Tuesday, 3 December 2019

Diabetes: Types, Symptoms and Treatment




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:


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.

Future hope on diabetes treatment 

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.

Attacking the origin with immunotherapy

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.

The needle-free revolution

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 managementprevention and educating people so as to make them aware of this chronic disease. We urge the people to eat healthy and exercise daily. #FightDiabetes

If you have any queries, email us at hello@turacoz.in








 
 








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