It was during some children's camps for children with type 1 diabetes organized by the Joslin Clinic in Boston that he attended during his university years, when Dr. Roque Cardona (Las Palmas de Gran Canaria, 44 years old), a pediatrician and expert in child endocrinology in Hospital Sant Joan de Déu in Barcelona, made the decision to direct his professional career towards the care and research of the less popular diabetes: type 1 diabetes. In this field, much remained to be done.
And to know.
Type 2 diabetes, associated with obesity and unhealthy habits, grabs most of the headlines and is in the sights of health authorities due to its increasing prevalence.
But the other, type 1 diabetes, of an autoimmune nature and that usually appears in pediatric ages, is also on the rise and represents, Cardona warns, another great health challenge: a study published in
The Lancet Diabetes & Endocrinology
warns that the number of people with type 1 diabetes in the world will double in 2040 (between 13.5 and 17.4 million, according to the estimates of these researchers).
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Type 1 diabetes is growing by 3.4% a year in Europe and nobody knows why
In both cases, it is a disease that affects the way the body regulates blood sugar.
That is, glucose, essential gasoline to feed the cells and start the body.
Insulin is nothing more than the key to enter those cells, but in the case of type 2 diabetes, that key is broken, as if it does not fit well;
in type 1 diabetes, there is no key directly: the lymphocytes of the immune system itself destroy the beta cells of the pancreas, responsible for producing insulin.
Ask.
What is behind type 1 diabetes?
Why it happens?
Response.
Unfortunately, science today does not have an explanation for it.
We know that there is a genetic basis, which is equivalent to saying that one has a series of lottery tickets that makes it more or less likely that a person can develop diabetes.
But then there must be an external agent that is not identified, which means that, in the end, this genetic predisposition ends up leading to this activation of the immune system that destroys beta cells.
P.
Does the population understand the meaning of a diagnosis of this type?
A.
There is a great distortion of the concept in favor of type 2 diabetes, but they are two completely different diseases.
They share a common manifestation, which is hyperglycemia, but the production mechanisms, the consequences it generates and the way to treat them are significantly different.
Q.
What differences are there between a therapeutic approach to one type of diabetes and another?
A.
The main difference is that the treatment of type 1 diabetes, as the mechanism that conditions it is the destruction of the cells that produce insulin, is aimed at replacing that insulin that the body cannot produce.
Therefore, in the end, it is about imitating the release of the pancreas of a person who does not have diabetes.
And the human body is the most perfect machine that exists.
And simulating that release of insulin with drugs or with current technology has not been entirely easy.
There are some important differences with respect to type 2 diabetes, where the approach is more related to prevention, to lifestyles, and also towards drugs that in the end manage to regulate the mechanism by which this diabetes appears, which is different: that of insulin resistance.
Type 1 diabetes conditions, [on average], a loss of 17 years of life for a person who suffers from it”
Q.
How does the therapeutic approach change?
R.
It is completely different.
[In type 1 diabetes] it involves mimicking the release of insulin from the pancreas of a person who doesn't have diabetes.
This is obviously done with insulin preparations, which have a long-acting and fast-acting profile, the latter to coincide with the times of intake.
But in addition, the great difficulty that diabetes has is that it involves making very frequent decisions: a person with diabetes can make more than 60 or 100 decisions throughout their day.
That is why education is very important, which, in the end, manages to empower patients so that they can carry out those decisions that diabetes requires.
But, even so, they represent a very important wear.
Hence the impact of technologies applied to diabetes,
because it helps to automate the release of insulin, make it more programmed and based on the glucose values that exist at that moment.
With this, they remove that burden, that decision making that is what in the end ends up wearing down people with diabetes or their caregivers.
Q.
What kind of decisions do they have to make?
A.
Very many!
About the dose of insulin, the moment I'm going to take it, the amount of food I'm going to eat: if it's carbohydrates, proteins, fats... and how is that going to affect my glucose;
if I am going to do physical exercise, if I am going to be quiet or if I have a concomitant illness on those days, such as the flu or a cold, and that is going to affect my glucose levels.
This entails a series of decisions that are not easy to manage, especially in children and adolescents.
Q.
The
Lancet Diabetes & Endocrinology
study presents an index, like a database, to map and measure the human and economic impact of type 1 diabetes. Why is it necessary to have that information?
A.
The economic impact of type 1 diabetes is very high, both in treatments and in the production of complications that can lead to premature death.
Therefore, it is essential to have this data to be able to properly plan resources or identify needs.
For example, one of the things we know in Spain is that, in general terms, type 1 diabetes conditions, [on average], a loss of 17 years of life for a person who suffers from it.
P.
In practice, what quality of life do these measures have?
A.
Within the comparison that allows this index to be made in the different countries, Spain has one of the best results in type 1 diabetes: with the insulins that exist and the technologies available, they can have a life just as long, healthy and happy as a person who does not have diabetes.
But this index helps us to identify, to put a face to, certain aspects that we can improve in order to reduce the impact associated with type 1 diabetes. For example, if we were to obtain financing for insulin pump systems, sensors and, above all, automated insulin release system, that would condition being able to earn almost four years on average adjusted to quality of life per person with type 1 diabetes in Spain, in general statistics.
P.
What causes that, on average, there is a loss of 17 years of life due to the disease?
A.
There is one factor that clearly determines the evolution of type 1 diabetes: the achievement of glycemic control goals.
This is the main factor identified in the literature, but there are other factors, such as cardiovascular risk, which are important to control in people with type 2 diabetes, but also in those with type 1: blood pressure control, lipid control, obesity, and non-smoking.
Q.
What happens inside the body so that a diagnosis of diabetes implies, de facto, an increased risk of cardiovascular disease?
A.
Hyperglycemia can damage both small and large blood vessels: microvascular disease can affect the retina or the kidney, while macrovascular disease is one that can lead to, for example, a myocardial infarction or a stroke. .
Both blood glucose values and cardiovascular risk factors are what determine that a person with diabetes may have one evolution or another.
Spain has one of the rates of good evolution of diabetes, but measures are still needed by the Administration.
We are closer than we have ever been to a cure, but we still have a long way to go.
Q.
Like which ones?
A.
On the one hand, access to automated insulin release or artificial pancreas systems for all patients: today everyone can receive it, but there is a waiting list to access this type of system.
And, on the other hand, investment in research to be able to investigate diabetes and advance knowledge.
Q.
In the article in
The Lancet Diabetes & Endocrinology
they warned that they were going to increase diagnoses.
Why is that happening?
R.
The new diagnoses do not know very well why.
There must be something in the environment that is conditioning the increase in cases of type 1 diabetes. Let's think about things that can alter the immune system: one is the hygiene hypothesis, that is, we are increasingly moving in an environment that is much more hygienic and that means that our immune system could be less exposed to those foreign agents and in the end, what it does is attack its own, since it has no external enemies.
That is a possible hypothesis.
It is also true that diagnoses are becoming more precise and fewer cases escape.
But what this index warns is that the number of people with diabetes is going to increase significantly and that is, to a certain extent, good, because it means that people with diabetes live longer,
Q.
Are they close to a cure?
A.
We are closer than we have ever been, but we probably still have a long way to go.
Because in order to cure type 1 diabetes, we need to know very well how the immune system works and there are many characteristics that we still do not know.
Many therapies try to regenerate the insulin-producing cell, the beta cell, but it is important, in addition to regenerating, to act on the immune system so that it does not destroy it again.
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