Production: Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences
Professor: Computer Network Information Center, Chinese Academy of Sciences
According to the World Health Organization, there are 280 million people with diabetes worldwide, and one person dies of diabetes every 10 seconds. According to a survey conducted by the Ministry of Health of China, there are more than 130 million diabetic patients in China. The prevalence of diabetes in adults is 11.6%, and those in pre-diabetes account for 50.1% of the total population. Diabetes has become a serious public health problem, and the worst thing is that most people don’t know anything about it.
In the past many years, it has been widely believed that diabetes is an incurable disease. Medicine can only be used to relieve the development of the disease. But now there are some different voices. There are many reports that can cure diabetes at one time, so that patients can get rid of lifelong medications, such as stomach bypass surgery, Chinese medicine, massage, and even reports that through diabetes, diabetes can heal.
Can diabetes be completely cured?
First, we need to know what diabetes is. Diabetes is a common endocrine system disease. It is caused by the lack of insulin in the body, or the quality of insulin itself and other reasons, which can not play its normal physiological role. It is caused by sugar metabolism, sugar and fat. A syndrome of metabolic disorders of matter.
Diabetes are mainly divided into four types: type 1 diabetes (T1DM), type 2 diabetes (T2DM), gestational diabetes, and special type diabetes.
We will give a brief introduction below.
The cause of T1DM is that the beta cells in the human pancreas are damaged and unable to secrete a sufficient amount of insulin, resulting in high blood sugar levels, resulting in symptoms of diabetes. At present, the method of supplementing insulin from outside is mainly used to reduce blood sugar concentration. However, in vitro supplementation does not allow beta cells in the body to produce insulin on their own, and it is impossible to completely cure diabetes, which requires lifelong use.
The beta cells in T2DM patients can normally secrete insulin, but their muscle, fat, liver and other cells are not sensitive to insulin. The receptors on the cells cannot bind well with insulin, resulting in insulin not functioning properly. The effect is on the blood sugar level. T2DM is closely related to lifestyle, such as long-term unhealthy diet and lack of exercise. The key to treating T2DM is lifestyle change, supplemented by medication. Drugs can increase the sensitivity of cells to insulin or stimulate beta cells to secrete more insulin. But these drugs can’t completely change the sensitivity of cells to insulin, and they need to be taken all the time.
Gerce-negative diabetes refers to diabetes that occurs during pregnancy. It is caused by an increase in the secretion of hormones that antagonize insulin, such as estrogen and progesterone, during pregnancy, resulting in absolute or relative deficiency of insulin. During pregnancy, patients must be strictly controlled diet and supplemented with insulin-based medications. Most of the patients’ glucose metabolism can return to normal after delivery, but the chance of developing type 2 diabetes will increase in the future.
Special type of diabetes is caused by a “bad” gene in the human body, also known as single-gene mutation diabetes, which mainly includes hereditary beta cell defects, islet disease, endocrine diseases, and drug factors. Diabetes, due to the different pathogenesis, most need to use insulin to treat.
The existing medical treatment can not completely cure diabetes
The current claim that it can completely cure diabetes, the principle of gastric bypass surgery is through gastric block, gastrointestinal anastomosis, intestinal Anastomosis and the like change the physiological flow of the food, thereby improving the insulin resistance of the patient’s body. However, gastric bypass surgery requires strict, high risk, and low success rate. It is only suitable for T2DM patients with a history of diabetes less than 15 years and less than 70 years old. Patients need to pass the autoimmune diabetes antibody test, insulin endocrine function evaluation and other tests, after the conditions are met before surgery. The effectiveness of Chinese medicine law still needs scientific verification. Therefore, these sounds that believe that diabetes can be cured at one time are lack of scientific basis.
Diabetes can’t be cured now, but it can be well controlled, and the current treatment methods can be used. Most patients can live and work like normal people. So what are the current treatments? Simply put, it is mainly based on western medicine, such as oral hypoglycemic agents, injection of insulin, etc., supplemented by some traditional Chinese medicines.
Insulin therapy is the only method for T1DM caused by defects in insulin secretion. There are two ways to do this. One is to inject insulin on a regular basis or on demand every day, and the other is to automatically inject insulin into the patient according to the blood glucose concentration by hanging the insulin pump. Most of the insulin secretion in T2DM patients is normal, but the biological effects are impaired. Therefore, the treatment control program is mainly based on the age of onset, blood sugar, glycosylated hemoglobin and past medication, including the following five aspects: diabetes education, diet therapy, Exercise therapy, medication, blood glucose monitoring. Every link affects the efficacy.
1. Diabetes publicity and education: The key to behavior change is the change of concept. Therefore, diabetes education is very important. Diabetes health education should not only target diabetic patients, but also include the general population, high-risk groups, and family members. We must not rely solely on doctors, but also organically combine nutritionists, sportsmen, nurses, and social workers to adopt a variety of publicity and education that is easy to understand and easy to learn, to form a sound health education system, and truly achieve the goal of health education.
2. Dietary therapy: Dietary therapy is the basis for the treatment of various types of diabetes, and is an indispensable measure for the prevention and control of diabetes, because the key to controlling blood sugar levels is to control the “mouth.” Therefore, the control of total calories and balanced diet is the first principle. Regular, noon, and late meals should be regularly dosed to avoid increasing or decreasing food intake and carrying snacks.
3. Exercise therapy: Appropriate exercise can increase the sensitivity of patients to insulin, increase the utilization of glucose in muscle tissue, lower blood sugar, and improve metabolic disorders. Exercises suitable for diabetic patients include continuous and regular moderate-intensity aerobic exercise such as cycling, walking, jogging, swimming, and dancing. Studies have shown that the mortality rate of diabetic patients who have been exercising for decades has been significantly reduced.
4. Drug treatment: drug treatment mainly refers to oral hypoglycemic agents supplemented by traditional Chinese medicine treatment. There are two main types of oral hypoglycemic agents, one is sulfonylureas, insulin secretagogues, biguanides, insulin sensitizers (glitazones), alpha glucosidase inhibitors; the other is insulin. It is divided into four types: short-acting, medium-acting, dual-phase and long-acting.
The choice of appropriate insulin preparations must be closely combined with the consideration of the disease, so that on the one hand, it can quickly and permanently eliminate hyperglycemia, diabetes, ketones and other metabolic disorders, avoid hypoglycemia, and promote the body to use sugar. Class, to ensure nutrition; on the one hand, blood sugar, plasma insulin concentration fluctuations close to the physiological range, to avoid the occurrence of acute complications and disease infection.
5. Monitoring blood glucose: Self-monitoring allows patients to fully understand their medication levels and control levels. Without self-monitoring, all previous treatments were blind and not contrastive. Therefore, diabetic patients should go to the hospital for monitoring regularly. When the economic conditions permit, you can purchase a blood glucose meter, so that you can monitor blood sugar at any time, adjust medication and better control diet, avoid high blood sugar, and then reduce The occurrence of diabetic complications.
New Progress in Diabetes Prevention
In recent decades, although no method has been developed to cure diabetes, some new progress has been made.
1. Increase the detection rate through early diagnosis: At present, diabetes screening is mainly to comprehensively investigate fasting blood glucose and postprandial blood glucose. Duke University in the United States invented a T2DM early diagnosis method called HgA1c, which screens diabetes by detecting the average blood glucose level of the human body within 6 weeks, and improves the accuracy of detection. They examined 1,235 high-risk groups and found that 4.5% of people had diabetes, and the final detection rate was 75%. Many patients showed “no disease” using traditional screening methods.
In addition to the HgA1c assay, the South African Medical Science Council has also invented a T2DM assay that measures the ratio of pre-insulin to insulin in the blood. Proinsulin is a protein secreted by the pancreas that can be converted to insulin, whereas pre-insulin in patients with T2DM cannot become insulin. Therefore, by detecting the ratio of the two substances, diabetes can be detected.
2. New minimally invasive treatments: for example, intelligent insulin patches that automatically sense blood sugar and release quantitative insulin, the specific principle is to embed glucose oxidase and insulin in a polymer. Attached to the surface of the patch that penetrates the skin part, glucose reacts with oxidase to release the internal insulin. This minimally invasive patch can minimize the patient’s pain while regulating the patient’s physiological condition.
3. Development of new drugs to replace insulin: Recently, a natural hormone called glucagon-like peptide-1 (GLP-1) has received great attention from the medical community. GLP-1 is a brain-gut peptide secreted by the ileum and plays an important role in regulating glucose homeostasis in the body. The main physiological roles of GLP-1 in the pancreas include stimulation of insulin secretion and biosynthesis after eating, promotion of pancreatic β-cell proliferation, inhibition of apoptosis, and inhibition of glucagon secretion. GLP-1 has glucose-dependent hypoglycemic effect, and GLP-1 exerts hypoglycemic effect only when blood glucose level is elevated, which provides a very good prospect for the treatment of T2DM.
There is currently no replacement for insulin by GLP-1. Since GLP-1 is a polypeptide, it cannot be administered orally. Secondly, GLP-1 produced by the human body is easily degraded by dipeptidyl peptidase IV (DPP-IV) in vivo. Its plasma half-life is less than 2 minutes and must be sustained. Intravenous infusion or continuous subcutaneous injection can produce therapeutic effects.
In order to solve the above problems, the researchers proposed two options. The first is to develop GLP-1 analogues that retain both GLP-1 efficacy and resistance to degradation. Second, the development of DPP-IV inhibitors, so that GLP-1 secreted by the body itself is not degraded. At present, both studies have made some progress. It is believed that with the deepening of research on the GLP-1 signal system, more new targets will be discovered, thus developing a new drug that is safer and more convenient.
It’s not hopeless to completely cure diabetes
Until now, diabetes is still incurable. Is there no hope of cure? of course not. We must have confidence in the future and science. Through the unremitting efforts of scientists, in the future we are expected to achieve a complete cure for diabetes through stem cell transplantation. Stem cells are a class of cells with diverse differentiation potentials that can differentiate into a variety of cells in an appropriate environment. At present, scientists have realized the differentiation of human stem cells into mature islet β cells and successfully transplanted them into experimental animals. However, this technology also needs to solve the problem of the body’s own immune response, and it needs to be treated with anti-rejection drugs.
In addition to stem cell metastasis therapy, gene therapy is currently the focus of global attention. About 5% of people with diabetes in China are of special type diabetes. Nowadays, gene therapy is a breakthrough in research in the world. If you study the diabetes caused by a single gene problem, the T2DM type diabetes caused by multiple gene problems will have the hope of being conquered.
In addition, foreign scientists are actively studying diabetes vaccines. Recently, King’s College London is preparing to conduct the world’s first T1DM vaccine human trial in conjunction with the University of Bristol. When the vaccine enters human blood, it produces protective cells that block white blood cells that destroy islet beta cells. If successful, it can also take a big step forward in diabetes research.