Jeddah: Dr. Abdel Hafeez Yahya Khoja
Last Monday, the world celebrated World Diabetes Day. The latest statistics issued by the International Diabetes Federation for the year 2021 indicated that the number of diabetes patients in the world reached 537 million, an increase of 74 million patients over the last report issued two years ago (2019), where developing and middle-income countries constituted the majority of type 1 patients. And the second type of disease.
Since the publication of the first report of the International Diabetes Federation nearly 20 years ago, the number of people with the disease has more than tripled in the age group between 20 and 79 years, as the number jumped from 151 to 537 million, more than 90 percent of whom had type 2 diabetes. After the expected increase, the number of infected people is estimated at 783 million in 2045.
According to the expectations of the International Diabetes Federation, developing countries and countries in southern and central Africa will be the most affected. The report also indicated that deaths due to diabetes represent about one tenth (10 percent) of all deaths in the world, half of which were due to diabetes complications from cardiovascular diseases for people under the age of 60. Insulin deficiency, delayed diagnosis, or misdiagnosis also contributed to the high incidence of disease-related deaths.
diabetes in the Arab world
WHO and the International Diabetes Federation report that the prevalence of diabetes in the Middle East and North Africa in adults (20-79 years) is currently the highest in the world (16.2 percent), and will rise to 19.3 percent by 2045. The region will also witness The second highest projected increase (86 percent) in the number of people living with diabetes, with numbers expected to jump from 73 million in 2021 to 136 million by 2045. The region also has the highest diabetes-related mortality (24.5 percent), with The number of deaths in 2021 reached about 428,000. Total spending on diabetes healthcare was about $33 billion, which is only 3.4 percent of global spending, even though the region is home to 13.6 percent of diabetes patients globally.
In the Arab world, Egypt is the highest country in the region, and one of the highest countries in the world (the tenth in terms of classification) in terms of the number of adults with diabetes in 2019 and 2021, with about 11 million patients, and the estimated increase is 20 million by 2045.
diabetic
Dr. Amina Salamani, who specializes in internal medicine, endocrinology and diabetes at the Canadian Specialist Hospital in Dubai, spoke to the “Your Health” supplement, stressing that the importance of talking about diabetes lies in its early diagnosis and good treatment, and then avoiding its serious complications that may be fatal in the future. sometimes.
• chronic disease. She explained that diabetes mellitus is a chronic disease resulting from a defect in the pancreas gland, either with a deficiency or lack of insulin secretion, or insulin secretion completely with the body not benefiting from it in an optimal way. And insulin is the hormone that controls the level of sugar in the blood.
The main difference between type 1 and type 2 diabetes is that type 1 diabetes is a genetic condition that often appears early in life, and type 2 is mainly related to lifestyle and develops over time.
In type 1 diabetes, the immune system attacks and destroys insulin-producing cells in the pancreas. These patients need to compensate for the lack of insulin through injections, which is still the case since the invention of insulin, which means that patients need insulin injections 3-4 times a day, to compensate for the amount of insulin that the pancreas had to produce.
The main symptoms. Unjustified weight loss, extreme thirst and hunger, frequent urination, fatigue and tiredness, blurry vision, slow wound healing, recurring infections in the body, especially the skin ones, as well as at the level of the urinary and genital tracts. Sometimes there may not be any symptoms, and this is what we notice with regard to type 2 diabetes, especially in its early stages, until the diagnosis is made by confirming high blood sugar or with its presence in the urine.
Symptoms of diabetes may appear suddenly, but they may often be less noticeable. Therefore, the disease may be diagnosed several years after the onset of symptoms, that is, after the occurrence of complications. Hyperglycemia, or high blood sugar, is a common effect of uncontrolled diabetes, and over time, it leads to severe damage to many body systems, especially nerves and blood vessels, and is a major cause of blindness, kidney failure, and seizures. Heart attacks, strokes, and lower extremity amputations. A healthy diet, good physical activity and not smoking can prevent or delay type 2 diabetes. In addition, diabetes can be treated and its consequences avoided or delayed through medication, regular check-ups and treatment of any complications.
Types of diabetes
The World Health Organization has classified diabetes into several types, according to the different causes and methods of treatment. In general, there are 4 types of diabetes, they are:
• Type 1: This is what was previously called insulin-dependent diabetes. It affects especially children and adolescents, and is caused by an immune defect in the body.
• The second type: It is the most common and was previously called non-insulin-dependent diabetes mellitus, or what is termed diabetes mellitus, in this case there is sufficient secretion of insulin, but the cells of the body do not benefit from it normally.
• The third type: secondary diabetes mellitus, in general, is the result of underlying systemic diseases, which usually affect the glands, such as the adrenal gland, thyroid gland, and parathyroid glands, or as a result of the presence of tumors at the level of the pancreas, or as a result of the use of certain drugs such as steroids.
• Type 4: It is gestational diabetes. It is diagnosed by conducting laboratory tests starting from the 24th to the 28th week of pregnancy. It may give us an idea that this patient is at risk of developing type 2 diabetes in the future. The vulnerable groups are women who have obesity, polycystic ovaries, over the age of 35, or have a family history of diabetes.
Complications and prevention
Complications. It usually occurs as a result of late diagnosis of the disease or its poor treatment, and is represented in the injury of the small arteries in the body, especially at the level of the retina, kidneys, or nerves, causing vision loss, renal insufficiency, or amputation of the foot. It may also affect the large arteries in the body, especially at the level of the brain or the heart or at the level of the peripheral circulation, causing strokes or heart attacks or high blood pressure. To detect these complications, the patient must conduct periodic examinations determined by the attending physician.
To avoid the complications of diabetes, we advise patients to follow a healthy lifestyle, including a healthy diet and exercise, maintain a normal weight, adhere to medication, visit a specialist doctor regularly, take good care of the feet, control blood sugar and cholesterol levels, control arterial blood pressure, and quit smoking. .
• protection. Type 1 diabetes cannot be prevented, but healthy lifestyle choices that help prevent type 2 diabetes or gestational diabetes may also help boost immunity and prevent these diseases. These options include:
Eat healthy foods that are low in fat and calories and rich in fiber.
Follow the Mediterranean diet, which relies on eating fish, vegetables, whole grains, and fruits in moderation.
Do moderate physical activity for at least 30 minutes a day.
– Getting rid of excess weight.
Take some medications, such as Metformin, for example, to improve the effectiveness of insulin in the body.
Treatment updates
Dr. Sarla Kumari, a specialist in diabetes at the Canadian Specialist Hospital in Dubai, spoke to Sehatak, stressing that researchers and scientists around the world did not stand idly by, but rather they are trying to find a treatment for pancreatic cells and pancreatic transplantation.
In the future, an effective treatment would be the transplantation of pancreatic cells to improve health outcomes for people with diabetes. However, transplantation relies on organ donors, which has limited its use on a large scale.
A world-first study conducted by Monash University in Melbourne, Australia has discovered an insulin-replenishing pathway in pancreatic stem cells, a major advance towards new therapies for the treatment of type 1 and type 2 diabetes.
By using pancreatic stem cells from a donor with type 1 diabetes, the researchers were able to effectively reactivate them to become insulin-expressing and functionally similar to the beta-cell-like cells that are destroyed in patients with type 1 diabetes to replace them with newborn insulin-producing cells.
– There is an aging population worldwide and the challenges of increasing numbers of patients with type 2 diabetes, which is closely linked to the increase in obesity, so the need for a treatment for diabetes becomes more urgent.
More work is needed to characterize these cells and establish protocols to isolate and expand them, and this treatment represents an important step along the way to creating a permanent treatment that may be applicable for all types of diabetes.
– Over a decade ago, Harvard University’s Department of Stem Cells and Regenerative Biology developed stem cell replacement therapy to provide a functional treatment for people with type 1 diabetes.
The Harvard Department of Biology has shown very promising results from stem cell therapy for type 1 diabetes.
– Recently, a new drug, “VX-880”, has been approved by the US Food and Drug Administration, but it is not yet authorized by us, for the treatment of diabetes. This therapy (VX-880) is an investigational stem cell-derived, fully differentiated, insulin-producing therapy manufactured using proprietary technology. It is evaluated for patients with type 1 diabetes (T1D) with poor awareness of hypoglycemia and severe hypoglycaemia. VX-880 has the ability to restore the body’s ability to regulate glucose levels by restoring the function of pancreatic islet cells, including glucose-responsive insulin production. This drug (VX-880) is given by infusion into the hepatic portal vein and requires immunosuppressive therapy to protect the cells from rejection by the immune system. VX-880 produced a robust restoration of pancreatic β-cell function at day 90 in the first patient in a phase 1/2 clinical trial.
These promising results bring great hope that fully differentiated stem cell-derived cells could offer a life-changing treatment for people suffering from the burden of diabetes, especially lifelong type 1 diabetes.