Your Brain and Diabetes

This content originally appeared on diaTribe. Republished with permission.

By Brett Goerl and Matthew Garza

Recent studies have shown a link between brain diseases like Alzheimer’s and Parkinson’s and diabetes.  Unfortunately, these conditions are becoming more common as our population grows older. Find out more and ways to improve brain health.

What are neurodegenerative diseases?

The term “neurodegenerative diseases” refers to a range of diseases in which the cells in our brains break down and can no longer perform their designated functions associated with movement or mental ability, according to the EU Joint Programme – Neurodegenerative Disease Research. The most common neurodegenerative diseases that affect people with diabetes are mild cognitive impairment (MCI) and dementia, which includes Alzheimer’s disease.

As we age, it is completely normal for our memory, thinking, and judgment to slightly decline. However, MCI occurs when our mental abilities decline faster than expected and begin to interfere with our daily lives. Age is by far the biggest risk factor for MCI, but diabetes, smoking, high blood pressure and cholesterol, obesity, and depression can further increase a person’s risk of developing MCI.

In around 10-15% of cases each year, the mental decline seen in MCI may progress further, making it difficult for us to carry out a healthy and happy life. When this happens, it is called dementia. The two most common types of dementia that affect people with diabetes are Alzheimer’s disease (AD) and vascular dementia.

While the symptoms of AD and vascular dementia are similar, they are caused by two different processes that occur in our brains. AD is thought to be caused by the abnormal build-up of proteins in the brain. One protein is “amyloid,” which clumps together in spaces around brain cells. The other protein is “tau,” which get tangled up inside brain cells. Vascular dementia, on the other hand, occurs when the blood vessels in our brain become narrow or start to bleed. This reduces the brain’s ability to get the oxygen it needs to keep brain cells healthy and for the brain to function properly. In both cases, brain cells become damaged, leading to a wide range of problems such as memory loss, worsened judgment, and personality changes.

AD is the most common form of dementia in the US, making up 60-70% of dementia cases. In the US, an estimated 5.4 million people of all ages are affected by AD, and one in eight people 65 years and older suffer from it. Considering the 14.3 million adults aged 65 and older in the U.S. who have diabetes, and it is easy to see why Alzheimer’s disease and diabetes are two of the most common diseases of aging. And recent research has suggested that they may be linked in various ways.

How do neurodegenerative diseases like Alzheimer’s and vascular dementia relate to diabetes? 

We often think of diabetes as a problem with our metabolism since the lack of insulin (in type 1 diabetes) or insulin resistance (in type 2 diabetes) affects our body’s ability to maintain normal blood glucose levels. However, our brain consumes the most glucose compared to any other organ in our body. While the brain accounts for roughly 2% of our body weight, it uses almost 20% of the sugars we eat or release from our body’s stores.

An increasing amount of research shows that people with AD and other forms of dementia experience insulin resistance in the CNS (central nervous system, which includes the brain and the spinal cord), similar to what people with type 2 diabetes experience in other areas of the body, such as the muscles, the liver, and the fat. Scientists have yet to determine exactly what the relationship between diabetes and AD or other forms of dementia may be caused by, but there are a few theories that have been proposed.

  • One of these theories focuses on brain insulin resistance, which is when brain cells stop responding normally to insulin, leading to problems related to the ways our brain cells communicate, use energy, and fight infection.
    • Insulin receptors can be found in many areas of the brain, where they are involved with brain cell growth, communication, and survival. While insulin levels are lower in the brain than in the bloodstream, all the insulin that makes its way to the brain comes from the same insulin produced in the pancreas – it crosses over what is known as the blood-brain barrier (or BBB). This barrier prevents unwanted things from the bloodstream from entering the brain. However, injected insulin does not cross the BBB. The reduced transport of insulin across the BBB may be why brain insulin levels are lower when the body experiences insulin resistance (such as in pre-diabetes and type 2 diabetes) and in diseases such as AD.
    • Insulin in the brain is known to help control our metabolism in certain other organs of the body, like the liver and fat tissue. The hypothalamus, the part of our brain that controls hunger, thirst, and emotions, is highly sensitive to levels of insulin in the brain. The association between type 2 diabetes and brain health may be due to problems with insulin’s actions in the hypothalamus, increasing a person’s likelihood of developing whole-body insulin resistance.
  • Diabetes also increases the risk for damaged blood vessels, leading to heart disease and stroke. Damaged blood vessels can starve the brain of oxygen, leading to cognitive decline and vascular dementia.
  • Diabetes disrupts how our bodies produce amylin, a hormone related to insulin that helps our bodies digest food. People with obesity and pre-diabetes often have high amounts of amylin, some of which can circulate and cross into the brain. Studies have shown that amylin can interact with the same protein deposits in the brain known to cause AD.
  • Experiencing hyperglycemia for long periods of time can degrade the myelin sheath (a protective layer that surrounds your neurons). This leads to issues in how your nerves send and receive signals to your body. It can also lead to your brain cells dying.

Type 1 diabetes could be a risk factor for dementia for many of the same reasons as type 2 diabetes. In particular, the cardiovascular complications such as heart disease and stroke that are associated with type 1 diabetes could provide an explanation for its relationship with vascular dementia. Additionally, higher rates of cognitive dysfunction for those with type 1 diabetes could be related to frequent cases of hyperglycemia and hypoglycemia. Indeed, severe hypoglycemic and hypoglycemic events are associated with increased dementia risk for older adults with type 1 diabetes.

Is diabetes a risk factor for developing neurodegenerative disease? 

On average, people with diabetes experience slightly more cognitive difficulties associated with MCI across their lifespan, but experiencing cognitive difficulty does not mean you will eventually get diagnosed with dementia or AD. The prevalence of type 2 diabetes and neurodegenerative diseases, however, both increase with age, meaning it is more common for older people (65+ years) with type 2 diabetes to get diagnosed with vascular dementia or AD.

Data suggests that people with diabetes have a 73% increase in the risk of developing any type of dementia and 56% increase in the risk of developing AD compared to people who do not have diabetes. This makes diabetes one of the strongest risk factors for getting dementia aside from aging. Health measures like A1C, cholesterolhigh blood pressure(or hypertension), and eGFR are negatively impacted by diabetes and may also be associated with cognitive performance and neurodegenerative diseases.

  • In the ACCORD-MIND trial, the largest and most rigorous study on diabetes and the brain to date, higher A1C levels were associated with lower cognitive function in people with diabetes. Similarly, another study found that the risk for dementia increased as a person’s A1C level increased, regardless of whether or not the person had type 2 diabetes.
  • A recent analysis of over 100 studies found that higher levels of LDL cholesterol (known as “bad cholesterol”) was an independent risk factor for the development of AD.
  • High blood pressure in middle-aged people has been linked to future cognitive decline and dementia, and in particular, vascular dementia. This may be due to high blood pressure in the brain causing damage to blood vessels, such as small blockages and bleeding.
  • In a study on kidney health and dementia recently published recently, researchers found that lower rates of kidney filtration (as measured by eGFR) were associated with higher risk of onset of both vascular dementia and AD.

What about Parkinson’s Disease?

Parkinson’s Disease (PD) is another neurodegenerative disease associated with aging. In PD, the cells in your brain deteriorate and begins to affect a person’s ability to perform daily activities associated with movement. Symptoms can include tremors (rhythmic shaking), muscle stiffness and rigidity, and PD can even slow your movement in a process called bradykinesia. It can also lead to other symptoms not associated with movement such as disrupting sleep, constipation, anxiety, depression, and fatigue.

As with other neurodegenerative diseases, research has been conducted to identify if there is a link between diabetes and PD. In particular, one study from 2018 showed an association between the two conditions. The researchers looked at the English National Hospital Episode Statistics and Mortality Data from 1999-2011 and divided the data into two cohorts, those with type 2 diabetes (2,017,115 people) at the time of hospital admission and those without (6,173,208 people). It was found that those with diabetes had a 30% higher chance of developing PD than those without, and the younger a person was with diagnosed type 2 diabetes, the more likely their chance of developing PD.

Though researchers do not yet understand the exact way that diabetes and PD are related, they do have a few hypotheses. Namely, there is the chance that certain genetic abnormalities that lead to diabetes may also lead to PD; even if one of these conditions does not directly cause the other, people who have one may be more likely to also have the other. In addition, when diabetes and PD coexist in a person, they may create a more hostile environment in the brain, leading the neurodegenerative processes underway in PD to speed up and be more severe.

What are strategies to reduce the risk of developing a neurodegenerative disease?

There is evidence that leading a healthy lifestyle can reduce your risk of developing diabetes-related complications like dementia or PD. For example, heart attacks and stroke can increase the risk of developing vascular dementia; therefore, lifestyle modifications that help you maintain an ideal blood pressure and levels of cholesterol for your age and health status are important. This can be accomplished by exercising regularly and consuming a diet low in saturated fat, salt, and sugar.

Below are some other tips for improving brain health, which can go a long way in reducing the risk of neurodegenerative diseases like AD. The good news is that many of these strategies are also recommended for managing diabetes.

  • Take control of your blood glucose levels by aiming for a greater time-in-range (TIR). To learn more about time-in-range goals, click here.
  • Smoking is associated with higher rates of dementia. In a recent review, smokers were 40% more likely to develop AD than non-smokers. Given that people with diabetes are at an increased risk of developing dementia, smoking is likely to increase this risk further. If you smoke or experience nicotine addiction, talk to your healthcare professional about a plan to quit or cut back.
  • Keep blood pressure at the target discussed with your health care provider (which might be 130/80 mmHg or less, if you are at high risk of cardiovascular disease) by exercising regularly and eating a diet low in salt (aim for less than 2,300 mg of sodium each day)
  • Take your diabetes medications consistently and as directed by your healthcare team. Some early evidence shows that certain diabetes drugs, like GLP-1 receptor agonists, may be beneficial for brain health. In fact, exenatide, a GLP-1 receptor agonist, is currently in clinical trials for treating PD.
  • A very active area of research focuses on the dementia-preventing effects of having an active and stimulating mental life and rich social networks. Working to maintain an active and socially rich lifestyle could help prevent some of the effects of diabetes on dementia risk.

If you are 65 years of age or older and have memory concerns or other cognitive complaints (i.e., brain fog, depression, personality change), talk to your healthcare provider about getting a cognitive assessment. Learn more here.

Source: diabetesdaily.com

Heart Failure – The Overlooked Diabetes Complication, Part 1: What and Why?

This content originally appeared on diaTribe. Republished with permission.

By Ben Pallant

Learn what heart failure is, what it has to do with diabetes, and how to identify and talk about this complication that’s often less discussed.

Healthcare professionals often discuss diabetes complications such as vision loss (retinopathy), chronic kidney disease (nephropathy), and cardiovascular disease (referred to as atherosclerotic cardiovascular disease by healthcare professionals). However, there is a less talked about heart complication, heart failure. Heart failure refers to a condition where the heart’s ability to pump blood is less than normal, often meaning not enough blood is effectively circulating to the rest of the body.

This is part one of a two-part series on heart failure and diabetes.

What is heart failure?

First, it’s important to differentiate heart failure from other conditions such as cardiovascular disease, a heart attack, or cardiac arrest. There is also the broad term “heart disease,” which can encompass any heart issue. Because the names can get confusing, here are some brief explanations:

  • Cardiovascular disease, or atherosclerotic cardiovascular disease, is related to the process called atherosclerosis, which occurs when a substance called plaque builds up in your arteries making it difficult for blood to flow normally. The plaque buildup can be caused by high blood pressure, high cholesterol or triglycerides, smoking, or a number of other reasons. When it builds up in the arteries that supply blood to heart muscles or the brain, a heart attack or stroke can occur. Read our article on diabetes and heart disease here.
  • In a heart attack, the blood flow (and the oxygen supply, since blood carries oxygen throughout the body) to the heart muscle is blocked, causing damage to the heart muscle.
  • Heart failure happens when the heart isn’t able to pump enough blood to the rest of the body.
  • Cardiac arrest is the sudden loss of heart function. Usually due to an issue with the heart’s electrical system that disrupts a regular heartbeat, cardiac arrest causes the heart to stop pumping blood to the rest of the body.

There are a number of reasons why heart failure can occur, including coronary artery disease, high blood pressure, previous heart attacks, or other conditions and structural issues that damage the heart muscle (like cardiomyopathy or heart valve problems). Your chances of developing heart failure also increase as you get older. The heart’s inability to pump enough blood usually happens in one of two ways:

  1. When the heart muscle becomes stiff, the chambers in the heart cannot relax. This decreases the fill capacity of your heart chambers. Nevertheless, the heart is still able to release more than 50% of the blood in the heart chamber to the rest of the body. This type of heart failure is called “heart failure with preserved ejection fraction,” or HFpEF.
  2. When the heart muscle becomes weaker, not enough blood goes out to the body with each heartbeat. Thus, the percentage of blood that is released to the body is less than 50% of the amount in the heart chamber. This type of heart failure is called “heart failure with reduced ejection fraction,” or HFrEF.

Diabetes and prediabetes have been associated with both types of heart failure. Heart failure overall is a widespread health challenge – over 6 million Americans live with heart failure, and it leads to about 1 million hospitalizations per year in the US.

Heart failure is usually a chronic condition that progresses over time. At first, people may not experience any physical symptoms at all because the body has ways of trying to compensate – the heart may become bigger, it could develop more muscle mass, or it could try to pump faster. Over time though, heart failure worsens leading to shortness of breath, fatigue, inability to exercise, and more. Eventually the heart’s decreased ability to pump blood causes fluid to build up in other parts of the body, including the legs and lungs, which makes ordinary things like breathing and walking difficult. This is called congestive heart failure (CHF).

To learn more about heart failure, check out the American Heart Association’s heart failure resources.

What does heart failure have to do with diabetes?

Heart failure is unfortunately one of the most common and deadly complications of diabetes, especially for people with type 2 diabetes. They are two to four times more likely to develop heart failure than people without diabetes, and having diabetes increases a person’s risk for repeat hospitalizations for heart failure. This is partly because many of the key risk factors for heart failure are common in people with type 2 diabetes, such as a body mass index (BMI) over 25 (click here for a BMI calculator), high blood pressure, coronary artery disease, or a history of a heart attack. Other risk factors for heart failure include heart valve problems, sleep apnea, lung disease, and smoking.

But the shared risk factors alone don’t explain everything – diabetes itself is an independent risk factor for heart failure. According to several research studies, each percentage point increase in A1C is associated with an increased risk (8-36%) of heart failure. Researchers suspect that over time, high blood sugar levels either damage the cells of the heart muscles or force the heart to work harder due to damage to smaller blood vessels throughout the body and in the heart – this may be why high glucose levels are associated with heart failure.

Signs, symptoms, and screening

The Mayo Clinic and the American Heart Association have identified a number of possible symptoms of heart failure. These include:

  • Shortness of breath during activity or when you lie down
  • Tiredness and weakness
  • Swelling in your legs, ankles and feet, and very rapid weight gain (due to fluid retention)
  • Rapid or irregular heartbeat
  • Persistent coughing or wheezing (or coughing that produces pink, foamy mucus)
  • Chest pain if the heart failure is caused by a heart attack
  • Lack of appetite or nausea
  • Confusion or impaired thinking

It is especially important to seek immediate medical attention if you experience chest pain, severe fatigue or weakness, rapid or irregular heartbeats with shortness of breath or fainting, or sudden, severe shortness of breath especially if it is associated with coughing up pink, foamy mucus. For CHF especially, seeking timely medical attention is essential.

Talking to your healthcare team is key to making sure you are staying healthy, and it can help identify an early diagnosis. If you are experiencing any of the above symptoms, ask your healthcare professional if you can be tested for heart failure. Even if you aren’t exhibiting symptoms, start a conversation about what you can do to stay healthy and prevent future complications.

How do healthcare professionals test for heart failure?

Heart failure is most commonly assessed using medical imaging techniques that allow healthcare professionals to “see” the heart and assess its function. The most common test associated with heart failure is echocardiography (often called an “echo”) which is a non-invasive, painless ultrasound image of the heart. The echocardiogram can show how thick the heart muscle is and how much blood is pumped out of the left ventricle (one of the heart’s four chambers) with each beat. This information can be used to determine whether heart failure involves preserved or reduced ejection fraction.

Other imaging tests include an x-ray, an MRI, and a myocardial perfusion scan. An x-ray can see if the heart is enlarged or if there is fluid in the lungs, two signs of CHF. If your healthcare professional is concerned that there may be damage to the heart muscle or blockages of major blood vessels to the heart muscle, they may recommend an MRI. A myocardial perfusion scan uses a tiny amount of a radioactive substance that allows the heart to be imaged. It can show how well the heart muscle is pumping and areas with poor blood flow. This scan is often done with an exercise stress test (explained below).

In addition to these different imaging techniques, healthcare professionals use exercise stress tests (which measure how a person responds to increasingly difficult exercise) as a measure of heart function, blood tests to check for heart failure-associated strain on the kidney and liver, or an electrocardiogram (EKG or ECG) test to look at the heart’s electrical activity for signs of a heart attack and to see if the heart rhythm is abnormal.

Before any of these heart tests are ordered, your healthcare team will usually conduct a physical exam to determine what your symptoms are and what tests are needed. It’s important to be honest – your healthcare team needs to know about your lifestyle, including whether you smoke cigarettes, eat a lot of high-fat foods, and are physically active. Be prepared to answer other questions too:

  • When did symptoms begin?
  • How severe are the symptoms?
  • Does anything make the symptoms better or worse?
  • Do you have a family history of heart disease, diabetes, or high blood pressure?
  • Are you taking any medications, including over-the counter-drugs, vitamins, supplements, or prescriptions?

To learn more about heart failure, including prevention, medication options, and management tips, read “Heart Failure – The Overlooked Diabetes Complication, Part 2: Prevention and Management,” which our team will be updating this summer. You can also check out the Know Diabetes By Heart resources on heart failure.

This article was originally published on June 15, 2018. It was updated in May 2021 by Matthew Garza as part of a series to help people with diabetes learn how to support heart health, made possible in part by the American Heart Association and American Diabetes Association’s Know Diabetes by Heart initiative.

Source: diabetesdaily.com

What Are SGLT-2 Inhibitors and How Can They Help Your Heart?

This content originally appeared on diaTribe. Republished with permission.

By Mary Barna Bridgeman

SGLT-2 inhibitors can protect your heart! This type of medicine is recommended for people with type 2 diabetes who have heart disease or risk factors related to heart disease. Learn about the use of these medicines, including side effects, their effect on A1C, and their role in supporting heart health

Diabetes is a risk factor for heart disease: people with diabetes are twice as likely to have heart disease or a stroke compared to those without diabetes. Heart disease is often a “silent” condition, meaning that symptoms are not necessarily present until a heart attack or a stroke actually happens. It is important for people with diabetes to realize they may be at risk – click to read more about the link between diabetes and heart disease from Know Diabetes By Heart.

There are many ways to take care of your heart and to reduce the risk of heart disease while living with diabetes. New medicines, including sodium-glucose cotransport 2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) agonists, have been shown to protect the heart and reduce the risk of many specific heart-related outcomes. This article will focus on SGLT-2 medications, and our next article will focus on GLP-1 medications.

Heart diseases

Image source: diaTribe

Click to view and download diaTribe’s helpful infographic on preventing heart disease.

What are SGLT-2 inhibitors?

There are currently four medicines that are categorized as SGLT-2 inhibitors:

These medicines help people with type 2 diabetes manage their glucose levels: they work in the kidneys to lower sugar levels by increasing the amount of sugar that is passed in the urine. SGLT-2s increase time in range and reduce A1C levels while also lowering blood pressure and supporting weight loss. For people with diabetes who have had a heart attack or are at high risk of heart disease, or who have kidney disease or heart failure, these medicines could be considered regardless of A1C level. While SGLT-2 medications are expensive, some assistance programs are available to help with cost – see one of diaTribe’s most popular articles, “How to Get Diabetes Drugs For Free.”

What do you need to know about SGLT-2 inhibitors?

SGLT-2s have a low risk of causing hypoglycemia (low blood sugar levels). Because they increase sugar in the urine, side effects can include urinary tract infections and genital yeast infections in men and women. Dehydration (loss of fluid) and low blood pressure can also occur. Symptoms of dehydration or low blood pressure may include feeling faint, lightheaded, dizzy, or weak, especially upon standing.

Before starting an SGLT-2 inhibitor, here are some things to discuss with your healthcare team if you have type 2 diabetes:

  • How much water to drink each day
  • Ways to prevent dehydration and what to do if you cannot eat or you experience vomiting or diarrhea (these are conditions that may increase your risk of developing dehydration)
  • Any medicines you take to treat high blood pressure

When prescribed for people with type 2 diabetes, SGLT-2s rarely cause diabetic ketoacidosis (DKA), a serious and potentially life-threatening condition. For people with type 1 diabetes, DKA is a well-known risk when SGLT-2s are prescribed. Call your healthcare professional if you have warning signs of DKA: high levels of ketones in your blood or urine, nausea, vomiting, lack of appetite, abdominal pain, difficulty breathing, confusion, unusual fatigue, or sleepiness. When you are sick, vomiting, have diarrhea, or cannot drink enough fluids, you should follow a sick day plan – see Dr. Fran Kaufman’s article on developing your sick day management plan. Your healthcare professional may instruct you to test your urine or blood ketones and stop taking your medication until symptoms go away.

If you have type 1 diabetes or chronic kidney disease, depending on your level of kidney function, these medicines may not be for you. Additionally, SGLT-2s are associated with increased risk of lower limb amputation.

SGLT-2 inhibitors are usually taken as a pill once a day – often in the morning before breakfast – and can be taken with or without food.

What do SGLT-2 inhibitors have to do with heart health?

Results from clinical studies suggest SGLT-2 inhibitors may play an important role in lowering heart disease risks.

Jardiance was the first SGLT-2 inhibitor to show positive effects on heart health in the EMPA-REG OUTCOME trial. In this study, more than 7,020 adults with type 2 diabetes and a history of heart disease were followed. Participants received standard treatment for reducing heart disease risk – including statin medications, blood pressure-lowering drugs, aspirin, and other medicines – and diabetes care, plus treatment with Jardiance. Over a four-year period, results from the study showed that, compared to placebo (a “nothing” pill), Jardiance led to:

  • a 14% reduction in total cardiovascular events (heart attacks, strokes, heart-related deaths)
  • a 38% reduction in risk of heart-related death
  • a 32% reduction in overall death
  • a 35% reduction in hospitalizations from heart failure

Read diaTribe’s article on the results here.

Similarly, the heart protective effects of Invokana have been shown in two clinical studies, CANVAS and CANVAS-R. These two studies enrolled more than 10,140 adults with type 2 diabetes and a high risk of heart disease, randomly assigned to receive either Invokana or placebo treatment. In the CANVAS studies, treatment with Invokana led to the following:

  • a 14% reduction in total cardiovascular events (heart attacks, strokes, heart-related deaths)
  • a 13% reduction in risk of heart-related death
  • a 13% reduction in overall death
  • a 33% reduction in hospitalizations from heart failure

Read diaTribe’s article on the results here.

Farxiga may also reduce heart disease risks. In the DECLARE-TIMI 58 study, more than 17,000 people with type 2 diabetes received Farxiga; 40% of participants had known heart disease and 60% had risk factors for heart disease. Importantly, more than half of the people included in this study did not have existing heart disease. While Farxiga was not found to significantly reduce total cardiovascular events (heart attacks, strokes, heart-related deaths) compared with placebo, its use did lead to a 17% lower rate of heart-related death or hospitalization for heart failure. Read diaTribe’s article about the results here.

More recently, the DAPA-HF study evaluated the use of Farxiga for treating heart failure or death from heart disease in people with or without type 2 diabetes. The study included more than 4,700 people with heart failure; about 42% of those enrolled had type 2 diabetes. Farxiga was shown to reduce heart-related death or worsening heart failure by 26% compared to placebo, both in people with type 2 diabetes or without diabetes. Learn more about these results here.

All of the available SGLT-2 inhibitors have evidence suggesting benefits of this class of medications for people with established heart failure. Click to read diaTribe’s article on SGLT-2 Steglatro and heart health.

Other possible benefits of SGLT-2 inhibitors

InvokanaFarxiga, and Jardiance have also been shown to reduce the progression of kidney disease. Learn more about diabetes and kidney disease here.

SGLT-2s have been studied in people with type 1 diabetes, but are not yet approved for use by the FDA – you can learn about SGLT-2s for people with type 1 diabetes here.

What’s the bottom line?

You can reduce your risk of heart disease and promote heart health while living with diabetes. You and your healthcare team should develop a personalized plan to determine what ways are best for reducing your risk of heart disease. According to the latest evidence and treatment recommendations, SGLT-2 inhibitors may be most useful for people with type 2 diabetes and heart disease or at high risk of heart disease.

About Mary

Mary Barna Bridgeman, PharmD, BCPS, BCGP is a Clinical Professor at the Ernest Mario School of Pharmacy at Rutgers University. She practices as an Internal Medicine Clinical Pharmacist at Robert Wood Johnson University Hospital in New Brunswick, New Jersey.

This article is part of a series to help people with diabetes learn how to support heart health, made possible in part by the American Heart Association and American Diabetes Association’s Know Diabetes by Heart initiative.

Source: diabetesdaily.com

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