The majority of people in the United States with type 2 diabetes are not managing risk factors for heart disease, according to a new analysis aimed at guiding doctors and patients in the latest ways to help.

Less than one-fifth of people with type 2 diabetes who have not been diagnosed with heart disease have healthy blood sugar, blood pressure and cholesterol levels and don’t smoke, said Dr. Joshua J. Joseph, assistant professor of medicine in the Division of Medicine. Endocrinology, Diabetes and Metabolism at The Ohio State University School of Medicine in Columbus.

A team of experts led by Joseph wrote the American Heart Association’s new report, which was published Monday in the journal Circulation. It reviews the latest science on diabetes and heart disease, including discoveries about new drugs that have transformed diabetes care in recent years.

“This new scientific statement is an urgent call to action to follow the latest evidence-based approaches and develop new best practices to advance treatment of type 2 diabetes” and reduce the risk of cardiovascular disease, Joseph said in a news release.

Type 2 diabetes is the most common form of diabetes. It affects more than 34 million people in the United States, according to the Centers for Disease Control and Prevention.

Cardiovascular disease is a leading cause of death and disability in people with type 2 diabetes, which occurs when the body cannot effectively use the insulin it makes or the pancreas loses its ability to produce insulin. Adults with type 2 diabetes are twice as likely to die from cardiovascular disease, including heart attack, stroke and heart failure, compared to adults without diabetes.

The report reviews the latest science on diabetes and cardiovascular disease and recommends that the best care should include healthy lifestyle interventions and treatments such as medication or surgery to support a healthy weight.

Modifiable lifestyle and social issues account for 90% of the factors associated with managing type 2 diabetes and heart disease. “Social determinants of health, including health-related behaviors, socioeconomic factors, environmental factors, and structural racism, have been thought to have profound effects on outcomes in cardiovascular disease and type 2 diabetes,” Joseph said.

Goals for reducing heart disease risk in people with type 2 diabetes include controlling blood sugar, blood pressure, and cholesterol levels; increasing physical activity; eating a healthy diet; maintaining a healthy weight; not smoking; not drinking alcohol; and getting psychosocial care.

The AHA’s last scientific statement on blood sugar control, or glucose, was published in 2015, when research began to show that blood sugar-lowering drugs might also reduce the risk of heart attack, stroke, heart failure or cardiovascular death.

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Since then, several national and international clinical trials have examined the drugs, Joseph said. Drugs known as GLP-1 receptor agonists have been “game changers in reducing the risk of heart disease, stroke, heart failure and kidney disease.”

GLP-1 drugs stimulate insulin release to control blood sugar. They can also reduce appetite and help people feel fuller, which may help with weight management.

Other drugs, called SGLT-2 inhibitors, stimulate the kidneys to process excess glucose through the urine, thereby reducing the risk of heart failure and slowing the decline in kidney function common in people with type 2 diabetes.

While many of these drugs are already more commonly covered by health insurance plans, cost can be a barrier, Joseph said. Not all patients know that these new drugs help reduce the risk of heart disease, stroke, heart failure and kidney disease.

The statement also addresses the treatment of high blood pressure; the use of statins and other drugs to address “bad” LDL cholesterol levels; and the use of low-dose daily aspirin.

The statement encourages physicians and patients to work together to develop an individualized care plan. But helping patients manage risk goes beyond what happens in a healthcare setting, Joseph said.

“One way to continue to address and advance diabetes management is to break down the four walls of the clinic or hospital through community engagement, clinic-community linkages, and academic-community-government partnerships, which may help address and support Modified lifestyle behaviours such as physical activity, nutrition, smoking cessation and stress management.”