World Diabetes Day was marked yesterday. Medical student Matthew Pace gives an overview of the disease at present and looks at possible future treatments.
Diabetes. The term is ubiquitous at this point, considering that it is one of the most prevalent diseases globally, particularly in the Western World. In Malta the situation is no different, with studies showing that over 10 per cent of the adult population is diabetic.
But what really is diabetes? Can it be prevented? And how is it treated?
Diabetes mellitus is a disorder of high blood glucose (hyperglycaemia) and comes in three main types: type 1, type 2 and gestational diabetes. Typical symptoms include sweet-smelling breath, the need to frequently urinate, increased hunger and fatigue but as they can go unnoticed for a very long time and complications can be serious, it is very important to get checked by your doctor yearly.
The main organ concerned in diabetes is the pancreas, a pear-shaped structure which sits just behind the stomach. Its main function is to produce insulin, glucagon and other important digestive secretions. Insulin and glucagon are two hormones with opposite effects, respectively lowering and increasing blood glucose (a type of sugar) and as all food is converted by our body to glucose, these hormones are crucial to proper digestion and maintaining optimal health.
There is no cure for diabetes mellitus at present, however, various treatment options exist. In other words, once diagnosed, patients have the condition forever, but can keep it under control. In fact, patients lead a relatively normal life and avoid dangerous complications if they remain consistent with their treatment.
Mechanisms are different for each type. The most common and only preventable form of diabetes is type 2. In type 2 diabetes, the pancreas does not produce enough insulin to lower blood sugar back to healthy levels, largely due to overeating and a lack of exercise.
This causes excessive amounts of glucose in the blood. Furthermore, the body develops resistance to insulin if chronically released in high amounts, further increasing blood sugar levels. The good news is that although genetic factors do increase the risk of its onset, type 2 diabetes can be prevented by sticking to a healthy, balanced diet and exercising regularly.
On the other hand, type 1 diabetes mellitus is not preventable. Patients are born with the disease: their pancreas produces little or no insulin whatsoever. As a result, patients constantly have high blood sugar levels unless treated and − is the case in type 2 − if left uncontrolled, this can be fatal. It is the result of gene mutations, however recent studies have shown that environmental factors, particularly enteroviruses, can also be a cause.
Treatment options are quite subjective as what works for one patient might not work for another
Gestational diabetes mellitus occurs during pregnancy. Although the precise pathophysiology remains unknown, the placenta is thought to be the primary cause. The placenta is an organ which develops during pregnancy, connecting the mother’s and foetus’s blood supply. It produces an abundance of hormones, almost all of which act as insulin blockers, preventing insulin from attaching to its specific receptors. As the receptors do not receive insulin, blood sugar levels do not decrease. Most cases of gestational diabetes self-terminate after birth, however, it can reappear in future pregnancies or lead to type 2 diabetes down the line.
Treatment options are quite subjective as what works for one patient might not work for another. However, all diabetes mellitus patients are advised to avoid foods with high sugar content, to eat regularly so as to maintain consistent glucose levels, to watch what they are eating and ensure that it is healthy and to try and exercise regularly (30 minutes a day can work wonders).
Specialised treatment options then exist for each type. For instance, type 1 diabetics inject insulin two to four times a day to have enough hormone circulating in their body.
Type 2 diabetics are often put on oral drugs such as Metformin which lower blood sugar.
Although there is no current cure, new and exciting research is constantly hinting at future possibilities. Earlier this year, American Diabetes Association-funded researcher Rafael Arrojo e Drigo and his team discovered that cells in the pancreas are not all of the same age as was previously thought. Certain cells remain the same for life, whereas others divide to form new ones and then die.
Arrojo e Drigo believes that people with or at risk for diabetes may have fewer ‘young’ cells, which are likely to function better than old ones. Hence a potential treatment for diabetes patients could be figuring out a way to induce the pancreas to produce these younger, higher-functioning cells to replace older ones.
In 2016, the Diabetes Research Institute of the US announced that for the first time ever, a type 1 diabetic was treated with donated insulin-producing cells and no longer requires insulin therapy as a result.
Oral drug trials in Japan which induce insulin production while suppressing glucagon (GLP-1 agonists) have shown highly-encouraging results, mainly as insulin is only induced to release by these drugs when sugar levels are low.
This completely avoids dangerous low blood sugar episodes which can arise if the patient is on standard drugs which release insulin upon ingestion, and then delays their next dose.
All in all, although diabetes mellitus is not a favourable condition to have, those affected by it need not feel dejected or shamed, mainly as it can be managed with efficacy but also as the future looks bright. Perhaps diabetes will get its ‘sweet escape’ once and for all.
Free health checks
The Malta Medical Students’ Association (MMSA) will be organising its annual World Diabetes Day event on Sunday, from 9.30am to 2pm in front of Parliament in Valletta. Free health checks will be offered to the public and there will be a number of stands promoting awareness and information on the disease.