Diabetes: an increasing threat to people and society

Approximately 31 million people in the European Union are suffering from diabetes, a devastating disease with severe consequences for patients and their families, but also for the society at large and the economic prosperity of Europe. This week EH Online will focus on innovative strategies in diabetes care and on new management systems to support physicians and patients alike. Moreover, we will look at new research that might provide better treatment.

Photo: Diabetes: an increasing threat to people and society

Diabetes is not only a medical issue anymore. It has become a political issue. Since it has become known that nearly 31 million people in the European Union are living with diabetes, the public healthcare systems of each European country has begun to develop strategies to face this challenge.

Complications caused by diabetes
For decades, physicians and researcher have been trying to find ways to control the pathological blood sugar regulation. But even with genetically produced human insulin, which diabetes patients inject to keep the blood glucose level down, experts are fighting the complications caused by the disease. There are no patients who will not die of these late sequelae if they aren’t killed in an accident, is the drastic description some experts use. Cardiovascular diseases, amputations, blindness are just some of the consequences diabetes may provoke. Data from Germany show that 27,000 heart attacks and 44,000 strokes, 8,000 new foot ulcers, 28,000 amputations, 6,000 cases of loss of sight and over 8,000 new dialysis patients were associated with diabetes. Within one year! The reasons are obvious:

Fatty deposits narrow the large vessels which reduces vessel elasticity and blood flow. The risk of stroke, heart attack or arterial occlusive disease increases. Small vessels (capillaries) are even more sensitive to high blood sugar concentrations. Thickening of the small vessels is called microangiopathy. Diseased small vessels in the back of the eye can cause a so-called diabetic retinopathy, in the kidneys accordingly a diabetic nephropathy can develop.

Even cancer may be caused by diabetes – one alarm signal being too high but also too low levels of LDL cholesterol as Chinese researchers recently found out. Increasingly, data suggest an association between type 2 diabetes and an elevated risk of cancer, including breast, pancreatic and liver cancers.

Diabetes management strategies
Optimal blood glucose control is required to limit the risk of complications. The United Kingdom Prospective Diabetes Study (UKPDS), whose results were presented at this year's congress of the European Association for the Study of Diabetes, showed impressively how good disease management can help avoid these complications: After ten years of intensive treatment patients continue to profit from the therapy for a further decade. The researchers call this the “legacy effect”. In view of these findings, the German Federal Ministry of Education and Research recently funded the first diabetes mellitus project.

Several other organisations collaborate on a further project titled Computer-assisted Diabetes Risk Management (CDRM). It was designed to examine how eHealth solutions can improve diabetes care. The eHealth specialist InterComponentWare (ICW), Roche Diagnostics, telematics company GeTeG, Philipps University Marburg and the University Medical Center Groningen combined different software solution and digital devices. These components automate data flow and documentation and thus facilitate diabetes management that conforms to current treatment guidelines. For example, the Roche Diagnostic glucose meters Accu-Check can save up to 400 values. At the patients next consultation these data will be transferred to the physician’s computer and uploaded to the CDM Diabetes Monitor, a software solution based on ICW’s Care and Disease Manager application. In addition to blood glucose data, other relevant information for diabetes patients as weight, blood pressure, etc. will be collected to ensure optimal treatment.

Alternatives and research outlook
A rare but possible way to treat diabetes patients is to transplant new insulin-producing cells, so-called islets of Langerhans, into the liver where they take over the blood glucose regulation. Unfortunately, within one or two years the insulin production will cease. Now researcher at Linköping University and Uppsala University in Sweden found that the accumulation of protein aggregates called amyloid, known to be associated with Alzheimer’s disease, causes the death of the new Langerhans cells. These findings may point at ways to prevent the production of amyloids and thus protect the transplanted cells.

In experiments using blood cells from human patients with diabetes and other autoimmune disorders, Massachusetts General Hospital (MGH) researchers have confirmed the mechanism behind a potential new therapy for type 1 diabetes. Type 1 diabetes and other autoimmune diseases are caused when the body's immune cells mistakenly attack an individual's own cells.
A team led by Denise Faustman, MD, PhD, director of the MGH Immunobiology Laboratory, showed that blocking a metabolic pathway regulating the immune system specifically eliminated immune cells that react against a patient's own tissues. Several teams are working on similar therapies since they know that fighting the cause of type 1 diabetes is the most promising way to protect patients from complications.


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