Diabetes is sometimes called America’s “silent killer” because millions are not aware they have it and the signs may not even be noticeable. But, if you’re at risk for diabetes, you may also be at risk for heart disease — the leading cause of death in America.

Diabetes shares many of the same risk factors with heart disease. These include: being overweight, lack of exercise and poor diet. The diseases are also coupled because two out of three people with diabetes die from heart disease or stroke.

Despite progress in smoking, high cholesterol and high blood pressure rates, obesity and diabetes rates are on the rise. They must be addressed if heart disease and stroke deaths are going to drop 20 percent by 2020, one of the major goals of the American Heart Association/American Stroke Association.

Diabetes, which causes blood sugar (glucose levels) to rise to dangerous levels, is reaching epidemic proportions. An estimated 19.7 million adults are currently diagnosed and another 8.2 million adults have undiagnosed diabetes, according to the most recent American Heart Association/American Stroke Association Heart Disease & Stroke Statistics. Even more alarming, it’s projected that one in three Americans will have diabetes by 2050. African-Americans, Hispanic/Latino Americans and other ethnic groups have even higher risks.

According to American Heart Association statistics, more than 87 million people, almost 40 percent of Americans, have pre-diabetes. Many of these people will develop Type 2 diabetes and up to one-third of them will have a complication by the time they are diagnosed. While this is a serious and common public health problem, many people and health care professionals underestimate a person’s risk for diabetes. Without a clear diagnosis it is hard to treat.

Unfortunately, many Americans believe they have what is sometimes called “borderline diabetes” and that it isn’t very serious. But if left undiagnosed or untreated, Type 2 diabetes can lead to many serious medical problems such as nerve damage, blindness or kidney failure. Even mild elevations of glucose levels greatly increase the risk of heart disease and stroke.

How can you control your risk factors for diabetes?  While some factors you can’t control, like family history, race, ethnicity, age and history of diabetes during pregnancy, many risk factors you can control. If you are overweight, losing 5 percent to 7 percent of your body weight can cut your risk of developing pre-diabetes.  Secondly, if you are physically inactive, adding 150 minutes per week of moderate exercise can improve your health and minimize risks for diabetes and cardiovascular disease. Third, it’s important to keep your blood pressure under control as untreated high blood pressure has been linked to the development of diabetes.  Fourth, keep your cholesterol levels in normal range by maintaining a healthy diet.

Studies have shown that lifestyle changes, such as losing weight, eating healthy and increasing physical activity can prevent or delay the onset of diabetes by nearly 60 percent. If you’ve already been diagnosed with diabetes, these same lifestyle changes can slow the progression of the disease.

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This column was written by Jay Shubrook, D.O., FACOFP, FAAFP, an associate professor of family medicine and diabetologist at Ohio University Heritage College of Osteopathic Medicine.  He serves on the American Diabetes Association Primary Care Advisory Panel and is Research Chair on the Steering Committee for The Guideline Advantage, a quality collaborative for the American Diabetes Association, American Cancer Society and the American Heart Association.