The Heartache of Cardiovascular Comorbidities
More than the Sum of Their Parts
Beyond Blood Sugar: How Diabetes Affects the Heart
How Nurse Practitioners Can Identify and Treat Diabetic Heart Disease
- Look beyond blood sugar. While regulating a patient’s blood sugar levels is a primary objective in treating diabetes, a healthy A1C level should represent but one rung of the overall treatment ladder. Regulating blood glucose can reduce microvascular damage like retinopathy, a disease of the retina which impairs vision, but it has less of an effect on macrovascular damage, like heart ischemia.  Refrain from assuming that well-controlled sugar levels protect a patient from developing cardiomyopathy. In addition to glucose management, blood pressure regulation also needs to be considered when treating diabetic patients, as this demographic’s blood pressure goal is lower than that of the general population. According to Georgetown University’s School of Nursing & Health Studies assistant professor Melissa H. Frisvold, Ph.D., CNM, APRN, using statins to decrease cholesterol (and therefore high blood pressure) is more effective than prescribing insulin alone.
- Intervene early. At the first sign of a cardiac symptom in a patient previously diagnosed with diabetes, Nurse Practitioners may consider ordering additional tests or intervening with an appropriate therapy rather than the “watchful waiting” method.
- Educate the patient population. Patients newly diagnosed with diabetes may not understand their cardiovascular risk. NPs can raise awareness among populations of diagnosed and suspected diabetes patients through educational campaigns in provider offices and the community at large. This is when NPs should not only educate patients about the risks related to diabetes exacerbation, says Frisvold, but also inform them about health choices to prevent cardiovascular disease, such as appropriate exercise, nutrition, and smoking cessation.
- Consider social determinants of health. Environmental, social, and behavioral factors of a patient’s situation can greatly influence a Nurse Practitioner’s treatment plans. For example, patients with low literacy levels may not adhere to a medication regimen simply because they cannot interpret the dosing on the label. Patients without reliable transportation can face obstacles that prevent them from making it to their provider’s appointment. Diabetics who live in an urban food desert will find it challenging to achieve optimal dietary goals. By identifying and addressing social determinants of health, Nurse Practitioners simultaneously influence well-being in their patients who are experiencing multiple comorbidities.