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Type 2 diabetics can reduce cardiovascular disease risk

Raghu Kshitiz

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With proper treatment and not smoking, individuals with type 2 diabetes can significantly reduce their risk of cardiovascular disease, according to a new study in Sweden.

Individuals with type 2 diabetes have 10 times the risk for heart attack, heart failure and stroke, and five times the risk for premature death compared with the control group.

In a study published in The New England Journal of Medicine, researchers at University of Gothenburg in Sweden said that the increased risks could be theoretically eliminated.

“The study shows that patients with type 2 diabetes with all risk factors within therapeutic target range had an extremely low risk of premature death, heart attack and stroke. This is definitely good news,” author Aidin Rawshani, a doctoral student at the Institute of Medicine, Sahlgrenska Academy, said in a press release.

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For the study, researchers analyzed data on 271,174 patients with type 2 diabetes registered in the Swedish National Diabetes Register from 1998-2014 and matched with 1.35 million controls on the basis of age, sex and county. In a median followup of 5.7 years, there were 175,345 deaths.

Risk factors that can be controlled by medication, and cigarette abstinence, are blood pressure, long-term blood glucose, lipid status, renal function and smoking, according to the researchers.

Smoking was the most important risk factor for premature death and an elevated blood glucose level was the most dangerous factor for heart attack and stroke.

“By optimizing these five risk factors, all of which can be influenced, you can come a long way,” Rawshani said adding, “We have shown that the risks can be greatly reduced, and in some cases may even be eliminated.”

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In some cases, patients with type 2 diabetes have no more than a 10 percent elevated risk of premature death, heart attack and stroke compared with the general population. The risk for heart failure is 45 percent higher among those with type 2 diabetes in those instances.

In addition, the risk of complications, especially heart failure, is greatest among those under 55 years.

“This makes it extra important to check and treat risk factors if you are younger with type 2 diabetes.” Rawshani added.

With Agency Inputs

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Suicide can’t be predicted by asking about suicidal thoughts : Study

Gorkha Post

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Most people who died of suicide deny they experience suicidal thoughts when asked by doctors in the weeks and months leading up to their death, a major Australian study has found.

The findings, co-authored by clinical psychiatrist and Professor Matthew Large from UNSW’s School of Psychiatry, Sydney that published in the journal BJPsych Open The meta-analysis challenge the widely-held assumption that psychiatrists can predict who will suicide by asking if they are preoccupied with thoughts of killing themselves.

The study showed that 80% of patients who were not undergoing psychiatric treatment and who died of suicide reported not to have suicidal thoughts when asked by their psychiatrist or GP.

“If you meet someone who has suicidal ideation there is a 98 per cent chance that they are not going to suicide,” said Professor Large, an international expert on suicide risk assessment who also works in the emergency department of a major Sydney hospital.

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“But what we didn’t know was how frequently people who go on to suicide have denied having suicidal thoughts when asked directly,” he added.

“This study proves we can no longer ration psychiatric care based on the presence of suicidal thoughts alone. We need to provide high-quality, patient-centred care for everyone experiencing mental illness, whether or not they reveal they are experiencing suicidal thoughts,” Professor Large said.

About one in 10 people will have suicidal ideation in their lifetime. But the study showed suicidal ideation alone was not rational grounds for deciding who gets treatment and who does not, Professor Large said.

“We know that suicide feeling is pretty common and that suicide is actually a rare event, even among people with severe mental illness,” Professor Large added.

Suicidal ideation tells us an awful lot about how a person is feeling, their psychological distress, sometimes their diagnosis and their need for treatment but it’s not a meaningful test of future behaviour.

Suicidal feelings can fluctuate rapidly and people may suicide very impulsively after only a short period of suicidal thoughts.

But, people had good reasons not to disclose thoughts of suicide, fearing stigma, triggering over-reactions or upsetting family and friends, and being involuntarily admitted for psychiatric treatment, Professor Large said.

Professor Large emphasized that clinicians should not assume that patients experiencing mental distress without reporting suicidal ideas were not at elevated risk of suicide.

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