“The diabetes revolution is weekly insulin injections.”

diabetes, Also known as diabetes, this disease is a condition in which the level of glucose (or sugar) in the blood is too high. Glucose is the main source of energy in the body. Your body can make glucose, but it also comes from the food you eat. Insulin is a hormone produced by the pancreas. Insulin helps remove glucose from blood flow to cells where it can be used as energy.

If you have diabetes, your body cannot produce insulin or use it properly; or both at the same time. Too much glucose remains in the blood and does not reach the cells. This can cause your glucose levels to become too high. Over time, high blood glucose levels can cause serious health problems. But you can take steps to control your diabetes and try to prevent these diseases.

In recent years, like other pathologies, changes in the field of pharmacy have led to important advances. In this case, one of the most important changes will be to administer basal insulin weekly. IN HEALTH, we’ll talk to Dr. Virginia Bellido, endocrinologist at the Virgen del Rocio Hospital to talk in detail about all these changes and a new look at the future in the fight against this disease. Bellido, graduate and Extraordinary Award in Medicine and Surgery 2007 University of Santiago de Compostela. Doctor of Medicine from the University of A Coruña in 2015.

Graduated in endocrinology and nutrition at the Central University Hospital of Asturias. He currently works in the Department of Endocrinology and Nutrition of the Virgen del Rocío University Hospital (Seville). She has been the principal investigator or co-author of various research projects in the field of diabetes, and has authored more than 100 conferences, articles, and book chapters. He is a member of the Digital Diabetes and Diabetes Technology Working Groups of SED and the SEEN Diabetes Division.

QUESTION: According to a recently published study, 50% of people with diabetes suffer from diabetes-related stress. What could be the reason for this circumstance and how could it have been avoided?

ANSWER: This type of stress occurs due to several factors, including the daily management of the disease, concerns about long-term complications, and the impact on quality of life. People with diabetes must perform several self-care tasks every day, such as measuring glucose levels, counting carbohydrates, administering insulin, and exercising regularly. This, coupled with fear of long-term complications, fear of hypoglycemia, or the impact on quality of life associated with all of the above, may contribute to diabetes-related stress.

Question: People with diabetes also have a higher prevalence of depression.

A – Diabetes and depression are closely related, and people with diabetes generally have a higher risk of experiencing depressive symptoms. We have support from psychiatric departments, but most public health diabetes departments do not have a psychologist position, which would be needed in many of these cases.

Question: To what extent can new technologies help improve the emotional well-being of people with diabetes?

A. – New technologies are playing an increasingly important role in the lives of people with diabetes, not only making it easier to manage the disease, but also helping to improve their emotional well-being. The use of instant and continuous glucose monitoring systems, as well as the use of automated insulin delivery systems, have been shown to reduce the burden of disease. The simple fact of constantly automatically detecting glucose levels and being able to anticipate hypoglycemia reduces the stress and anxiety associated with constant self-monitoring.

Question: Recently, at scientific conferences such as those of the Spanish Society of Endocrinology and Nutrition and the Spanish Society of Internal Medicine, it has been stated that these technologies reduce the number of complications.

A.- Instant glucose monitoring systems reduce the risk of acute complications, mainly mild and severe hypoglycemia, as well as hospitalizations due to complications. We recently conducted a study that assessed the clinical and economic effect of using rapid glucose monitoring compared with capillary glucose self-monitoring in adults with type 2 diabetes receiving basal insulin and poor control (HbA1c >8%). . We estimate that the use of these systems could prevent approximately 11,000 adverse events, which could result in savings of approximately €1.5 million for the system.

Question: What are the most important achievements in the field
Diabetes at a technological level?

A: For people with type 1 diabetes in particular, major advances have been seen in technology, from instant and continuous glucose monitoring systems to integrated sensor-pump systems that are becoming increasingly automated.

Q. – And in the field of drugs?

A.- In the field of drugs, there have also been many achievements in recent years. On the one hand, insulins are increasingly trying to mimic the physiological secretion of insulin by the pancreas. That is, fast insulins try to be more and more super-fast, and slow insulins try to be more and more super-slow. The next advance in this regard will be weekly basal insulin. On the other hand, there have been significant advances in the treatment of type 2 diabetes with the introduction of new drugs that not only improve glycemic control but also provide additional benefits in a safe manner. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) reduce weight, improve blood pressure, and have demonstrated renal and cardiovascular protection. Among incretin drugs
GLP-1 receptor agonists (GLP-1ar) and dual GLP-1/GIP agonists not only effectively control glucose levels, but also promote significant weight loss, reduce cardiovascular events, improve kidney health and promote a healthier metabolic profile.

Q.- What news can we expect in the near future?

A. – As I mentioned earlier, in the area of ​​insulins, the next step is to administer basal insulin weekly (rather than daily). As for other drugs, there are many drugs in development for the treatment of type 2 diabetes, including polyagonists, which, acting through more than one mechanism, provide additional benefits at the metabolic level in addition to glucose control. In type 1 diabetes, the FDA has already approved the first drug (teplizumab) that has been shown to slow the progression of type 1 diabetes in people at high risk of developing the disease. Immunomodulatory treatments are also being studied in people with newly diagnosed type 1 diabetes to preserve pancreatic beta cell function and slow the progression of the disease.

Question: Are there any technologies or treatments that are still in their infancy but experts predict will be available in about 10 years?

A. – As for drugs, what I already commented on earlier. In terms of technology, automated insulin delivery systems for people with type 1 diabetes will become increasingly automated.
Continuous glucose monitoring systems can become increasingly accurate, and with advances in artificial intelligence, they can work with decision support systems that help people with diabetes in their daily lives.

Question. — Regarding the use of artificial intelligence, what issues are you working on?

A. – I think, especially in decision support systems and that management becomes more and more automated. For example, they make it possible, perhaps with the help of a photograph, to determine the amount of carbohydrates included in each meal and, based on this, make recommendations on the dose of insulin used.