Current Treatment Modalities & Future Trend For Diabetes Management

Introduction:

Almost everything a human body eats gets converted into sugars or glucose, and this glucose is used by various organs and cells of the body as energy with help of a hormone called Insulin, which is secreted by the beta-cells of the pancreas. Diabetes is a chronic condition, in which these sugars keep on circulating in the bloodstream and don’t get utilized by organs and cells due to absence or inefficiency of Insulin.

According to the World health organization (WHO), from 1980 to 2014 the number of people with diabetes rose from 108 million to 488 million with a global prevalence in adults over 18 years of age also rose from 4.7% to 8.5%. Prevalence of diabetes is increasing in under-developed, low-income and middle-income countries as compared to high-income countries. Around 2.2 million deaths were linked with diabetes in 2012 and in 2016 almost 1.6 million deaths were directly caused due to diabetes.

Blindness, kidney failures, heart attacks, strokes, and lower limb amputations are mostly caused by long-term complications of uncontrolled diabetes. Half of the deaths are attributable to uncontrolled diabetes that is high blood sugars, and WHO depicts that diabetes is the seventh most leading cause of deaths globally. As it is clear how fatal diabetes can be and what are its global trends, and it is one of the major health problems leading to multiple other health related issues as its secondary complications, in this article we are going to learn about current treatment modalities for diabetes management and whether can we hope for a diabetes free future?

Section 1: Current Treatment Modalities For Diabetes Management

Diabetes is a chronic disease which occurs due to inefficiency of pancreas to produce insulin or because of inability of body to use the insulin being produced by the pancreas either of the reasons causes rise of sugars in blood stream which are not being utilized by the body organs due to absence or inefficiency of insulin.

Prevention is always better than cure, type 1 diabetes is unpreventable while type 2 diabetes is preventable. Obesity is major cause of development of type 2 diabetes, due to inactivity and sedentary lifestyle, so to lead a healthy lifestyle there need to be a proper balance of diet and physical activities.[1]

But once the diabetes is developed it can’t be cured or reversed but it is manageable with diet and exercise. Type 2 diabetes is generally manageable with oral hypoglycemic drug therapy which includes drugs like glipizide, glyburide, metformin etc. In certain cases of uncontrolled type 2 diabetes along with oral hypoglycemics insulin is also administered, along with a diet and exercise schedule.[1][2][3]

Type 1 diabetes is insulin dependent in which there is complete absence of insulin production, so there is need of administration of insulin after major meals along with a healthy diet, exercise and regular monitoring of blood glucose levels. Insulin administration is done with a needle syringe, modern insulin pens and most advanced are insulin pumps which acts as artificial pancreas for the body by simulating the pancreatic functions to some extent giving 2 types of regimes basal and bolus regimen of insulin to the body, now more advanced are insulin pumps with CGMs that are close glucose monitoring devices which monitors the blood glucose at regular intervals.[3]

Insulin pump therapies were a breakthrough in the history of diabetics easing the lives of type 1 diabetics to a large extent but insulin pumps are not a cure of diabetes, in certain cases of diabetes an individual can turn into a brittle diabetic which is a severe case of diabetes in which there might be loss of insulin sensitivity and hypoglycemia unawareness might occur, brittle diabetes is a life threatening situation in which case one might undergo a pancreatic transplantation.[3][4]

Pancreatic transplantation might be a cure for diabetes but the rates of success are low, as there are chances of getting organ reaction and the transplanted pancreas might get rejected by the host body and attacked by the immune system, pancreas transplant being done in various countries have a success rate of about 40%, generally people with pancreas transplant are on a number of medications generally immune-suppressants, which further suppress the immune system of the body posing a risk of getting infections as small as a cold virus leading to some serious conditions, so pancreatic transplant might be a a solution but it is not a full proof treatment for diabetes.[3]

Section 2: Future Trends For A Diabetic Free Future

Stem cell transplants are also being conducted but still there is no 100% success rate, stem cells from parent cells are being cultured or placental stem cells are being stored to generate certain beta cells (insulin producing cells) that can be transplanted in diabetic individual but still many research and developments are under process.

Scientists are conducting various experiments on stem cell regeneration, from bench to bedside therapy in which stem cells can be used in advancement of regenerative medicine, regenerating specifically beta cells of the pancreas for curing diabetes.

Pharmacogenetic studies are being conducted in which drug interactions are being affected by genetic variants being explored. The experiments for utilizing pharmacogenomics in development of novel drug therapies like developing personalized medicine for diabetics and even in the prevention of diabetes in the coming future, there is also underdeveloped personalized medicines being experimented for monogenic diabetes.

Pharmacogentics will basically develop medicine therapies or drugs that will be developed according to the genetic material of an individual, pharmacogenetics might be a breakthrough even in preventing any kind of diabetes, will mimic the role of vaccines but instead here it will prevent diabetes.

Many researches and developments are going on in all over the globe, in near future organ-bioprinting might be a success in replacing the whole pancreas with a brand new pancreas with zero rejection rates, as bio-printed organs might be developed on personalized basis, with modified bio-engineering, and culturing from embryonic stem cells as well as the parent cells of an individual.

Phytochemicals that can be extracted from certain medicinal plants are exhibiting an exciting opportunity to develop new and promising diabetes therapies, which has hastened the worldwide attempt to collect and harvest the medicinal plants that consists considerable amount of prospective phytochemicals showing beneficial effects in combating diabetes and diabetes-related complications.

Conclusion:

Diabetes can be an auto-immune disease which cannot be prevented and diabetes can be a lifestyle disease which can be prevented and even reversed in certain cases, but overall diabetes is a fatal and life-threatening condition which affects almost every single body organ and organ systems at same time.

WHO is focusing on preventing type 2 diabetes in low income and middle income countries by generating awareness and providing economical blood sugar monitoring systems all over the globe.

Every year 14th of November is celebrated as world diabetes day and awareness regarding diabetes is generated all over the globe through various means, the theme for world diabetes month 2020 was “the Nurse and Diabetes” and WHO is to launch global Diabetes compact in April 2021.

So according to all the information and research going on there might be a type 2 diabetes free future but type 1 diabetes free future might not be possible as it is an autoimmune disease, until unless there is invention of a very advanced genetic foetal modifications in which total modifications of genetic material is done leading to complete eradication of autoimmune diseases including type 1 diabetes.

Until then any type of diabetes is just manageable with the available insulin and drug regimes, still diabetes free future is hope of all the diabetics all over the world.

References:

  1. https://www.who.int/news-room/fact-sheets/detail/diabetes
  2. Skyler, J. S. (2018). Hope vs hype: where are we in type 1 diabetes?. Diabetologia, 61(3), 509-516.
  3. Bruni, A., Gala-Lopez, B., Pepper, A. R., Abualhassan, N. S., & Shapiro, A. J. (2014). Islet cell transplantation for the treatment of type 1 diabetes: recent advances and future challenges. Diabetes, metabolic syndrome and obesity: targets and therapy, 7, 211.
  4. Wainwright, S. P., Williams, C., Michael, M., Farsides, B., & Cribb, A. (2006). From bench to bedside? Biomedical scientists’ expectations of stem cell science as a future therapy for diabetes. Social science & medicine, 63(8), 2052-2064.
  5. Kleinberger, J. W., & Pollin, T. I. (2015). Personalized medicine in diabetes mellitus: current opportunities and future prospects. Annals of the New York Academy of Sciences, 1346(1), 45.
  6. Tiwari, A. K., & Rao, J. M. (2002). Diabetes mellitus and multiple therapeutic approaches of phytochemicals: Present status and future prospects. Current science, 30-38.

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