Diabetes: Concerns for India and the latest cures

Dr Anoop Mishra & Dr Neha Mittal As per global projections by International Diabetes Federation (IDF), the number of diabetes patients has risen sharply in recent years. While in 1985, 30 million people had diabetes worldwide; the number rose to 150 million in 2000, 285 million in 2010 and is estimated to be 435 million - 7.8% of the adult world population by 2030. India has the highest number of diabetics in the world. By next year, the country will be home to 50.8 million diabetics, making it the world`s unchallenged diabetes capital. And the number is expected to go up to 87 million -- 8.4% of the country`s adult population -- by 2030. Special concerns for India

Lack of awareness about Diabetes Mellitus among patients.

Lack of awareness among patients about what leads to Diabetes Mellitus.

Physicians not adequately trained in the treatment of Diabetes Mellitus.

Trained educators to support self management of diabetes are few.

Diet and exercise not explained to the patient properly by the educators and dieticians.

HbA1c, the key component in diabetes monitoring, not available in many centres.

Essential monitoring parameters like HbA1c, blood pressure, lipids are done only in half the patients by the clinicians.

Strict diabetes control not given adequate importance by patients.

Complications of diabetes not explained to the patient by the physician.

Side effects of drugs for diabetes not known by the patient.

Patients resort to alternative therapies, and leave allopathic treatment, which cause serious harm. New methods of treatment The drugs for diabetes are in an exciting new era of development. A number of new drugs and insulin have been introduced and nearly 75 new drugs are under development. The following are some of the therapies which have and will make a substantial difference in the management of diabetes. 1. GLP-1 based therapies a) Injectable therapy – An injection, Exenatide (Byetta) acts through special cells in intestines called the L-cells to increase a hormone, glucagons like peptide-1 (GLP-1) which benefits blood glucose and metabolism in many ways. Additionally it leads to weight loss. This drug is manufactured by saliva of the lizard ‘Gila Monster’. Long acting (once a week) preparation of this injection will be commercially available in near future. b) Oral therapy – These oral drugs, also act through the L-cells of intestine. These include Sitagliptin (Januvia – available in India), Vildagliptin (Galvus – available in India), and Saxagliptin (available from April 2010). 2. Newer insulins: a) Inhaled insulin – It was tried on some patients. However it was withdrawn due to side effects. Another type of inhaled insulin is under development. b) Oral insulin – This is being tested by Biocon India and remains an experimental therapy. Other new advances a)Stem cell therapy • This should be theoretically used for Type 1 Diabetic patients in whom insulin secreting cells are destroyed. • Stem cells therapy is potentially useful in diabetic foot ulcers which are difficult to treat by conventional methods. It is expected that stem cell treatment will increase new vessels in ulcer area so that healing is accelerated. We have been using this treatment now for the first time in India. b) Pancreas/ Islet cells (insulin producing cells) transplant • In this therapy the whole of the pancreas is replaced or only insulin producing ß cells are given. This has been carried out in few centres in the world, but more research needs to be conducted. Prof. Anoop Misra is the Director and Dr Neha Mittal is Consultant, Department of Diabetes & Metabolic Diseases, Fortis Hospitals, New Delhi.