Modern Technology in the Treatment of Diabetes
Modern Technology in the Treatment of Diabetes
Diabetes is one of the most common non-communicable diseases (NCDs) in Thailand, along with hypertension and dyslipidemia. It affects approximately 8.9% of the Thai population.[1] news.article-17-p1-1
Type 1 Diabetes Mellitus (T1DM) occurs when pancreatic cells are unable to produce sufficient insulin. As a result, body tissues cannot properly absorb glucose from the bloodstream for energy use. It commonly develops in young patients with genetic abnormalities affecting insulin production from birth. Patients in this group usually require lifelong insulin replacement therapy through regular injections.
Type 2 Diabetes Mellitus (T2DM) results from insulin resistance, a condition in which body tissues do not respond properly to insulin. Consequently, glucose cannot enter cells effectively. Insulin resistance is often associated with long-term excessive carbohydrate intake (such as rice, flour, and sugar), which reduces insulin sensitivity. Treatment typically begins with lifestyle modification and dietary control, followed by oral medications to lower blood glucose levels. Some patients may eventually require insulin injections.
Gestational Diabetes Mellitus (GDM) occurs during pregnancy and is triggered by hormonal changes that cause insulin resistance. It is usually diagnosed during the second or third trimester of pregnancy. In most cases, blood glucose levels return to normal after delivery.
The primary goal of diabetes treatment is to reduce and delay the long-term complications associated with consistently high blood glucose levels. Chronic hyperglycemia can damage small blood vessels (microvascular complications) and other organs, leading to conditions such as coronary artery disease, stroke, chronic kidney disease, diabetic retinopathy, and peripheral neuropathy. Damage to peripheral nerves can cause loss of sensation in the feet, which may lead to chronic diabetic foot ulcers. Individuals with diabetes have about a 50% higher risk of mortality compared to those without the condition.[1,2]
Current treatment guidelines recommend starting with[1] weight reduction, regular exercise, and dietary control before proceeding to oral antidiabetic medications and insulin therapy as needed. Diabetes management continues to evolve with ongoing medical advancements. However, despite improvements in treatment strategies, the number of people diagnosed with diabetes continues to rise. As a result, efforts are ongoing to develop new and more effective treatment options to enhance clinical outcomes and improve the quality of life for patients living with diabetes, for example:
Nanotechnology is being developed to improve insulin delivery methods. Traditionally, insulin must be injected into the subcutaneous fat layer. With nano-sized particles, insulin may be delivered through alternative routes, such as intranasal administration or transdermal patches. These innovations may improve blood glucose control and reduce complications associated with repeated subcutaneous injections.[3,4]In addition, real-time continuous glucose monitoring (CGM) devices allow more consistent and accurate tracking of blood glucose levels.[3]
Gene Therapy involves introducing genetic material into the body to enable the production of specific substances. In diabetes, this may include transferring genetic codes that allow other cells (non-pancreatic cells) to produce insulin, or to generate substances that help lower blood glucose levels.[3]
Stem Cell Therapy is a key pathophysiological mechanism of diabetes is the body’s inability to produce sufficient insulin. Stem cell therapy helps regenerate and replace dysfunctional pancreatic cells, aiming to restore insulin production. Several studies have shown a trend toward reduced insulin injection dependence among patients who received stem cell therapy.[3,5,6]Research has explored stem cells from multiple sources, including bone marrow- and adipose tissue-derived stem cells, with generally consistent and promising results.
คลิกดูรายละเอียดเพิ่มเติมได้ที่นี่ ข้อมูลเพิ่มเติมเรื่องการรักษาด้วยสเต็มเซลล์
In summary, new diabetes treatment approaches aim to enhance patient response, reduce complications, and improve the quality of life for both diabetic patients and their families. While some methods are still in the research phase, many are currently undergoing testing with patients. It is important for patients to receive initial treatment while also making lifestyle changes at the same time to achieve sustainable outcomes.
References
1) The Diabetes Association of Thailand, under the Royal Patronage of Her Royal Highness Princess Maha Chakri Sirindhorn. Guidelines for the Practice of Diabetes Mellitus. 2560. [Online]. 2017. Available at: https://www.dmthai.org/attachments/article/443/guideline-diabetes-care-2017.pdf. [August 2021]
2) Rowley WR, Bezold C, Arikan Y, Byrne E, Krohe S. Diabetes 2030: insights from yesterday, today, and future trends. Population health management. 2017 Feb 1;20(1):6-12.
3) Tiwari P. Recent trends in therapeutic approaches for diabetes management: a comprehensive update. Journal of diabetes research. 2015 Aug;2015.
4) Mo R, Jiang T, Di J, Tai W, Gu Z. Emerging micro-and nanotechnology based synthetic approaches for insulin delivery. Chemical society reviews. 2014;43(10):3595-629.
5) Jiang, R., Han, Z., Zhuo, G., Qu, X., Li, X., Wang, X., ... & Han, Z. C. (2011). Transplantation of placenta-derived mesenchymal stem cells in type 2 diabetes: a pilot study. Frontiers of medicine, 5(1), 94-100.
6) Bhansali A, Asokumar P, Walia R, Bhansali S, Gupta V, Jain A, Sachdeva N, Sharma RR, Marwaha N, Khandelwal N. Efficacy and safety of autologous bone marrow-derived stem cell transplantation in patients with type 2 diabetes mellitus: a randomized placebo-controlled study. Cell Transplantation. 2014 Sep;23(9):1075-85.