Diabetes Patients with Low Blood Glucose Could be at Risk for Heart Disease
The effect of a gene that increases the risk of heat disease is even stronger in people with diabetes who have poor blood glucose (BG) control, according to a new study.
Previous studies had shown that nondiabetic people with two copies of this gene, located on chromosome 9p21, had higher rates of coronary artery disease than those who didn't. So the researchers wondered what this would mean for people with diabetes.
They found that the level of BG control was crucial. People with diabetes who had two copies of the gene along with poor BG control had a fourfold increased risk of heart disease compared with diabetic people without the gene and with "better BG control." Those who had two copies of the risky gene with better glucose control had an increase of only twofold.
People without the gene had no increase in heart disease even with poor BG control.
"We are entering the age of personalized medicine, in which the genetic profile will help doctors decide the best therapy for each patient, and this is an example of what may lie ahead," said Alessandro Dorio, who led the study.
What does this mean for you? Should we all go out and get tested for this gene so we'll know our risk?
I don't think so. First of all, this type of testing is currently available only at research institutions, and it's very expensive. Dorio said this is an example of what may lie ahead, not what's available today. But even if this gene test became available at your local hospital, would it be a good idea to be tested?
At this point in our knowledge, I think it might be counterproductive. Poor BG control affects many things. The gene on chromosome 9p21 is only one gene. There might be other genes that had the same effect. If you were tested and found not to have the gene, so that particular gene wouldn't increase your risk of heart disease if you had poor BG control, you might let your control lapse, figuring it didn't matter. But some other gene might make the BG control essential.
So I think we're all better off assuming we do have these dangerous genes and doing our best to control our BG levels as much as those who know they have the gene.
Another important thing we can learn from this study is that sometimes the complications we get are beyond our control. One person may have terrible BG control and never have any complications because he had the right genes. Another one might work very hard and have excellent BG control and get complications anyway.
It's analogous to the situation with weight. One person may eat a healthy diet and exercise and still put on weight. Another person may pig out on fast food and spend all day in a recliner and remain skinny. Life isn't fair.
The important lesson from this study is to remember is that if you do get some complications despite working very hard to control your diabetes, it may not be your fault. Like being born blind, deaf, or blonde (who would want to have to listen to all those wolf whistles), sometimes we just have bad luck.
Until scientists know everything, which is unlikely to occur in the near future, we can only do as much as we can and just hope whatever genetic predispositions we have can be overcome with good control. It's difficult -- especially during this holiday season -- to stick to the straight and narrow, but it's important.
Hang in there! It will soon be January, all those tempting treats will be gone, and the bookstores will be full of books wanting to tell us how to lose all that extra weight we gained over the holidays. If we're careful, we won't have to buy the books.