According to theInternational Diabetes Federation there were 463 million adults living with this pathology in 2019 and it is expected that the number will rise to 700 million by 2045. The diabetes it has become a global epidemic. It affects millions of people around the world and is increasingly associated with another major health emergency of the moment: theobesitywith whom he already lives beyond 10% of Italians adults.
Experts from all over Europe discussed this, the future of therapies, both pharmacological and technological, as well as the management of obesity – a key element for the prevention of metabolic and cardiovascular diseases – during the event Update on Diabetes and Cardiovascular Disease, recently promoted in Milan with the patronage ofIRCCS MultiMedica, of theUniversity of Milan State and of D&CVD – Diabetes and Cardiovascular Disease Study Group of EASDthe European Association for the Study of Diabetes.
«Estimates say that throughout the world, in the next few years we will have to deal with millions of diabetic subjects and in Italy we are already in the order of 6 million, practically a very large city», highlights Doctor Cesare BerraHead of Clinical Diabetology, University Endocrine-Metabolic Department ofIRCCS MultiMedicaamong the scientific managers of the event.
But why do we talk about a “diabetes epidemic”, what is behind the scale of these numbers?
«The reasons are numerous: they range from the aging of the population to incorrect lifestyles, to the very ability to diagnose it adequately. Probably, compared to the past, we are also much more careful about carrying out a banal blood test (the one relating to blood sugar control, ed) which allows us to understand what the risk of developing diabetes is in the population. In general, however, lifestyles are unfortunately something that has worsened the epidemiology of diabetes. In Italy and beyond.”
A fairly new fact is the age of onset: there are more young patients. How come?
«It is precisely lifestyle that has the greatest influence, also with regard to these data, which are a sign of less physical activity and less attention to what is a healthy and balanced diet, such as, for example, Mediterranean diet, which reduces cardiovascular risk in subjects who take it regularly. These are the two most important aspects underlying the risk of seeing cases increase type 2 diabetes in the Italian population. Then there is also an increase in type 1 diabetes but this is a slightly more complex analysis. Type 2 affects 90-95% of people with diabetes worldwide, so it is clear that the social and economic impact is certainly greater.”
What important emerged from the congress recently concluded in Milan?
«The Congress brought together the best European diabetologists and cardiologists in two days of discussion focused mainly on the cardiovascular risk in type 2 diabetes, considering that unfortunately heart disease is one of the reasons why we must treat diabetes as best as possible and prevent complications for prevent stroke. Patients with type 2 diabetes have a risk of developing heart disease twice as high as those without diabetes.”
The good news, however, is that pharmacological research is proceeding with important results. What are the latest truly significant news in terms of treatment?
«If being a diabetologist has been exciting in the last ten years, it will be even more so in the coming years. In addition to technology, we have a lot of new things going on. Currently, for example, we have the possibility of using numerous classes of drugs that can help reduce blood sugar and improve metabolic compensation, thus reducing cardiovascular failure and the risk of stroke. Among these there are the GLP-1 receptor agonists (to which the already well-known Ozempic and Wegovy belong, ed.), but we will also have other molecules, currently present in some states and not yet in Italy – always developed in combinations with high-dose semaglutide and active in obesity, capable of reducing cardiovascular risk. Semaglutide has been available in Italy for a year now but higher doses currently under study will also arrive with wonderful effects on metabolic compensation and above all on weight loss. We therefore have important prospects in the coming years.”
What about daily blood sugar management?
«Weekly insulin will soon be available, which is already used in some clinical studies with great satisfaction. It will mean no longer having an injection every day, but once a week. An innovation that will significantly improve the quality of life of patients.”
What should we pay attention to to prevent the current epidemiological numbers from growing dramatically?
«There are essentially two things to pay attention to: the first is to understand, in the risk categories – that is, in people who are familiar with the disease and those diagnosed with arterial hypertension, overweight or obesity – how much there is already and what could happen. So, simply, do a blood test and check blood sugar and glycated hemoglobin, given that these two tests are enough to understand what the state of the art is. Also because the earlier we treat hyperglycemia, the better the results are both in terms of metabolic compensation and in terms of the development of complications. The second big issue is then understanding how to treat metabolic syndrome, that is, that set of risk factors that can represent an incidence in ischemic heart disease and stroke, namely: the presence of obesity and hypertension, visceral obesity, hyperglycemia, dysglycemia , high cholesterol. In risk categories the approach must be behavioral and therefore aimed at encouraging adequate physical activity and a balanced diet.”
What does “prevention” mean in this sense?
«The network of general practitioners is making a great contribution in this sense: they invite their patients to change their lifestyle for the better by adopting healthier choices in terms of physical activity and diet. They range from the banal advice of parking far away to walk more, or walking up the stairs, to respecting a more controlled diet. After all, the Mediterranean diet is the one we are lucky enough to be able to use: animal fats reduced to the bare minimum, if possible to zero; fruit without exaggerating; extra virgin olive oil; some carbohydrates; vegetables; a little meat and a little fish. In other words, the possibility of adequately using what nature offers us.”
Source: Vanity Fair
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