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Maria Javier Ramirez Gil, Professor of Pharmacy and Nutrition at the University of Navarra, School

Juan Manuel Irache Garreta, Professor of Pharmacy and Nutrition, University of Navarra, School

Diabetes, the pandemic that is already upon us

On the occasion of World Health Day on Sunday 7 April, we would like to draw attention to a condition, diabetes, whose numbers have already made it a pandemic.

Sun, 07 Apr 2019 13:19:00 +0000 Published in Diario de Navarra and Diario Montañés
María Javier Ramírez

Juan Manuel IracheCurrently approximately 1 in 11 adults in the world suffers from diabetes. It is, in fact, considered the seventh leading cause of death by the World Health Organisation (WHO). By 2040, globally, it is estimated that there will be 640 million people with diabetes and the cost of this ailment will exceed 800,000 million dollars (about 75% of Spain's GDP) and will be manager directly responsible for a reduction of up to 12 years in the life expectancy of patients and 5 million deaths per year worldwide. In reality, a person with diabetes has a reduced life expectancy and a mortality rate double that of the general population. In Spain, 400,000 new cases are diagnosed each year.

This chronic disease is characterised by high blood glucose (blood glucose) levels and occurs when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Prolonged high blood glucose levels fees can cause damage to blood vessels and various organs (e.g. eyes, kidneys, heart, etc.). There are three main types of diabetes: subject 1, subject 2 and gestational diabetes. Gestational diabetes (associated with unhealthy lifestyles) is the most prevalent and accounts for more than 90% of all cases in many countries.

The fight against diabetes today focuses on education and prevention campaigns, as well as on the development of new anti-diabetic drugs and new systems for monitoring glucose levels and administering insulin. In terms of prevention, the WHO recommends a series of measures that have been shown to be effective in preventing or delaying the onset of diabetes subject 2, such as: maintaining a certain level of physical activity (at least 30 minutes at moderate intensity), controlling weight, following a healthy diet per diem expenses (avoiding refined sugars and saturated fats) and eliminating tobacco.

On the other hand, in recent years, new therapeutic advances have been introduced to facilitate the control of this disease and patient acceptance of and compliance with treatment. New drugs with novel mechanisms of action have been developed. These include incretin compounds that induce insulin production in the pancreas in response to the presence of food, which help to maintain blood glucose levels within the normal range. Other novel drugs include substances that increase the renal (via urine) elimination of glucose, resulting in lower blood glucose levels. Another innovation in the field of diabetes treatment has been the emergence of combinations formulated in a single tablet, making it easier for patients to adhere to treatment.

In terms of delivery systems, the last few years have also been very fruitful in terms of innovations in this field. Traditionally, insulin has been associated with subcutaneous syringe administration; it was not until the last decades of the last century that alternatives such as insulin pumps or pens appeared. Currently, a lot of resources are being devoted to development of the so-called "artificial pancreas", for automatic glucose control without patient intervention. This system would consist of the integration, by means of mathematical algorithms, of a sensor capable of continuously monitoring glycaemia and a continuous insulin infusion pump.

Another interesting strategy developed by the pharmaceutical industry concerns systems for the pulmonary or oral administration of insulin. In this field, the emergence in 2014 of inhaled rapid-acting insulin stands out. A treatment that would eliminate, at least in the internship, the psychological barriers associated with subcutaneous injection of traditional systems (needle phobia and incorrect injection technique). Finally, it is worth highlighting the novelty of oral insulin formulations, marketed in different countries - such as India or Ecuador - or administered orally.

Faced with these new scenarios in the prevention and treatment of diabetes, it is necessary for all those involved (patients, carers, staff health, managers...) to be aware of the advantages of therapeutic advances and prevention for the correct treatment of the disease. There is no doubt that all this will help to delay the onset of complications such as blindness, dialysis, non-traumatic amputations or cardiovascular disease, as well as improving the quality of life and life expectancy of diabetic patients and contributing to the sustainability of the healthcare system.