BOHR International Journal of Current Research in Diabetes
and Preventive Medicine
2023, Vol. 1, No. 2, pp. 48–51
DOI: 10.54646/bijrdpm.2023.09
www.bohrpub.com
METHODS
The role of diet therapy and ECG monitoring in preventing
cardiovascular diseases in diabetes mellitus: A review
Itra Singh * , Neha Rastogi and Rahul Rastogi
Agatsa Software Pvt. Ltd., Noida, India
*Correspondence:
Itra Singh,
[email protected]
Received: 22 August 2023; Accepted: 19 September 2023; Published: 10 October 2023
Background: Diabetes increases the risk of cardiovascular diseases. Corrective diet and Regular ECG monitoring
can be used as a tool for prevention and timely diagnosis.
Introduction: Diabetes increases the risk of atherosclerosis, which is associated with Acute coronary syndrome.
Almost 25 to 30% of patients who have ACS also have diabetes (1). Acute Coronary syndrome (ACS) represents a
group of diseases with abnormal S T elevations, which is detectable through ECG graphs. Patients with diabetes
frequently exhibit dyslipidemia, which is an abnormal level of 1 or more types of fat in blood, which over time
can lead to vascular abnormalities (2). High concentration of serum- Low-Density Lipoproteins (LDL) indicates a
tendency for clot formation. High Concentration of these fatty acids in the blood is largely a consequence of the
unhealthy dietary habits of diabetic patients apart from the metabolic disorder itself.
Method: Search engines for example PUBMED and GOOGLE SCHOLAR were explored to find out the evidence
in the given respect for past 10 years. Only English language studies were included.
Result and Discussions: Significant relationship has been established by previous research studies, suggestive
of the coincidence of dyslipidemia in diabetic people ultimately associated with an increased risk of heart attack.
Regular Electrocardiogram monitoring and a remedial diet are highly advisable to avoid cardiac emergencies in the
diabetic population.
Keywords: diabetes, cardiovascular disease, dyslipidemia, Diet, ECG
Introduction prevalence of non-communicable diseases as compared to
other regions (6). It has been predicted that by 2040, 642
Diabetes mellitus (DM) is a metabolic condition marked million individuals would have diabetes mellitus worldwide
by unnecessarily high blood glucose levels. Type 1, against 536 million in 2021 (7, 8). The primary risk factor
Type 2, maturity-onset diabetes of the young (MODY), for major health conditions, such as non-communicable
illnesses, may be uncontrolled high blood sugar levels (9).
gestational diabetes, neonatal diabetes, and other types of
In the current global-scenario, it is very important to
DM are among them (3). Heart failure is one of the
understand the associated risk of both diseases, diabetes and
most incapacitating cardiovascular problems that diabetes
cardiovascular disease.
patients are predisposed to, in terms of prognosis. An
epidemic of diabetes-related heart failure has emerged due
to the rising prevalence of diabetes worldwide and the Methodology
aging population (4). According to estimates, 10–11% of
all vascular deaths are caused by heart disease, which A literature survey was done on PUBMED and GOOGLE
is still a leading cause of morbidity and mortality in SCHOLAR using the key words “DIABETES AND
type 2 diabetes (5). Developing countries have a higher CARDIOVASCULAR DISEASES,” ”DIABETES AND
48
10.54646/bijrdpm.2023.09 49
DYSLIPIDEMIA,” “ACUTE CORONARY SYNDROME was a randomized, multicenter study that enrolled
AND ECG,” “DIET IN DIABETES,” ‘DIET IN 10,251 middle-aged diabetic patients at risk of CVD.
CARDIOVASCULAR DISEASE.” Only books and Participants were split up into the Overarching
documents, clinical trials, and randomized control trials Glycemia Trial, the Blood Pressure Trial, and the
in the past 10 years were included. Systematic reviews, Lipid-profile Trial. These studies evaluated the impact
meta-analyses, and review reports were excluded as these are of therapies on different cardiovascular risk factors
considered as the secondary source of data and in this study, in diabetics. The mean age of the subjects was 62
we were considering primary source of data only which throughout all trials, and they were disproportionately
are helpful to ensure the qualitative research and to avoid female, mostly White, and had a range of educational
biasness toward pre-existed hypothesis. A total of 233 articles backgrounds. BP Trial participants had greater
were found and 20 met the criteria and reviewed. OPEN mean systolic and diastolic blood pressure levels
AI (GPT-3) has been used selectively in the simplification than those in the other studies, indicating variances
of statistical analysis of the reviewed literature, to convert in cardiovascular health measures. The usage of
the given data analysis in a simplified manner to extract the antihypertensive drugs varied little among the trials.
information. There is no conflict of interest and this review The greatest values of mean LDL-C were seen in
is not sponsored. the BP Trial, while lipid profiles exhibited variability
in mean LDL-C levels. Men had higher levels of
HDL-C than women did. Participants shared similar
Inclusion criteria median and mean triglyceride levels across trials.
Statin usage, which affects lipid levels, was largely
• Primary source of data-Original Research, Clinical constant across trials. Biochemical measurements
Trials, and Randomized Controlled Trials. including mean serum creatinine and potassium levels
• Study covered under the period of 10 years. were comparable across trials, indicating a constant
biochemical condition at baseline. Overall, despite
some changes in cardiovascular risk variables between
Exclusion criteria the study arms, participant baseline characteristics
showed some recurrent patterns. For analyzing
• Drug intervention study. the trial data and evaluating the efficacy of the
• Secondary data information-review, systematic therapies used in the ACCORD study, it is essential to
review, meta-analysis to avoid the biasness understand these baseline characteristics (13).
toward a hypothesis.
2. Dyslipidemia in Diabetes and associated diagnosis of
• Surgical intervention study.
Cardiovascular Diseases:
• Study including critically ill patients.
Metabolic dyslipidemia was linked to greater risks of CVD
events in big diabetic sample size with BMI > 24. Type
Result and discussion 2 diabetes (T2DM) is characterized by significantly high
prevalence of metabolic dyslipidemia. Regular Monitoring of
1. Cardiovascular manifestation of Diabetes Mellitus- lipid profile can give a better understanding of the trends
Diabetes and heart failure (HF) are two conditions of lipoproteins in blood. Spikes in LDL or triglycerides can
that are related to one another. Even in the absence of be managed by dietary modification and medicines. In the
additional HF risk factors including coronary artery look-ahead study, 4,199 diabetic participants having a mean
disease and hypertension, HF is more common in age of 58.4 years (62% women) were assessed through lipid
those with diabetes (10). Heart failure and diabetes profile and followed for 9.5 years for the cardiovascular
have a complicated and reciprocal interaction. risk assessment. The results show the prevalence incidence
Nevertheless, the presence of cardiomyopathy solely percentage as-
related to diabetes has been the topic of debate
because, among other things, there isn’t a widely • n-TG and n-HDL: 26.4%,
accepted definition. Additionally, there is no universal • h-TG and n-HDL: 11.6%,
agreement on the pathophysiological findings • n-TG and l-HDL: 22.5%,
required for the description of cardiomyopathy due to • h-TG and l-HDL (metabolic dyslipidemia): 39.5%.
diabetes or its types (11). Clinical and experimental
evidence is mounting that diabetics experience a Of these, 500 patients were detected with composite
heart muscle condition separate from atherosclerotic cardiovascular diseases, 396 with coronary artery diseases
coronary artery disease (12). ACCORD-Action (CAD), 423 had coronary artery disease without stroke, and
to Control Cardiovascular Risk in Diabetes Trial 100 experienced strokes (11).
50 Singh et al.
3. Preventive measures: • Regular ECG Monitoring
A. Foods to be recommended-For Vegetarians-diet
therapy Acute Coronary syndrome comprises multiple conditions
• Whole grains pulses should be included in the diet as including ST-elevation myocardial infarction (STEM), non-
these are rich sources of fiber, having lower glycemic ST elevation myocardial infarction (NSTEM), and unstable
index than refined cereals. The husk of whole grain angina. ACS is responsible for 1/3 of deaths in people
cereal & pulses contains Thiamine. Example-wheat, of mid-thirties. Some forms of Chronic Heart Disease
oats, sorghum, barley, pearl millet, and quinoa. Whole (CHD) may not show any symptom but ACS always shows
pulses include chickpeas, kidney beans, chickpea flour, (18). Cardiovascular mortalities are the highest in numbers,
red lentil, soybean (14). globally. The approximate number of CVD was 271 million
• Saturated fats like coconut oil, butter, lard, and palm in 1990, which increased two folds to 523 million in
oil, have some very deleterious health effects. Try to 2019, worldwide. Whereas, the deaths due to cardiovascular
stick with the 5:2 rule, i.e., in a week, no saturated fat diseases raised steadily from 12.1 million in 1990 to 18.6
(butter, cream, lard, and coconut oil) for 5 days and million in 2019 (19). Most of such cardiovascular mortalities
2 tsp. saturated fat (butter, cream, lard, and coconut are preventable with early detection and timely intervention.
oil) in a day for 2 days. Recommended Cooking oils- ECG is the widely used imaging tool helping in detecting ACS
olive, mustard, rice bran, canola (30 ml/day). A total of (19). In diabetes, it becomes really important to monitor the
one handful of unsalted nuts 10 almonds, 10 pistachios, cardiac health. For this, ECG at every 6 months is advisable.
and two walnuts every day is advisable 1tsp (5 g) of flax
seeds and chia seeds should also be taken daily (15).
• Heart-friendly foods include green leafy veggies. Make Conclusion
sure you consume 50 g or 100 g of green leafy vegetables
every day or three times a week. A total of 150 g The purpose of this review was to assess the relation
salad cucumber, onions, tomato, and lettuce as a mid- between diabetes and onset of cardiovascular diseases. The
meal snack can be very helpful to add fiber to the results show that diabetic patients are at higher risk of
diet, and also to avoid overeating.(16) A fibrous diet developing dyslipidemia and eventually cardiac diseases.
is helpful in maintaining healthy weight. Fruits 150 to The correlation between dyslipidemia in diabetes and an
200 g apple/papaya/guava/blueberries/pear/melons/to elevated risk of heart attack has been demonstrated in
be taken daily. this paper. The de-arranged lipid profile increases the
risk of atherosclerosis many folds (20). To reduce the
B. For Non-vegetarians risk of cardiac crises in the diabetic population, regular
• If the lipid profile is normal, six eggs per electrocardiogram monitoring and dietary intervention are
week can be taken. strongly recommended. Foods rich in fiber, mono and
• Two servings of low-fat chicken (150 grams each poly-unsaturated fatty acids, antioxidants, polyphenols, and
serving) or 2–4 servings (150 g per serving) of protein have a protective and anti-inflammatory action on
freshwater fish- salmon, mackerel, trout, tuna, and the tissues, which prevents oxidative damage as well as
Katla per week is recommended (17). inhibits bad cholesterol deposition. Very often, coronary
artery diseases remains asymptomatic in diabetic patients
C. Foods to stay away from: due to sensitive neuropathy (21). Regular complication
• It includes jams, jellies, marmalade, honey, maple assessment such as ECG, ECHO along with biochemical
syrup (used in pancakes and pastries), sugar, jaggery, investigation is highly advisable by the healthcare providers
sugarcane, and jams. High Fructose Corn Syrup to keep a check on cardiac health.
(HFCS) is used in sweetened breakfast cereals like
cornflakes, Krispies, tetra packs for sweetened milk,
and sweetened beverages like fruit juices, fudge, Author contributions and
and toffees packed. acknowledgment
• Sweet bakery items cakes, biscuits, sweet pieces of
bread, cookies, etc. I am thankful to NR and RR, the founders of Agatsa
• Aerated beverages, fruit juices, pancake syrup, Software Pvt. Ltd., a med tech organization making portable
tinned fruits, etc. ECG devices. Mrs. and Mr. Rastogi not only encouraged
• Saturated fats [ghee, butter, coconut oil, palm oil, me to undertake the publication journey of Agatsa but
cheese, and trans fats (reheating oil, majority of outside also took social responsibility after developing diagnostic
fried foods) saturated fat containing non-veg. Food devices. Portable ECG devices are easy to use, quick, and
Mutton, pork, and bacon should not be consumed (red accurate in interpretations and bridging the gap between
and processed meat)]. a doctor and a patient in need of the hour and leading
10.54646/bijrdpm.2023.09 51
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