Diabetes

The global incidence of diabetes is increasing at an alarming rate. It is thought that currently, over one hundred and seventy-one people worldwide suffer from diabetes, a number that is expected to double over the next quarter of a century

Diabetes is much more common in developed nations due to various food and lifestyle factors, and therefore rapid increase of cases of diabetes can be forecast in countries where development is ongoing, such as some in Asia and Africa. A ‘Western’ diet containing lots of sugars, and particularly processed sugars, is often blamed for the diabetes boom, particularly type-2 diabetes.

Diabetes mellitus is a chronic disease and a cure is not currently possible, therefore medical treatments for this type of diabetes focus on management and control of symptoms as much as possible. Education is an important part of diabetes treatment, and making sufferers aware of their condition, how it manifests, what their limitations are and what to do in an emergency, are all key factors in treatment of the disease.

The main aim of diabetes control is to keep blood sugar levels within acceptable normal limits. This requires a vigilant self-monitoring on behalf of the patient, and goes a long way towards reducing the likelihood of long-term complications due to diabetes, Diet (weight loss) and exercise are also commonly prescribed, and can be substantially helpful in terms of reducing risks.

Type 2 diabetes can be treated with a variety of oral drugs, and both type 1 and type 2 diabetes can be treated with insulin, either as a first step or when oral medication has failed to have the desired effect.

Additionally, diabetes comes with an increased risk of developing cardiovascular problems, and all treatment should be given in the context of controlling cholesterol levels and blood pressure, and generally improving cardiovascular health, in order to ward off these problems as much as possible. If lifestyle changes are insufficient or unsuccessful, there are several different kinds of drugs that can be taken to help reduce blood pressure and cholesterol levels.

Where it is available, diabetes care can be given outside of a hospital environment, in a community or home setting, with only serious cases requiring hospital treatment - for example if complications present, or blood sugar levels prove particularly difficult to stabilize.

A multidisciplinary approach is recommended, given the diverse nature of the impact of diabetes on people’s lives, and the possible complications that can arise as a result of the disease. Patients may need to see dietitians and physiotherapists, as well as clinicians and optometrists, as diabetes can also cause loss of vision in acute cases. In countries where healthcare is not covered by the state, the cost of diabetes management can be very high indeed.

Type 1 diabetes is caused by the failure of relatively simple cell types in a single organ, and therefore possible curative research is focused around the possibility of replacing cells in the pancreas. Type 2 diabetes is a more complicated disease, and a proper cure is unlikely in the immediate future. Being caused primarily by insulin resistance, it is a reversal of this situation that would lead to a possible cure of Type 2 diabetes.

Currently, Type 1 diabetics can receive a kidney-pancreas transplant, and become essentially insulin-dependent. In such cases, the patient is usually considered to be technically ‘cured’, but will be monitored closely particularly with regard to their immune system which may reject the transplant organs at any time and without warning. For this reason, patients who receive kidney-pancreas transplants will be kept on a course of immunosuppressant drugs, possibly for the rest of their lives.

Experiments on both mice and humans have shown some success with the process of transplanting exogenous beta cells, but this technique is not yet properly available. It would require the same precautions and long-term cause of immunosuppressants as the kidney-pancreas transplant described above.

Another avenue being explored is with regard to controversial stem-cell research, which may allow for regrowth of what are known as Islet cells, and these would possibly eliminate the risk of rejection by the immune system and therefore also the need for immunosuppressants.

This is still theoretical at the moment, though a very recent study of patients with type 1 diabetes showed considerable success in patients whose own bone marrow was used to foster stem calls from which treatment cells were then cultured. The majority of these patients required either no or very little insulin treatment following the procedure.

Nanotechnology is another field that may in the future provide solutions for diabetics. These mostly focus around extremely tiny insulin pumps implanted directly into the body, which are sensitive to blood-sugar levels and can dispense an appropriate amount of insulin as and when required in order to keep them constant.

Researchers in Toronto are also working on a preventative solution involving destruction of the pancreatic sensory nerves, which may substantially reduce the chance of a patient developing diabetes. This research suggests a strong link between diabetes development and neuropeptides, and in the research carried out on mice, the animals also displayed reduced insulin-resistance, the primary cause of type 2 diabetes. Any possible treatment solution involving these methods would be some time away.

The risk of developing type 2 diabetes can be substantially reduced by making pre-emptive lifestyle and dietary changes. A nutritious, balanced, low-fat diet and moderate exercise regime (around two and a half hours of moderate exercise per week) is thought to be effective in warding off potential diabetes. Moderate alcohol intake is also recommended.

Some studies show that a variety of currently-available drugs may be helpful in slowing the onset of diabetes in patients who are predisposed to develop the disease. These include hydroxychloroquine, valsartan, rosiglitazone and metformin.