Frederic J. Vagnini, M.D., FACS, is the medical director of The Heart, Diabetes, and Weight loss Centers of New York, and author of the recent book, “Weight Loss Plan for Beating Diabetes” and the upcoming book, “Breaking the Glycation Connection.” Dr. Vanini can be reached at his Web site or by e-mail at fvagnini@vagnini.com.
Have you noticed an increase in the number of patients diagnosed with type 2 diabetes? Are there lifestyle/dietary patterns that appear in these patients?
Vagnini: There is no question at the present time in the United States and throughout the world, diabetes and pre-diabetes is an absolute epidemic. The problem is many diabetics and pre-diabetics are not diagnosed, and they are not being treated properly when they are diagnosed. There is an area I call the glucose-heart disease connection. Many people with heart problems have underlying glucose abnormalities, and research has shown two out of three men going in the hospital for heart attack have pre-diabetes or diabetes, and two out of three women with high blood pressure have glucose abnormalities. There is a genetic tendency for diabetes, but presently many individuals are becoming diabetic regardless of genetics. There is an increase in consumption of sugar, calories, saturated fat and carbohydrates, as well as lack of exercise. There is no question these dietary and lifestyle patterns associated with genetic problems lead to obesity and diabetes. Of particular importance is visceral adiposity, with belly fat that is associated with metabolic syndrome. An individual with belly fat, high triglycerides and a family history of diabetes has an eight out of 10 chance of becoming diabetic.
As the medical director of the Heart, Diabetes and Weight Loss Centers of New York, what connections do you see between these three matters of health?
As indicated above, individuals with heart disease have a high incidence of pre-diabetes and diabetes, which was previously thought to be an endocrine disorder, and has now been identified by the American Heart Association (AHA) and American Diabetes Association (ADA) as also a cardiovascular disease (CVD). Individuals who are overweight, and especially those with visceral adiposity, have an increased risk of diabetes and heart disease. So there is no question of the significant relationship between these three elements.
What are the major issues or symptoms patients complain about prior to being diagnosed with diabetes?
The importance of diagnosing pre-diabetes is avoiding progression into frank diabetes and the problems pre-diabetes can lead to, including heart attack, stroke, Alzheimer’s disease, various cancers and dementia. I see diabetics in my office every day who have been misdiagnosed because doctors do not realize a fasting blood sugar of 90 or higher is pre-diabetes, and a diabetic is level at 126. The general medical population is unaware of these new guidelines. As a result, I am seeing many patients with diabetes who don’t know it. Common signals that suggest a predisposition to becoming diabetic begin with risk factors, including family history, hypertension, visceral adiposity, high triglycerides, low high-density lipoprotein (HDL), low testosterone and elevated uric acid. Symptoms that can be a clue to diabetes are unexplained weight loss, fatigue, blurry vision, dizzy spells, poorly healing wounds and other nondescript symptoms of fatigue.