Diabetes Treatment News
HEALTH: Poor struggle to access diabetes care, says study
BANGKOK, 2 March 2011 (IRIN) – Ineffective or insufficient diabetes treatment can be fatal for millions worldwide, according to a new study by the US-based Institute for Health Metrics and Evaluation.
Of the areas evaluated – the United States, Iran, Mexico, Scotland, England, Colombia and Thailand – only in Thailand did the poorest have more trouble accessing diabetes care than the general population.
Thai chronic disease specialists say screenings, high-quality labs and treatment for the risk factors that can lead to diabetes – high blood sugar, blood pressure and cholesterol – are lacking outside big cities.
Lack of awareness
Using data from 2004, the study found more than eight out of 10 Thai men and women were not adequately treated for these risk factors. Some had never been screened: of 3.2 million people nationwide with diabetes in 2004, 1.8 million people were unaware of their condition.
“This is an insidious disease that can be asymptomatic,” said the study’s Thailand-based researcher, Wichai Aekplakorn, at Ramathibodi Hospital.
Diabetes, which the UN World Health Organization (WHO) says causes about 6 percent of deaths worldwide (mostly in developing countries) every year, is a chronic condition that occurs when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces.
But since 2009, Aekplakorn said, things have been improving. Of the 3.5 million estimated to have the disease that year, 2.4 million people knew. Of those seeking treatment, 28.5 percent were considered to be under “good control” versus 12.2 percent five years earlier.
Universal health coverage, launched in 2002, has slowly extended care to more people, now reaching some 48 million, he added.
The still-low numbers being screened for diabetes may be concentrated in groups that do not have national identity cards – needed to obtain subsidized medical care – or those who migrate frequently, said Jureephon Congprasert, deputy director of the Health Ministry’s Bureau of Non-communicable Diseases.
Poor diabetes management is in part due to the shortage of trained medical staff (such as ophthalmologists, nephrologists, dieticians) to deal with disease complications, she added.
Diabetes is the main cause of partial vision loss and blindness in adults in developed countries and accounts for most limb amputations that are not caused by accidents, according to WHO.
Catching up
While Thailand has been lauded for its performance in HIV care, reaching near universal coverage, chronic disease care lags behind.
“Having a system in place for one condition does not necessarily translate into good care for other conditions,” said Stephen Lim, a former research fellow in Thailand’s Ministry of Health from 2004 to 2007 and one of the authors of the new diabetes management study.
“For HIV, awareness and advocacy for treatment… has been very high, ie. there is a very public face to the disease. In general there is not the same movement behind combating chronic diseases like diabetes.”
Unlike infectious diseases, which have a culprit “agent”, chronic diseases have multiple causes, which make them harder to find, treat and wipe out, said Aekplakorn.
“Most NCDs [non-communicable diseases] have several factors – urbanization, [health] behaviours, global consumer trends. It is more complicated and we cannot end them by tackling only one issue.”
Improving The Diagnosis, Classification And Coding Of Diabetes, UK
A new report, launched by the Royal College of General Practitioners and NHS Diabetes, aims to improve the diagnosis, classification and coding of diabetes. It provides advice and support to all clinicians involved in this often complex diagnostic challenge as well as providing free, downloadable practice audit tools to aid accurate diagnosis.
It outlines:
– The results of a systematic review examining existing evidence on misdiagnosis, misclassification and miscoding
– The results of an analysis of two primary care databases of nearly one million patients establishing the extent of misdiagnosis, misclassification and miscoding
– Pragmatic Guidelines for diagnosis and classification
– Audit tools to improve diagnosis, classification and coding in clinical practice and the results of a pilot using them
A pilot of the audit tools across five practices with 1600 people on diabetes registers found 2.2% of people diagnosed with diabetes did not have it, 2.1% of people were classified with the wrong type of diabetes and 0.9% of people had their type of diabetes coded as indeterminable.
Dr Clare Gerada, Chair of the RCGP and a practising GP in London, said: “Diabetes is a growing concern for GPs and their teams and it is crucial that patients receive the correct diagnosis so that they can start to receive the appropriate treatment and care.
“The report found that the overwhelming majority of people are correctly diagnosed with what is increasingly recognised as a very complex condition. However in a few cases people have been misdiagnosed, misclassified or miscoded with diabetes. The new guidelines and audit tools will be of great benefit to doctors and patients and we will be working very closely with our members and other primary care colleagues to introduce them into widespread clinical practice.”
Dr Rowan Hillson, National Clinical Director for Diabetes, said: “It is reassuring that the vast majority of people with diabetes are correctly diagnosed. In a few complex cases people may have been misdiagnosed with diabetes or the type of diabetes misclassified, but this shouldn’t significantly affect their treatment. However, with 2 million people diagnosed with diabetes in England and the numbers predicted to go much higher, the classification algorithm and audit tools provided today make a valuable contribution to help GPs with diagnosis, classification and coding of diabetes.”
Anna Morton, Director of NHS Diabetes, said: “I am delighted that we worked with the RCGP and colleagues from across the diabetes community to produce this report. The key aim of NHS Diabetes is to work with frontline staff to improve diabetes care and we will be using all our efforts to see its recommendations translated into clinical practice across England.”
Avril Surridge, who has diabetes, said: “From talking to friends and colleagues I know how hard diagnosis hits people. To be told later that you do not have diabetes can be wonderful news but also distressing to realise they have lived under an unnecessary shadow sometimes for some time. Similarly, to be diagnosed with one type of diabetes and then later to have that changed to diagnosis of another type is both alarming and confusing and raises queries about the treatment they have had. I really hope that the recommendations in this report are taken up very quickly so that the accuracy of a diagnosis of diabetes improves.”
Turn-key to diabetes uncovered
Australian scientists appear to have discovered a major turn-key for type 1 diabetes while looking for a new way to safely transplant insulin-producing cells.
A solitary molecule – Interleukin 21 (IL-21) – has emerged as critical to the way these diabetics have an immune system which wrongly kills off their insulin-producing cells.
Researchers at Sydney’s Garvan Institute of Medical Research developed an experimental drug which neutralised this IL-21 in diabetic mice, to uncover a rapid and “unprecedented” effect.
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The mice were not only seen to readily accept a batch of donated insulin-producing cells without using conventional drugs to suppress their immune system.
After just two weeks of treatment, they also showed signs of returning to healthy pancreas function over and above the strength of these donated cells.
“This is unprecedented in a sense, and I can’t think of one other example where neutralising one molecule would have such a huge effect, said Dr Cecile King who undertook the research along with Dr Helen McGuire.
“… And what we noticed when we looked at the pancreas of the transplant recipients, they were beginning to regain function and many of those mice could be fine without the transplant after a period of time.”
Dr King said the study showed the importance of a steady supply of IL-21 to the immune system’s killer T-cells – which patrol the body looking for foreign invaders and, incorrectly in the case of type 1 diabetics, insulin-producing cells.
Without access to IL-21, the T-cells did not target or reject donor insulin-producing cells when transplanted into the mice.
Doing was also seen to put their pancreas on a path towards sustained healthy insulin-producing function, as though they no longer had type 1 diabetes.
“Perhaps what we see in the pancreas is such a chronic inflammation … and once we halt that process we actually see a lot of new growth, and a lot of the (insulin-producing) islets that are there regain functionality,” she said.
Further studies in diabetic mice – including whether the drug could have a positive effect on its own without a transplant – would follow, Dr King said, and the next major step would be a trial in people.
Despite the positive signs, she also cautioned the research had taken seven years to reach this point and it would take more time to prove the same technique was safe and effective in people.
“This study is very encouraging and it does offer hope for people with type 1 diabetes but, realistically, we’re a decade away from seeing this (treatment) in humans,” Dr King said.
The research is published in the international journal Diabetes.