure is only mildly elevated. It suggests that patients and providers “have more time,” the authors write, “at least up to one year, to focus on diabetes self-management and lifestyle modification.”

“Among middle-aged adults with diabetes, the harms of a one-year delay in managing blood pressure may be small,” the authors conclude. “Health care providers may wish to focus on diabetes management alone in the first year after diagnosis, to help patients establish effective self-management and lifestyle modification. However, after the first year, it is clear that achieving and maintaining tight blood pressure control among US middle-aged adults with diabetes has the potential to generate substantial population-level health benefits.”

The National Institutes of Health funded this study. Additional authors include Priya John, David Meltzer and Elbert Huang, all of the University of Chicago.

If you have diabetes you should aim to keep your blood pressure well controlled. Having high blood pressure (hypertension) is one of several risk factors that can increase your chance of developing heart disease, a stroke and some other complications. Treatment includes a change in lifestyle risk factors where these can be improved. Many people with diabetes need to take medication to lower their blood pressure.

How common is high blood pressure in people with diabetes?

In the UK, about half of all people aged over 65, and about 1 in 4 of all middle-aged adults, have high blood pressure (hypertension). It is less common in younger adults. High blood pressure is more common in people with diabetes. Around 3 in 10 people with type 1 diabetes and around 8 in 10 people with type 2 diabetes develop high blood pressure at some stage.

People with diabetes are more at risk of developing high blood pressure if they:

  • Are of African-Caribbean origin.
  • Are from the Indian sub-continent.
  • Have a family history of high blood pressure.
  • Have certain lifestyle factors – for example, those who:
    • Are overweight.
    • Eat a lot of salt.
    • Do not eat much fruit and vegetables.
    • Do not take much exercise.
    • Drink a lot of alcohol.

What is high blood pressure?

This is not as simple to answer as it may seem. In general, the higher the blood pressure, the greater the risk to health. Depending on various factors, the level at which blood pressure is said to be high (hypertension) can vary from person to person.

The cut-off point for blood pressure that is said to be high is 140/80 mm Hg or above for people with diabetes and 130/80 mm Hg for those with diabetes and complications (for example, kidney disease). These are lower than the cut-off point for people who do not have diabetes.

Note: high blood pressure actually means that your blood pressure remains above the cut-off point each time it is taken. That is, your blood pressure is sustained at a level higher than it should be and is not just a one-off high reading when you happen to be stressed.

High blood pressure can be:

See separate leaflet called High Blood Pressure (Hypertension).

What causes high blood pressure?

The cause is not known in most cases. This is called essential hypertension. The pressure in the blood vessels depends on how hard the heart pumps, and how much resistance there is in the blood vessels (arteries). It is thought that slight narrowing of the arteries increases the resistance to blood flow, which increases the blood pressure. The cause of the slight narrowing of the arteries is not clear.

Various factors probably contribute. (It is a bit like water in a hosepipe. The water pressure is increased if you open the tap more but also if you make the hosepipe narrower by partially blocking the outflow with your thumb.)

Diabetic kidney disease

Diabetic kidney disease (diabetic nephropathy) is a complication which develops in some people with diabetes. In this condition the kidneys are damaged, which can cause high blood pressure. This is more common in people with type 1 diabetes.

Rarely, high blood pressure is caused by other conditions. It is then called secondary hypertension. For example, certain kidney or hormonal problems can cause high blood pressure.

Do I need any tests?

If you are diagnosed as having high blood pressure (hypertension) you are likely to be examined by your doctor and have some routine tests which include:

  • A urine test to check whether you have protein or blood in your urine.
  • A blood test to check your kidney function and to check your cholesterol level.
  • A heart tracing (electrocardiogram, or ECG).

The purpose of the examination and tests is to:

  • Rule out (or diagnose) a secondary cause of high blood pressure.
  • Check to see if the high blood pressure has affected the heart.
  • Check whether you have other risk factors such as a high cholesterol level.

Several of these tests are ones that are routinely done anyway if you have diabetes, even if you do not have high blood pressure.

Why is high blood pressure a problem?

High blood pressure (hypertension) is a risk factor for developing a cardiovascular disease (such as a heart attack or stroke) and kidney damage, sometime in the future.

If you have high blood pressure, over the years it may have a damaging effect on blood vessels (arteries) and put a strain on your heart.

In general, the higher your blood pressure, the greater your health risk. However, high blood pressure is just one of several possible risk factors for developing a cardiovascular disease.

Other risk factors that also increase the risk of developing a cardiovascular disease are:

  • Lifestyle risk factors that can be prevented or changed:
  • Smoking.
  • Lack of physical activity (a sedentary lifestyle).
  • Obesity.
  • An unhealthy diet.
  • Excess alcohol.
  • Diabetes.
  • High cholesterol blood level.
  • High fat (triglyceride) blood level.
  • Kidney diseases that affect kidney function.
  • A strong family history. This means if you have a father or brother who developed heart disease or a stroke before they were aged 55, or in a mother or sister before they were aged 65.
  • Being male.
  • An early menopause in women.
  • Age. The older you become, the more likely you are to develop furring or ‘hardening’ of the arteries (atheroma).
  • Ethnic group. For example, people who live in the UK, with ancestry from India, Pakistan, Bangladesh or Sri Lanka, have an increased risk.

Diabetes plus high blood pressure is a particularly strong combination of risk factors.
In addition, some other complications of diabetes are more common if you have high blood pressure. For example, damage to the back of the eye (diabetic retinopathy) and kidney damage related to diabetes (diabetic nephropathy).

What are the benefits of lowering blood pressure?

There is now plenty of good evidence from studies that controlling blood pressure in people with diabetes reduces the risk of future complications.

A large research study called the UK Prospective Diabetes Study confirmed this. In this study, many people with diabetes were monitored over several years. The study found that those with well-controlled blood pressure had nearly a third less risk of dying from complications related to diabetes (heart attack, stroke, etc) compared with those with poorly controlled blood pressure.

In fact, this study found that good control of blood pressure was even more beneficial than good control of the blood sugar (glucose) level to reduce the risk of developing complications from diabetes.

Since this study, other studies have been undertaken which confirm these results.

How can blood pressure be lowered?

There are two ways in which blood pressure can be lowered:

Lifestyle treatments to lower high blood pressure

  • Lose weight if you are overweight:
    • Losing some excess weight can make a big difference.
    • Blood pressure can fall by up to 2.5/1.5 mm Hg for each excess kilogram which is lost.
    • Losing excess weight has other health benefits too.
  • Regular physical activity:
    • If possible, aim to do some physical activity on five or more days of the week, for at least 30 minutes. For example, brisk walking, swimming, cycling, dancing, etc.
    • Regular physical activity can lower blood pressure in addition to giving other health benefits.
    • If you previously did little physical activity and change to doing regular physical activity five times a week, this can reduce your blood pressure.
  • Have a low salt intake:
    • The amount of salt that we eat can have an effect on our blood pressure. Government guidelines recommend that we should have no more than 6 grams of salt per day. (Most people currently have more than this.)
    • Tips on how to reduce salt include:
      • Use herbs and spices rather than salt to flavour food.
      • Limit the amount of salt used in cooking and do not add salt to food at the table.
      • Choose foods labelled ‘no added salt’ and avoid processed foods as much as possible.
  • Eat a healthy diet
    • If you have diabetes you will normally be given plenty of advice about a healthy diet.
    • A healthy diet provides health benefits in different ways. For example, it can lower cholesterol and help control your weight. It also has plenty of vitamins, fibre and other nutrients which help to prevent certain diseases. See separate leaflet called Type 2 Diabetes Diet for Healthy Eating.
  • Drink alcohol in moderation:
    • Too much alcohol can be harmful and can lead to an increase in blood pressure.
    • You should not drink more than the recommended amount. That is for both men and women no more than 14 units of alcohol per week, spreading the units out through the week and having at least two alcohol-free days a week.
    • Pregnant women and women trying to become pregnant should not drink alcohol at all.
    • One unit is in about half a pint of normal-strength beer, or two thirds of a small glass of wine, or one small pub measure of spirits.
    • Cutting back on heavy drinking improves health in various ways, including lowering your blood pressure.

Treatment with medication

  • If you have diabetes, treatment with medicines is usually advised if your blood pressure remains at 140/80 mm Hg or above despite lifestyle treatments.
  • The target blood pressure is below 130/80 mm Hg if you have had kidney or eye problems, or have had a stroke.

There are several different medicines that can lower your blood pressure. The one chosen depends on such things as:

  • Whether you have other medical problems.
  • Whether you take other medication.
  • Possible side-effects of the medicine.
  • Your age.
  • Your ethnic origin.

The first medicine most often used is a medicine called an angiotensin-converting enzyme (ACE) inhibitor. ACE inhibitors protect against kidney damage as well as helping to control blood pressure. Read more about diabetic kidney disease.

One medicine reduces high blood pressure to the target level in less than half of cases. This therefore means that it is common to need two or more different medicines to reduce your blood pressure to a target level (140/80 mm Hg or below).

In about a third of cases, three medicines or more are needed to get blood pressure to the target level. See separate leaflet called Medicine for High Blood Pressure.

How long is medication needed for?

In most cases, medication is needed for life. However, in some people whose blood pressure has been well controlled for a period of time, medication may be able to be stopped. In particular, in people who have made significant changes to their lifestyle (such as lost a lot of weight, stopped heavy drinking, etc). Your doctor will be able to advise you if you can reduce any of your medication.

Smoking and high blood pressure

Smoking does not directly affect the level of your blood pressure. However, smoking greatly adds to your health risk if you already have high blood pressure (hypertension) and diabetes. If you smoke, you should make every effort to stop.

When it comes to your first meal of the day, nothing may sound better than a bacon sandwich. But if you want to control your blood sugar levels, the popular breakfast treat should be avoided, as advised by the research charity.

It says: “The reason being that it is so often a deceptively processed food. Read the back of the pack of bacon and you’ll most likely be faced with a list of preservatives.

“Researchers are yet to fully understand why processed meats are so bad for us but the statistics repeatedly show a significant increase in risks of bowel cancer, heart disease and even type 2 sites associated with processed meats.

“Note that processed eats include burgers, sausages, hotdogs and store bought hams.”

A healthier alternative these meats is simply unprocessed red meat.

The research organisation adds: “Healthier options are larger cuts of meat that you can roast and slice yourself.

“Instead of bacon, look for belly pork and check to make sure there are no added sauces or unwanted ingredients.

“Chop or slice belly pork finely for a healthier alternative to bacon.”

Eating baobab extract could also help lower blood sugar levels.

Many Don’t Realize They Have Diabetes

The researchers say at least 7.8% of the U.S. population, or some 23.6 million people, have diabetes, including 5.7 million who don’t know they do.

The study also shows that:

  • 23.1% of people 60 and older, or 12.2 million people, have diabetes.
  • By 2034, this number will increase to 44.1 million.
  • By the same year, 14.6 million people who are Medicare-eligible will have the disease.
  • Annual diabetes-related spending is expected to reach $336 billion in 2034, which is almost three times the amount spent in 2009.
  • In 2007, diagnosed diabetes cost the U.S. an estimated $116 billion in direct medical costs and $58 billion in reduced productivity.
  • People with diabetes are responsible for about 20% of U.S. health care expenditures.
  • By 2025, more than half of people with diabetes will be 65 and older, and if this trend continues, it will become primarily a geriatric disease. In 2000, people 65 and older accounted for 40% of U.S. diabetes cases.
  • The prevalence of diabetes is projected to more than double between 2005 and 2050 for U.S. residents 20 to 64 and increase 220% for people between 65 and 74. For people 75 and older the prevalence is expected to increase 449%.
  • Diabetes is more common among non-whites; African-Americans are more likely to develop the disease than either whites or Hispanics.
  • African-Americans are more likely to die from diabetes than either Hispanics or whites. The overall diabetes mortality rate is 41% higher for Hispanics than for whites and 113% higher for non-Hispanic blacks than for whites.

The researchers say diabetes is the fourth leading cause of death among people 45 to 64, and the seventh leading cause of death for those 65 and older. Heart disease, the researchers say, is the main cause of death for older people with diabetes.

Researchers say that weight loss and exercise can be very effective in preventing diabetes in older adults who are at risk for diabetes.

When you’re diagnosed with diabetes, you may wonder, “Is this going to kill me? How long can I live with this?” These are scary questions. Fortunately, the answers have gotten better.

Advertisement

This article is about living longer with Type 1. Next week will be about Type 2.

History of life with Type 1
In Type 1, the insulin-producing beta cells in the pancreas are destroyed. Before insulin was discovered and made injectable, people with Type 1 diabetes generally wouldn’t survive more than a few months. The only treatment known to medicine was going on a low-carb, high-fat and -protein diet. People might live a few years that way.

According to the website Defeat Diabetes, “In 1897, the average life expectancy for a 10-year-old child with diabetes was about one year. Diagnosis at age 30 carried a life expectancy of about four years. A newly diagnosed 50-year-old might live eight more years.” (Probably, those 50-year-olds really had Type 2.)

In the 1920s, insulin was discovered and became available for use. Life expectancy with Type 1 went up dramatically. But when I started nursing in the 1970s, it was still common for people with Type 1 to die before age 50.

With better insulins, home testing, and lower-carbohydrate diets, people live longer. A study from the University of Pittsburgh, published in 2012, found that people with Type 1 diabetes born after 1965 had a life expectancy of 69 years. This compares to a life expectancy at birth of roughly 76 years for men and 81 years for women in the general population in the U.S.

A new study of about 25,000 people with Type 1 in Scotland found that men with Type 1 diabetes lose about 11 years of life expectancy, and women about 13 years compared to those without the disease.

According to WebMD, “Heart disease accounted for the most lost life expectancy among Type 1 diabetics, affecting 36% of men and 31% of women.”

A lot depends on glucose control. Well-controlled diabetes may have little effect on life span. A University of Tennessee study found a 44% reduction in overall risk of death for every 10% reduction in a person’s hemoglobin A1C. So reducing A1C from, say, 7.5% to 6.5% would cut risk of early death in half.

And it is possible to do even better. Dr. Richard Bernstein, author of Dr. Bernstein’s Diabetes Solution, was diagnosed with Type 1 at age 12. He is now 81 and still working out, practicing medicine, writing books, and looking good. He worked very hard to accomplish this, self-testing as many as eight times a day. By keeping his glucose in a normal range, he has had an exceptional life, despite all the needle sticks.

Not just glucose
Note that many early deaths in diabetes come from heart disease and strokes. Living longer with diabetes, then, is not only about reducing glucose, but about taking care of the heart.

Reducing blood pressure might be as important as controlling glucose when it comes to heart disease and stroke. Blood pressure can be treated with many different classes of medications. Healthy eating, relaxation, and exercise also bring pressure down. Stopping smoking should be the highest priority for people with diabetes. Smoking raises blood pressure and strains the heart.

You might wonder which drugs seem best for life expectancy. Current treatment guidelines call for insulin, one or more blood pressure medicines, usually a statin drug to lower cholesterol, and sometimes aspirin to prevent blood clots in the heart or brain. Although they may have harmful side effects, all of these do seem to prolong life, at least in people with Type 2 diabetes, in studies like this one from Belgium.

There are also herbal therapies. Diabates.co.uk reported: “Plant-based therapies that have been shown in some studies to have anti-diabetic properties include: aloe vera, bilberry extract, bitter melon, cinnamon, fenugreek, ginger, and okra.” I would add apple cider vinegar to that list. Please consult with your doctor before trying any of these for Type 1. There may be risk of interactions with your other medicines.

Relaxation and gentle exercise are good for the heart and will make you feel better as well. Longevity is not the only consideration. A long, miserable life is not a worthwhile goal. A life of happiness and love is worth working towards, and it may often turn out longer as well. Loving yourself is good for your heart.

At this point, most people with Type 1 can live close to a normal life span, if they work hard enough and get enough support. Without support or without money, it’s harder. Type 2 is more complicated, because more body systems are involved than the pancreatic knockout that is Type 1. We’ll look at that next week.

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