"One of the main causes of death in type 1 diabetes is diabetic ketoacidosis. According to a study conducted as part of the Alpha Endo charity program, more than half of children in the Russian regions are diagnosed with ketoacidosis when diagnosed. Ketoacidosis is a life-threatening condition when, due to lack of insulin, not only the sugar content in the blood rises, but also the ketone bodies, in other words, acetone, "says Anna Karpushkina, MD, head of the Alpha-charity program Endo. "
- • the amount of urine increases, it becomes almost as colorless as water, and sticky due to the presence of sugar in it,
- • there is a strong thirst,
- • despite increased appetite, the weight of the child is reduced,
- • fast fatiguability,
- • decreased attention span,
- • itching or dry skin,
- • nausea and vomiting.
Type 1 diabetes is a unique disease of its kind. There are many chronic ailments associated with dietary restrictions and lifelong medication. The difference between diabetes lies in the fact that a person goes far beyond the usual boundaries of standard patient behavior: just following medical prescriptions is not enough, you need to learn how to independently manage the whole system of your body. The doctor, of course, remains the indisputable authority and the main expert, but the bulk of the work and responsibility will be concentrated in the hands of the patient. Diabetes cannot be cured, but can be controlled successfully.
For the benefit of patients, technologies work - modern monitoring systems (when data from the meter is transmitted to a mobile device), pumps - devices for the automatic administration of insulin, information from which can be transmitted to the doctor through the development of telemedicine. According to statistics, the number of sick children and adolescents who are on pump therapy in our country is about 9 thousand people. In Russia, pumps are installed for free, at the expense of the federal budget under the high-tech medical care program and at the expense of the regional budget.
"Psychologists trained to interact with patients with diabetes work in 20 regions of Russia. For example, in every district of Moscow in the institutions of the city psychological and pedagogical center there are professional psychologists who are knowledgeable in the treatment of diabetes in children who are ready to help families in making a diagnosis, overcoming depression, improving mood and self-confidence. It is important to note that this help is absolutely free for the family, as well as medical care, "said Anna arpushkina, MD Head of the Alfa Endo Charity Program.
About the future
"I'm not a prophet, but two directions are promising - the creation of a closed-cycle pump that can become a technical analogue of the pancreas, and stem cells that can start to synthesize insulin. I think that a breakthrough in diabetes will happen in the next 10 years," says Joseph Wolfsdorf, Head of Endocrinology, Boston Children's Medical Center, Professor of Pediatrics at Harvard University.
The role of the pancreas
The pancreas helps to digest food, thanks to the secreted enzymes, and also produces insulin so that the cells of the body can properly use their main source of energy - glucose.
In type 1 diabetes, beta cells of the pancreas that produce insulin are affected. And ultimately, iron loses its ability to produce this vital hormone.
In type 2 diabetes, the pancreas can still produce some insulin, but it is not sufficient for the body to function properly.
Proper dosing of insulin is very important to maintain blood glucose levels in a safe range.
Diabetes is characterized by a chronic course and a violation of all types of metabolism: carbohydrate, fat, protein, mineral and water-salt. Approximately 20% of patients with diabetes develop kidney failure.
As of June 2017, there are advanced devices, for example, an artificial pancreas (a combination of an insulin pump and a continuous monitoring system for blood sugar), which greatly helps people with type 1 diabetes manage their condition and make their life easier. This device automatically checks your blood sugar and releases the right amount of insulin when necessary. The device works in conjunction with a smartphone or tablet. Today, there is only one type of artificial pancreas, and it is called the "hybrid system". It includes a sensor attached to the body to measure glucose every 5 minutes, as well as an insulin pump that automatically injects insulin through a pre-installed catheter.
Since the system is hybrid, it is not fully automated. This means that the patient must manually confirm the administered dose of insulin. Therefore, in 2017, researchers are studying completely closed insulin delivery systems to ensure that the correct dose of the hormone is administered without the need for user intervention.
2019: Capital on death: the price of insulin in the U.S. doubled
At the end of January 2019, the non-profit Institute for the Assessment of Medical Costs HCCI published a report according to which the cost of insulin for the treatment of type 1 diabetes in the United States almost doubled over the five-year period from 2012 to 2016, which justifies the protests from the population about the rise in prices for medicines .
According to the report, in 2012, an average person with type 1 diabetes spent $ 2,864 a year on treatment, while in 2016 annual insulin costs rose to $ 5,705. These figures represent the total amount paid by the patient and his insurer for medicines, and do not reflect discounts paid later.
The rising cost of insulin is causing some patients to jeopardize their own health. They begin to limit the use of vital medicines because they cannot afford the costs of insulin. Patients and members of their families have protested several times under the windows of the headquarters of insulin producers.
According to the HCCI report, the jump in spending was due to higher prices for insulin in general and the release of more expensive drugs by manufacturers. The average daily intake of insulin over the same five-year period increased by only 3%, and new drugs do not provide special benefits and make up only a small fraction of total consumption. At the same time, prices change for both new and old medicines - the same drug cost twice as much in 2016 as in 2012.
Drug manufacturers are justified by the fact that they periodically need to raise the price of medicines in the United States in order to compensate for the significant discounts that help them get into the insurance market. In 2017-2018 major pharmaceutical manufacturers have begun to curb the annual increase in prescription drug prices under growing pressure from the administration of US President Donald Trump and Congress.
Launched the world's first autonomous system for diagnosing diabetes
In July 2018, the United States launched the world's first autonomous AI-based diagnostic system to detect dibetic retinopathy, a serious complication of diabetes mellitus that, without proper monitoring and treatment, can lead to complete loss of vision. The system developer, IDx Company, has developed its own algorithm for diagnosing retinopathy in adults over 22 years of age with diabetes mellitus from fundus images. The University of Iowa was the first US healthcare organization to introduce technology to clinical practice. More details here.
2017: 45% of Russians at risk of developing diabetes in the next 10 years
Researchers at the Genotek Medical Genetics Center analyzed the results of 2500 DNA tests and found that 40% of Russians have a risky version of the TCF7L2 gene, which increases their predisposition to type 2 diabetes by 1.5 times - the CT genotype. In another 5%, a risky version of the same gene was found that increases the predisposition to the disease by 2.5 times - the TT genotype. In combination with a body mass index of more than 25, the CT genotype increases the likelihood of developing the disease at least 2.5 times, and the TT genotype - at least 4 times. According to statistics, out of 2500 Russians studied, an increased body mass index has more than 30%. For the study, we used the results of DNA tests of men and women aged 18 to 60 years.
According to the Ministry of Health, the threshold for the incidence of type 2 diabetes has dropped to 30 years. The World Health Organization predicts that diabetes will be the seventh leading cause of death by 2030. According to the WHO, in 2015, 4.5 million patients with a diagnosis of type 2 diabetes were registered in Russia, with each year the number increasing by 3-5%, over the past 10 years the number of patients has increased by 2.2 million people. Doctors find official statistics very low, as many patients do not seek help or turn too late. According to the forecasts of the Institute of Diabetes of the Federal State Budgetary Institution Endocrinological Research Center, the actual prevalence of type 2 diabetes in Russia is 3-4 times higher than official data, that is, about 10-12 million people.
The ratio of the contribution of genetic factors and lifestyle factors, according to experts of the Institute of Diabetes, is 90% to 10%, but the predisposition to the development of type II diabetes can never be realized with the right approach to the prevention of the disease. To determine preventive measures, it is necessary to calculate how much genetic risk is increased and how lifestyle factors affect it. The most important lifestyle factor in the case of diabetes is overweight, therefore it is important to add body mass index (BMI) to the results of genetic analysis to calculate individual risks. To find out the body mass index, it is necessary to divide the person’s weight in kilograms by his height in meters, squared, and then divide the weight by the result. The likelihood of diabetes increases by 1.6 times with a BMI of 25-30, which in medicine is considered overweight. With a BMI of 30-35, the likelihood of developing the disease increases 3 times, with 35-40 - 6 times, and with a BMI above 40 - 11 times.
`A DNA test is needed to determine the extent to which the problem concerns you. The presence of genetic markers that increase the risk of developing diabetes by 1.5 times and the presence of markers that increase it by 2.5 times is a different degree of risk and prevention measures that are different in effort. And if an increased body mass index is added to this, then the probability increases at least 1.6 times. It will be enough for someone to deny themselves a late dinner or dessert, and for someone, prevention will be a serious measure that completely changes the way of life. This study is aimed at drawing attention to the problem of diabetes in Russia and the development of individual preventive measures based on the characteristics of the genome`, commented the news geneticist, general director of the Genotek Genetek Medical and Genetic Center Valery Ilyinsky.
`Human DNA does not change over time, but the trends on which our lifestyle depends. With the prevalence of fast food and high sugar foods, with the growing problem of low physical activity, diabetes as a disease is getting younger. Already, doctors say that earlier it was diagnosed in older people over 60, but now it is increasingly detected in patients aged 30-35 years. The reason is a genetic predisposition aggravated by an unhealthy lifestyle, 'says Marina Stepkovskaya, MD, Ph.D., general practitioner at Genotek Medical Genetics Center.
What is diabetes?
Diabetes mellitus (DM) is a chronic disease that develops when the pancreas does not produce enough insulin, or when the body cannot use the produced insulin effectively.
Insulin is a hormone that regulates blood sugar. The overall result of uncontrolled diabetes is hyperglycemia, or an increased level of glucose (sugar) in the blood, which over time leads to serious damage to many body systems.
Diabetes mellitus causes damage to the heart, blood vessels, eyes, kidneys and nervous system. It is known that the development of type 2 diabetes, as a rule, is preceded by changes in the body, in medicine called prediabetes.
Signs of diabetes
Diabetes mellitus is a chronic disease that occurs when the pancreas does not produce enough insulin hormone, or when the body cannot fully use the insulin it produces for its needs.
It is insulin that maintains a normal level of glucose (sugar) in the blood. Due to insulin deficiency, blood sugar levels increase, hyperglycemia develops. If the elevated glucose level is not corrected for a long time with the help of drugs, various complications arise, including blindness or renal failure. Every second patient with diabetes develops myocardial infarction or ischemic stroke over time.
With good health, you can not measure the level of glucose in the blood.