On Sunday, November 14th, the entire world celebrates the 100th anniversary of the discovery of insulin. A hundred years ago, even scientists doubted whether it was necessary to inject a protein substance, unknown until that time, into a person under the skin in order to rid him of the “sugar disease”. But decades of successful use of the life-saving insulin shot dispelled all doubts. In 2021, there are already 537 million adults with type 1 diabetes in the world who cannot live a day without insulin. In Russia, at the beginning of 2020, there were hundreds of thousands of such out of 5.1 million adults with diabetes, and almost 50 thousand children.
But insulin delivery technologies, in fact, like the drug itself, are being improved. Although many problems remain. The main ones are – can and how to prevent diabetes, especially type 1? How to live with him? When to expect help with this genetic engineering? And will scientists be able to “rewrite” the human genetic code?
These and many other questions are answered by an expert, head. Department of Prediction and Innovation of Diabetes of the Federal State Budgetary Institution “National Medical Research Center of Endocrinology” of the Ministry of Health of the Russian Federation, President of the Russian Diabetes Association, Dr. med. Alexander MAYOROV.
“Don’t be afraid to switch to insulin”
“It is important to prevent complications in type 2 diabetes mellitus and switch to life-saving insulin in time,” warns Alexander Yuryevich. – But many patients “sit” on pills for a long time and bring themselves to exacerbations, when injections can no longer help. It is necessary to switch to insulin on time, not to wait for complications in the eyes (blindness may follow), on the legs (up to amputation of the limbs), on the kidneys, etc. Do not be afraid to switch to insulin: the quality of this drug today is heaven and earth in comparison with what it was before. It approaches the physiological one that is produced in the body. It is only important that patients learn to correctly calculate doses with the help of doctors. And today, when there are means of self-monitoring of blood glucose levels, this is no longer a problem.
Specialists, as they say, know better. In any case, much has changed in the practice of treating diabetes over the past hundred years since the discovery of insulin. Smart gadgets have emerged, in particular insulin pumps, which are an alternative to multiple daily injections of insulin with an insulin pen. This allows not only to carry out the necessary therapy in this case, but also to monitor the glucose level. It’s still not the beginning of the last century, when insulin was considered a scientific experiment, but 2021, when this drug is generally considered successful and continues to save millions of people with diabetes on the planet.
Help “MK”. Insulin was discovered by Canadian scientists Frederick Bunting and Charles Best in 1921. They isolated insulin from the cells of the islets of the pancreas, and the Canadian biochemist James Bertram Collip developed a method for its purification. Before that, the diagnosis of diabetes mellitus was a death sentence – in most patients this disease ended in death. And they did not immediately learn to determine sugar in urine with the help of tests, the diagnosis of diabetes mellitus in men was helped by … flies. They flocked to sweet drops of urine when the man went to the toilet.
The discovery of insulin in 1921 was recognized as the greatest achievement of the 20th century, and Banting himself was awarded the Nobel Prize along with the Scottish physiologist John McLeod, who first suggested that diabetes may be caused by a malfunction of the pancreas. The first injection of insulin with the help of a purified extract obtained from the pancreas, Frederick Bunting gave in 1922 to a boy with diabetes mellitus. And this saved his life.
As a result, insulin, obtained from the pancreas of various animals, immediately entered clinical practice – with its help, millions of patients with diabetes were saved. Artificial insulin synthesis was obtained much later. The first was carried out only in the 1960s, and the first genetically engineered human insulin was obtained in 1978. Baker’s yeast and Escherichia coli are used for the production of such recombinant insulin.
Before the advent of insulin, the life expectancy of diabetic patients was no more than 10 years. Such patients were doomed until the beginning of the 20th century, although the “sugar disease” was known as early as the 3rd millennium BC.
Now they do not die of sugar disease. But … The pandemic of the new virus made its own “amendments” here too …
Diabetics are 10 times more likely to “catch” COVID-19
It would seem, what does insulin have to do with the treatment of COVID-19? It turns out to be the most direct.
“The new virus is especially dangerous for the lives of people with diabetes,” says Alexander Mayorov. – Patients with elevated blood glucose levels are among the first at risk before any infection, and even more so before such an aggressive one as coronavirus. The explanation is simple: high blood glucose lowers immunity, and the diabetic becomes vulnerable to any infection. Therefore, patients with diabetes should definitely be vaccinated against it.
But … “People have completely lost their vigilance,” Doctor Mayorov was sincerely indignant at our conversation. “I could not even imagine that with the appearance of such a reliable domestic vaccine that protects our patients from premature death, I will have to convince them of its necessity to save their own lives.”
Our expert is even more outraged by the fact that many patients explain their refusal from immunization by the fact that doctors advised them so. Allegedly, if a person’s blood sugar is high, it is impossible and even dangerous to be vaccinated against covid. “This is sheer stupidity! – adds Mayorov. – Timely vaccination and revaccination against COVID-19 save patients with diabetes from death. By the way, the Russian Association of Endocrinologists also claims that “there are practically no specific contraindications for vaccination of patients with diabetes.”
This issue was recently discussed at the Council on Trusteeship in the Social Sphere under the Government of the Russian Federation. Where the Deputy Prime Minister of Russia Tatyana Golikova emphasized that in patients with diabetes, COVID-19 infection occurs 10.3 times more often. Patients with diabetes have a more severe course of the disease, more frequent development of acute respiratory distress syndrome, respiratory failure, the need for mechanical ventilation and, unfortunately, higher mortality. As a concomitant disease, diabetes occurs in 27% of confirmed cases of covid and is most often prevalent in the group of patients with severe course, and is complicated by an increase in glycemia in 90% of cases.
It was also noted at the government level that patients with diabetes are at high risk of developing pneumonia.
But, as you know, word of mouth is more convincing for someone. And, alas, the mortality rate of patients with diabetes during the pandemic rose sharply (according to some sources, by 20%). One of the reasons is that many of these patients do not get vaccinated, they go to doctors late. And routine care has become less available. And expensive drugs of a new class for the treatment of type 2 diabetes mellitus, which could reduce mortality from covid, are not yet available to many and only in wealthy regions. Although in Russia today clinical guidelines and standards for diabetes treatment have been developed and adopted, there is clearly a lack of modern effective drugs.
“We cannot promise a quick cure for diabetes. Bye”
Diabetes mellitus today ranks third in terms of the number of cases in Russia among non-infectious pathologies, endocrinologists say. While progress in the treatment of such patients is clear, what’s next? The incidence is only growing. However, mainly due to type 2 diabetes mellitus. But, oddly enough, patients with type 1 diabetes have more hope for new technologies in therapy in the near future. As Alexander Mayorov explained, “people who are insulin-dependent in the future may be able to transplant stem cells and convert them into beta cells. A more global solution and, of course, in the more distant future – gene editing in order to even prevent this disease. “
But patients with type 2 diabetes mellitus, as he believes, “do not have to hope for global changes in approaches to the therapy of this disease, and even more so for its complete cure, since there are many causes of this type of diabetes. Of course, heredity affects. But a lot depends on the lifestyle of the person himself. It is important what and how he eats (obesity is one of the main risk factors for type 2 diabetes mellitus), whether he moves a lot (physical inactivity is a real scourge of our time), etc., etc.
But there are also important problems that Dr. Mayorov spoke about.
– One of the most important conditions for the successful fight against diabetes in our country, I think, is the education of people who have this pathology or are at risk. It is important to inform the public in advance about the risks of improper lifestyle. Until 2012, the Federal Target Program “Diabetes Mellitus” operated in Russia, within the framework of which, among other things, special “Diabetes Schools” functioned. But recently, due to insufficient funding within the framework of the compulsory medical insurance system, these schools have practically ceased to work. Ideal: they should be at the clinics. And they should have a staffing table, experienced nurses who will work on special structured programs on how to live with diabetes. Because an endocrinologist after an eight-hour reception of patients is unlikely to be able to endure this load.
But we do not lose hope: now we are developing our proposals for the adoption of the Federal Project “Fighting Diabetes Mellitus”. As you know, today there are federal programs to combat cancer and cardiovascular diseases. It would be logical to adopt the same program to combat diabetes. In Russia, this disease has already taken the third place after cardiac pathologies and cancer.
But not only this worries an experienced endocrinologist. More attention should be paid to children with diabetes, he said. Apply at least to the little ones the most modern technical means that will save them from everyday painful finger pricks to determine the blood glucose level, and it will be easier for parents to control the blood glucose level of their children in real time.
In principle, it is time to talk about the convenience of therapy for all patients: the possibility of a flexible dosage regimen of insulin, the use of modern means of its painless administration. One of the significant problems is the availability of innovations. If you do not treat diabetes with modern means on time, this will lead to serious complications and will require financial costs many times higher than the costs of treating the disease itself.
Closing the curtain: medal – for life with diabetes
… Fortunately, medicine does not stand still in the field of diabetology. In particular, thanks to the use of modern insulin analogues, which are as close as possible to the physiological profile of action, people with this chronic disease can live an almost full and active life, says Alexander Mayorov. Worldwide, the Joslin Medal is awarded for 50, 75 and 80 years living with diabetes. There are such people in our country, on the initiative of the Russian Diabetes Association, more than 60 people have already been awarded the medal “For 50 Courageous Years with Diabetes”.
But one of the key questions is whether scientists will be able to “rewrite” the human genetic code? The prospect is tempting. And theoretically, according to advanced scientists, it is possible to remove the defective gene from the cells and “introduce” a healthy gene in its place. But when will it become possible in practice? And will it? Experts believe that it will be necessary to change the genetic code in all cells of the body, but it is necessary to make changes in only one target gene and not damage other, healthy genes. But these “obstacles” do not stop science. Research continues …
Hope is known to be the last to die.