New Report Outlines Heart Health Goals for People With Type 2 Diabetes

Cardiovascular disease is a leading cause of illness for people with Type 2 diabetes, but lifestyle factors can help reduce the risk. The American Heart Association (AHA) released a new Scientific Statement with advice for mitigating the risk of heart disease for people with Type 2 diabetes.

"It is estimated that having diabetes can double the risk of heart disease or stroke," says Erin Palinski-Wade, RD, CDCES, a dietitian, diabetes expert, and the author of "2 Day Diabetes Diet." "In fact, heart disease is the leading cause of death among people with diabetes."  

About the Scientific Statement

Cardiovascular disease (CVD) includes a variety of disorders of the heart and blood vessels, including coronary heart disease, heart failure, and peripheral artery disease. The new statement from the AHA outlines updated research on managing heart disease risk factors, including new information about anti-hyperglycemic medications that can help improve glycemic control.

There are a number of lifestyle changes that can help people with Type 2 diabetes manage cardiovascular disease risk factors, including nutrition, physical activity, limiting alcohol intake, increased education, and psychosocial care. In fact, the AHA statement indicates that adults with Type 2 diabetes that adhere to an overall healthy lifestyle experience a substantially lower risk of incident CVD.

Nutrition and Diet

There is no specific "diabetes diet" that helps everyone. Instead, a customized approach is important for CVD risk reduction. The right diet is one that is acceptable, affordable, and accessible, while balancing medical needs and personal preferences. For success, a dietitian should be involved in the care plan.

In fact, the AHA says that many different dietary patterns may be helpful. These include the Mediterranean, DASH, paleo, low-carbohydrate, high-protein, and vegetarian options.

"No one diet works for every person with diabetes," says Palinski-Wade. "You want to follow a meal plan that matches your health goals, but also works for your lifestyle and is one you can actually stick with."

Palinski-Wade says that instead of trying to make extreme changes, focus on making small changes you can be consistent with over time. For instance, she offers a number of tips that could be added gradually. These include filling half your plate with non-starchy vegetables at each meal, increasing fiber intake, reducing added sugars, and swapping out animal fats such as butter for more plant-based oils.

"Once you choose your dietary pattern, the foods you select each day also make a difference and should be limited in saturated fat, added sugar, and sodium," adds Toby Amidor, MS, RD, CDN, FAND, nutrition expert and author of the "Create-Your-Plate Diabetes Cookbook."

Importance of Physical Activity

Exercise is recommended for people with Type 2 diabetes because it helps improve blood sugar. It also helps reduce blood pressure, cholesterol levels, and inflammation. Physical activity is also associated with a lower risk of CVD.

Aim for 150 minutes of moderate-to-vigorous intensity aerobic activity per week. This can be spread out over at least three days, with no more than two consecutive days without activity.

In addition to aerobic activity, such as walking, biking, dancing, or swimming, it is also important to include two or three sessions of resistance exercise each week. Some examples include planks, resistance bands, weight lifting, or push-ups. Finally, add in some flexibility and balance training like stretching or yoga two or three times per week.

Impact of Alcohol Intake

Among individuals with Type 2 diabetes, light-to-moderate alcohol consumption, particularly wine, has been associated with fewer heart attacks and some improved cardiometabolic measures. But, heavy alcohol consumption increases blood pressure levels and increases heart attack risk. Moderation is important when you have Type 2 diabetes.

"Alcohol adds calories and can also lead to a drop in blood glucose levels because alcohol blocks the production of glucose in the liver," says Amidor. "Once the liver's stores of glucose are used up, a person who has been drinking alcohol can't make more right away, and that can lead to dangerously low blood glucose levels." 

If you do not drink alcohol, don't start. If you do drink alcohol, know that there is a potential risk of high blood pressure. Plus, alcohol makes it harder to manage blood sugar levels. Stick with no more than one drink per day for women and no more than two drinks per day for men.

"One drink is defined as 12-fluid ounces of beer, 5 fluid ounces of wine, and 1.5 fluid ounces of 80-proof liquor like rum and vodka," explains Amidor.

Blood Pressure and Cholesterol Levels

Part of a healthy lifestyle also includes regular checkups, ongoing education, psychological support (as needed), and monitoring clinical parameters like blood sugar and blood pressure levels.

Palinski-Wade says that, in addition to managing your diet, adding daily physical activity, managing stress levels, and getting adequate sleep can help promote healthy blood glucose and blood pressure levels.

"People with diabetes should focus on keeping their blood sugar, cholesterol, and blood pressure levels in as normal a range as possible to help to reduce their overall risk of developing heart disease," says Palinski-Wade.