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August 29, 2001

Complications

Question from Rotherfield, East Sussex, United Kingdom:

I am 28 years old, have had type 1 diabetes for over 14 years now, and I have a strong family history of cardiovascular disease. I do not have any symptoms of heart disease, and my cholesterol and blood glucose levels have been well controlled, but all this has made me very concerned. I wonder if I could have some sort of test to see what condition I am in. My diabetes nurse and my occupational health officer at work advised me to check with my general practitioner. What is the best I can do?

Answer:

Diabetes care is also the clinical management of multiple cardiac risk factors. It sounds like you have the correct attitude, in light of your family history and diabetes.

Good blood sugar control and good cholesterol levels are great. Make sure you have a yearly screen for microalbuminuria since the development of nephropathy is the most potent risk for cardiovascular disease in patients with type�1 diabetes.

I would recommend an aspirin each day, provided there are no contraindications. Early use of an ACE inhibitor for mild hypertension (greater than 130/80 mm Hg) or microalbuminuria is recommended. Finally, I would recommend a periodic cardiac stress test. Whether this is now or in one year or at age 30 may depend on your health plan’s individual policy. This would be important to review. See: Cardiovascular Health — Is Your Heart in It? on the American Diabetes Association website.

JTL