Insulin is an essential drug for the treatment of diabetes. This is especially true for people who have type 1 and those who are in the advanced stages of the most common type, type 2. There is currently ongoing treatment and research aimed at finding an alternative.
On the occasion of World Diabetes DayNovember 14, several experts on lto the Spanish Diabetes Society (SED) and the Ramón y Cajal Institute for Health Research (IRYCIS) They analyze current treatments for the disease and ongoing research to try to ensure that people with the disease do not have to depend on injected insulin.
“Completely different” diseases.
It is worth remembering that type 1 and type 2 diabetes are “completely different diseases”, as told to EFEsalud. the head of the Clinical and Research Unit on Type 1 Diabetes Mellitus of the IRYCIS, Lía Nattero.
According to data from the SED, this type of diabetes represents approximately one case in ten in Spain, with a prevalence in the general population of 2%.
These figures are much lower than those of type 2, which represents around 90% of cases and is estimated to affect 14% of the Spanish population, even if half of those affected do not know they are affected, he explains to EFEsalud. María José Picón, endocrinologist and vice-president of the SED.
In many cases it is possible to prevent it, because there are risk factors that contribute to its appearance, such as being overweight or sedentary.
Its causes are more complex and a priori there is no insulin deficiency, but instead it “struggles to act”, causing insulin resistance, reaching a point where the pancreas is exhausted to counteract it.
In the initial stages it can be treated with drugs, while insulin is necessary as the disease progresses.
Arsenal to stop the evolution of the disease
Before getting to insulin, “there is a therapeutic arsenal” for type 2 diabetes, such as GLP-1 analogue drugs, including semaglutide. -the ozempico-in case the patient is overweight.
It is the first step of treatment because it improves insulin resistance, according to Picón, who points to other older and cheaper drugs such as metformin, as well as glucosurics, which facilitate the elimination of glucose through the urine and offer “many benefits” .
This whole “battery” of drugs, combined with a healthy lifestyle, are intended to prevent the progression of type 2 diabetes and therefore ensure that patients do not have to resort to insulin.
“When insulin is administered to patients with type 2 diabetes it is because the other drugs are no longer enough and the beta cell, located in the pancreas responsible for insulin secretion, is exhausted, so the treatment will last a lifetime” , underlines Picón.
For his part, Nattero explains that insulin “should be avoided at all costs, not because it hurts, but because it is not the best solution” since first we must try to stop the progression of the disease.
Therefore, the researcher also focuses on alternatives to the elimination of insulin in drugs that fight obesity and improve insulin resistance, but also in bariatric surgery, so that the disease does not progress.
Present and future
In the case of the alternative to insulin for people with type 1 diabetes, both experts highlight some options that are already feasible in specific cases and others are still being studied.
The research focuses on a first line to prevent the onset of the disease with the first drug approved by the US Food and Drug Administration (FDA), Teplizumabexplains Nattero.
Once the disease appears, efforts focus on replacing insulin in patients who can no longer produce it, for which there are two ways: pancreas transplant and cell therapies.
«In the case of transplants the problem is the availability of donors and the need for lifelong immunosuppressive treatments», clarifies the vice-president of the MA.
As for cell therapies Pancreatic islets – the group of cells that produce insulin – can be transplanted from a donor, with an injection into the patient’s portal vein.
The disadvantage is that, as in organ transplantation, immunosuppression is required.
It is a technique, explains Nattero, approved by the FDA for patients in whom “diabetes management is very complex, with very severe hypoglycemia”.
On the other hand, it is found stem cell transplantwhich “is the most popular thing lately”, explains the researcher.
These are “pluripotent stem cells, like embryonic cells, and they are injected so that they differentiate into insulin-producing cells, or they are treated in the laboratory for this purpose and once differentiated, they are injected.”
Both techniques are in the experimental phase.
How do lifestyle changes impact the management of type 2 diabetes compared to type 1 diabetes?
Interview between Time.news Editor and Dr. María José Picón, Endocrinologist and Vice-President of the Spanish Diabetes Society
Time.news Editor: Good day, Dr. Picón, and thank you for joining us on this important occasion of World Diabetes Day. Your expertise in endocrinology and diabetes treatment is invaluable as we discuss these pressing issues. To start, could you share with us why insulin is considered an essential drug for those with diabetes?
Dr. María José Picón: Good day! Thank you for having me. Insulin is crucial, particularly for individuals with type 1 diabetes and those in the later stages of type 2 diabetes. It regulates blood sugar levels, which is vital for overall health. However, our goal is to minimize or even eliminate the need for insulin through various treatments and lifestyle changes.
Time.news Editor: That’s an interesting perspective. In your opinion, how do type 1 and type 2 diabetes differ in terms of treatment and management?
Dr. María José Picón: They are fundamentally different diseases. Type 1 diabetes is an autoimmune condition where the body cannot produce insulin due to the destruction of insulin-producing cells. In contrast, type 2 diabetes often involves insulin resistance, where the body struggles to utilize insulin effectively, and patients may also experience eventual pancreatic exhaustion. This means that while type 1 patients must rely on insulin, type 2 patients have a range of treatments available depending on their stage of the disease.
Time.news Editor: Speaking of treatments, what are some of the new and promising alternatives to insulin for individuals with type 2 diabetes?
Dr. María José Picón: We have an arsenal of medications, including GLP-1 agonists like semaglutide, which can help improve insulin sensitivity. Other important drugs include metformin and glucosurics that aid in glucose elimination through urine. We emphasize a combination of these medications with lifestyle changes to prevent disease progression and delay insulin use.
Time.news Editor: It seems like an integrated approach is critical here. You mentioned lifestyle changes. How significant are factors like diet and exercise in managing type 2 diabetes?
Dr. María José Picón: Extremely significant! Lifestyle factors such as maintaining a healthy weight and regular physical activity can substantially impact insulin sensitivity and help prevent the onset or progression of type 2 diabetes. In fact, many cases can be managed effectively without medication if individuals commit to these changes early on.
Time.news Editor: That’s encouraging to hear! Now, regarding type 1 diabetes, are there any ongoing research initiatives or alternative treatments on the horizon?
Dr. María José Picón: Yes, the research focus is expanding. We’re exploring options that may prevent type 1 diabetes in at-risk individuals and other innovative approaches are being studied. Some existing options already show promise, but more research is needed to establish effective alternatives to insulin.
Time.news Editor: The future of diabetes management seems hopeful. Do you believe advanced interventions such as bariatric surgery could play a significant role in this continuum?
Dr. María José Picón: Absolutely. For certain patients, particularly those with type 2 diabetes and obesity, bariatric surgery has shown positive results in not just weight loss, but also in improving insulin sensitivity, sometimes leading to remission of diabetes.
Time.news Editor: It’s evident that continuous treatment and research efforts are essential in managing diabetes effectively. Before we wrap up, Dr. Picón, what message would you like to convey to our readers on this World Diabetes Day?
Dr. María José Picón: My message would be one of hope and empowerment. Diabetes may present challenges, but with the right knowledge, treatment options, and lifestyle changes, we can manage the disease effectively. Education and awareness are key—so please stay informed and proactive about your health!
Time.news Editor: Thank you so much for your insights today, Dr. Picón. It’s been a pleasure having you here to discuss these crucial topics on diabetes management and research.
Dr. María José Picón: Thank you! It’s been a pleasure sharing this information, and I hope it inspires everyone to take charge of their health.