The 19th World Diabetes Congress held recently in Cape Town, South Africa, saw international experts discuss the latest issues and advances in diabetes.
IN its third edition of the Diabetes Atlas, the International Diabetes Federation (IDF) has stated that diabetes is one of the most common non-communicable diseases globally, and developing countries face the greatest burden of the disease.
“Diabetes is certain to be one of the most challenging health problems in the 21st century,” it said.
Among the complications of diabetes are coronary artery and peripheral vascular disease, stroke, diabetic neuropathy, amputations, renal failure and blindness.
This can result in increasing disability, reduced life expectancy and enormous health costs for virtually every society, it said.
The atlas estimates that Malaysia has a national prevalence rate of 12.3% – an estimated 2.8 million diabetics.
Strides made in the medical world on diabetes may still prove to be difficult for countries such as Malaysia and other South-East Asian nations to benefit from because of high costs.
“It is really going to be difficult. There are big issues. We are trying to find ways to make drugs cheaper and more available,” said Prof Philip Home, a Professor of Diabetes Medicine at Newcastle University in the UK and former vice-president of the International Diabetes Federation (IDF) when met recently at the 19th World Diabetes Congress in Capetown, South Africa.
“Medication needs to be cheaper for the poor.”
He said that there were a series of new things on the horizon that would enable diabetics to have much better control of their blood glucose levels without too many side effects.
Prof Home added that innovations, such as the insulin pump, was still expensive, where on average it costs about 1,200 pound sterling (RM8,160) a year. Consequently, only few people have access to it.
He also said that while insulin pumps have become more sophisticated over the years, it does not necessarily work a lot better for diabetics. It is, however, safer and more pleasant to use,” he said.
Insulin, which is delivered through injections, is traditionally used to treat type 1 diabetes, and in some cases, type 2. However, type 2 diabetics more often than not are put on a tablet regiment.
Another new technology that he said was where the insulin pump could be combined with a sensor that could monitor blood glucose levels.
On the new insulin inhaler, he said there were safety concerns such as effects on the lungs. “And again, it is expensive.”
Insulin is sprayed into the mouth by the inhaler and coats the membranes of the mouth, throat and tongue. Insulin is then passed quickly through the membranes into the bloodstream.
In general, insulin therapy over the last five years, he said, have improved, with better control of blood glucose levels, less hypoglycaemia (low sugar) and subsequently less complications to the diabetic patient.
He emphasised that neither the insulin pump nor inhaler were a solution to all the problems faced by diabetics.
This is because devices such as the insulin inhaler only helps when injecting proves difficult in those who have “poor” injection sites.
“In any case, there have been huge improvements in ‘pen injectors’ where it is easy to use and barely hurts,” he said.
He added that there were diabetics who still preferred the conventional method of injecting themselves with insulin.
In the case of type 2 diabetes, Prof Home said that there are newer medications that could be prescribed where patients would be able to achieve blood glucose levels which are closer to targeted levels.
Prof Home, who is also the chairman of the IDF Clinical and Guidelines Task Force, also said global guidelines are needed in certain aspects of diabetes management, such as the recently published edition for the management of type 2 diabetes, which contains information such as which medication is suitable to be prescribed first.
“The guidelines are simple. The website is open to all and any intelligent person who is a diabetic is able, for the most part, to be in charge of his own care.”
He also stressed that long-term diabetics are able to do very well and can avoid suffering from complications if their illness is under control.
“Just bring the levels close to normal. Stop gaining weight. And this guarantees a more or less normal life,” he said.
Stem cell challenge
Assistant Prof Dr Wendy Macfarlane from the University of Brighton, United Kingdom, said that the challenges in stem cell research to find a cure for diabetes include cultivating pure cell populations, having fully functional insulin-producing beta cells, controlling the growth of cells and maintaining safety.
The molecular biologist, who is involved in stem research, said that laboratories are currently trying to isolate insulin producing cells and producing pure cell populations while studies are still being done on two-dimensional cells.
“Currently, there is not enough production of beta cells,” she said.
“And in terms of safety, to what standards do we use? It has to be free from many things, such as microcontaminants.”
She said that potential new sources to obtain stem cells for this are from the bone marrow and cord blood.
This is as opposed to taking stem cells from embryonic stem cells.
Clinical trials, she said, is possible in the next five years.
It had been reported before that stem cell research allowed scientists to explore how to control and direct stem cells so they could grow into other cells. This includes insulin-producing beta cells, which is found in the pancreas.
This could mean a cure for type 1 diabetes because the new beta cells would serve as a replenishable source of cells for islet cell transplantation, besides being a tool to control type 2 diabetes.
“We need to get the magic cells,” she said, adding that there are controls such as islet transplants, encapsulating the cells and growing the cells.
“Until we know how it grows and how we can prevent degradation, we will not know the best method of delivery.”
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