According to statistics by the WHO, “The number of people with diabetes has risen from
108 million in 1980 to 422 million in 2014.” Also, “In 2016, an estimated 1.6
million deaths were directly caused by diabetes. Another 2.2 million deaths
were attributable to high blood glucose in 2012.”
Diabetes is a
chronic, metabolic disease in which the body does not properly process glucose
in blood for use as energy. This causes increased sugar level in the blood,
eventually resulting in heart disease, blindness, kidney failure, and
lower-extremity amputations. In 2019, Approximately 463 million adults (20-79
years) are presently living with diabetes and is expected to touch 700 million
by 2045. In India, about 73 million people suffer from diabetes, and this
figure is likely to go up to 80 million by 2025, making it the 'Diabetes
Capital' of the world. Presently, diabetes is the seventh leading cause of
death worldwide.
Diabetes can be
classified into: type 1 diabetes caused due to autoimmune β-cell destruction of
insulin producing pancreas, leading to absolute insulin deficiency), type 2
diabetes manifested by insulin resistance followed by relative deficiency in
insulin secretion, Gestational diabetes mellitus diagnosed in the second or
third trimester of pregnancy, specific types of such as neonatal diabetes and
maturity-onset diabetes of the young [MODY]), disease of pancreas such as
cystic fibrosis and pancreatitis, and drug- or chemical-induced diabetes. In
addition, over secretion insulin antagonistic hormones (cortisol, glucagon,
etc.) and certain viral infection (rubella, coxsackievirus B, cytomegalovirus,
adenovirus, and mumps) also causes diabetes.
Diagnostic
criteria for Diabetes
- Fasting blood glucose (FPG, no calorific intake for 8 hours) ≥126 mg/dL/7.0 mmol/L) or,
- Plasma glucose ≥200 mg/dL/11.1 mmol/L) after 2h of oral glucose load containing the equivalent of 75-g anhydrous glucose dissolved in water or,
- Glycated hemoglobin (HbA1C) ≥6.5%/48 mmol/mol or,
- A random plasma glucose ≥200 mg/Dl/11.1 mmol/L).
Symptoms of
diabetes:
- Urinating often
- The feeling of constant thirsty
- Extreme fatigue
- Blurry vision
- Cuts/bruises that heal slowly
- Weight loss—even though you are eating constantly (type 1)
- Tingling, pain,
or numbness in the hands/feet (type 2)
Risk of diabetes
Prediabetics are usually
referred to individuals whose glucose levels are towards upper limit of the
normal range. Prediabetes is usually associated with obesity, dyslipidemia,
cardiovascular diseases and hypertension. The ranges for the prediabetes are:
- HbA1C level: ≥5.7% but <6.4%/39–47 mmol/mol
- Fasting Plasma Glucose: 100 mg/dL (5.6 mmol/L) to 125 mg/dL (6.9 mmol/L)
- 2-h plasma
glucose (OGTT): 140 mg/dL (7.8 mmol/L) to 199 mg/Dl
At least annual
monitoring for the development of type 2 diabetes in those with prediabetes is
suggested
Metformin therapy
for prevention of type 2 diabetes should be considered in those with
prediabetes, especially for those with BMI ≥35 kg/m2, those aged <60 years,
and women with prior gestational diabetes mellitus
Treatment
People with type
1 diabetes should be treated with:
- Multiple daily injections of prandial and basal insulin, or continuous subcutaneous insulin infusion (CSII).
- Knowledge of patients on matching prandial insulin doses to carbohydrate intake, premeal blood glucose levels, and anticipated physical activity.
Pharmacologic
Therapy for Type 2 Diabetes:
- Metformin is the preferred initial pharmacologic agent for the treatment of type 2 diabetes and continued unless it shows any intolerable side effect. Other agents, including insulin can be added if needed.
- Periodic measurement of vitamin B12 levels should be considered in metformin-treated patients, especially in those with anemia or peripheral neuropathy.
- A choice of pharmacologic agents should be based associated comorbidities (atherosclerotic cardiovascular disease, heart failure, chronic kidney disease), hypoglycemia risk, impact on weight, cost, etc.
- Glucagon-like peptide 1 receptor are preferable to patients over insulin, requiring a greater glucose-lowering effect.
- The medication regimen should be reevaluated at regular intervals (every 3–6 months).
Recent challenges
and developments
About 65 million
people with type 2 diabetes need insulin, but only half of them can afford it. Insulin
is required to all type 1 diabetics. Data from 24 countries showed that access to
human insulin and analogue insulin at health center is only 61% and 5%
respectively. In high income countries people often ration insulin which can be
deadly for people who do not get the right quantity of the medicine
The World
Health Organization (WHO) on 13 November 2019, announced the start of a pilot program
to prequalify human insulin to increase treatment for diabetes
in low- and middle-income countries.
FDA on September 20, 2019, approved Rybelsus (semaglutide)
oral tablets to improve control of blood sugar in adult patients with type 2
diabetes, along with diet and exercise.
Lifestyle
Interventions
Diabetes Prevention Program (DPP) recommends
patients to achieve and maintain 7% loss of initial body weight and increase
moderate-intensity physical activity (such as brisk walking) to at least 150
min/week. IDF recommends physical activity at least
between three to five days a week, for a minimum of 30-45 minutes.
- Choosing water, coffee or tea instead of fruit juice, soda, or other sugar sweetened beverages.
- Eating at least three servings of vegetable every day, including green leafy vegetables.
- Eating up to three servings of fresh fruit every day.
- Choosing nuts, a piece of fresh fruit, or unsweetened yoghurt for a snack.
- Limiting alcohol intake to a maximum of two standard drinks per day.
- Choosing lean cuts of white meat, poultry or seafood instead of red or processed meat.
- Choosing peanut butter instead of chocolate spread or jam.
- Choosing whole-grain bread, rice, or pasta instead of white bread, rice, or pasta.
- Choosing unsaturated fats (olive oil, canola oil, corn oil, or sunflower oil) instead of saturated fats (butter, ghee, animal fat, coconut oil or palm oil.
Diabetes in smart phone applications
Few popular mobile applications available in android and iPhone,
that support diabetes management are:
Fooducate, My Net Diary Calorie
Counter PRO, MySugr, BG Monitor Diabetes, Health2Sync, Glucose Buddy, DiabetesConnect, Diabetes:M, Sugar Sense, One Drop, Diabetes and Blood Glucose Tracker (Apple); Diabetes and Diet Tracker (Android).
Figure 1: Natural remedies that can make some difference
The herbs and plant derivatives listed below are used by
native people in the treatment of diabetes, in the regions in which they grow:
- Allium
- Bauhinia forficata and Myrcia uniflora found in south America
- Coccinia Indica found in Indian subcontinent
- Ficus carica found in Spain and south-western Europe
- American GINSENG
- Gymnema sylvestre found in southern and central India, used in Ayurveda
- Momordica charantia, some areas of Asia, India, Africa and South America
- Ocimum sanctum is used in Ayurveda
- Opuntia streptacantha used by people of Mexican desert
- Silibum marianum
However, all these herbs and home remedies have limited evidence
for diabetes control. It should be used as a complementary along with the
mainstream treatment and under licensed medical practitioner.
Type 1 diabetes:
Replacing missing cells with cell therapy
Diabetes Research Institute in the US is developing a
bioengineered mini-organ where insulin-producing cells are encapsulated within
a protective barrier. In 2016, the institute announced that the first patient
in Europe treated with this approach in an ongoing phase I/II trial no longer
requires insulin therapy. A similar device is made by US based company Viacyte and this is also under clinical
trial.
The Belgian company, Orgenesis and UK based Islexa is working on
transforming patient’s liver/pancreas respectively into insulin-producing cells
to avoid the issues of sourcing cells from donors.
Sanofi, also a big name in diabetes, is working with the German Evotec in a beta cell replacement therapy
for diabetics.
Imcyse, a Belgian company is running a clinical trial with an immunotherapy
designed to stop type 1 diabetes by specifically killing the immune cells that
destroy the pancreas.
ActoBio Therapeutics is now running a phase I/II trial with to stop
the progression of type 1 diabetes by cheese-producing bacteria to deliver two
drugs that stimulate regulatory T cells to instruct the immune system not to
attack insulin-producing cells.
Type 2 diabetes:
- Stimulating insulin production
- Development of glucagon-like peptide (GLP)-1 receptor agonists to stop glucagon production
- Targeting the microbiome
An unbalanced and less microbiome composition has been found
in patients with diabetes. Fecal transplants, used to transfer the microbiome
of a healthy person to the gut of one with diabetes, can result in a short-term
improvement of insulin resistance in obese patients with type 2 diabetes.
Devices like GlucoTrack, GlucoSense, MediWise can measure glucose using
electromagnetic waves, laser like and radio wave respectively
Researchers are already anticipating about microchips that
can diagnose diabetes type 1 before the symptoms appear or nanorobots traveling
in the bloodstream while they measure glucose and deliver insulin.
Turacoz Healthcare Solution is committed to raise awareness about diabetes
management, prevention and educating people so as to make them aware of this chronic
disease. We urge the people to eat healthy and exercise daily. #FightDiabetes
