Diabetes, where are we?
Anna Novials, PI of the group “Pathogenesis and Prevention of Diabetes” at IDIBAPS/Clinic Hospital of Barcelona and member of CIBERDEM network.
Diabetes mellitus (DM) is a group of chronic metabolic disorders all characterized by hyperglycemia. It occurs either when the pancreas does not produce enough insulin or when the peripheral tissues cannot effectively use the insulin it produces. The global prevalence of diabetes and impaired glucose tolerance (the intermediate transition between normal blood glucose levels and diabetes) has been increasing over recent decades. The International Diabetes Federation (IDF) reported that in 2019 there were 463 million people between 20-79 years worldwide with diabetes, accounting for the 9.3 % of the global adult population. If this trend continues, it is expected to increase to 700 million by 2045. Furthermore persistent high blood glucose levels cause generalized vascular damage affecting the kidneys (nephropathy), the eyes (retinopathy), the nerves (neuropathy) and the heart (cardiovascular disease), leading to disabilities and premature death. The World Health Organization (WHO) reported diabetes to be the seventh leading cause of death. As a consequence the economic burden of diabetes has a high impact on the global health-care system.
The first national study in Spain published in 2012 (the Di@bet.es Study) revealed that the overall prevalence of DM in individuals ≥18 years old in our country was 13.8% and, about a half of them (6%) had unknown diabetes. In addition to this alarming values, the prevalence rates of isolated impaired fasting glucose (IFG) and isolated impaired glucose tolerance (IGT) 3.4% and 9.2%, respectively (2). Taken together, this study uncovered that almost 30% of the study population had some carbohydrate disturbance.
Type 2 Diabetes (T2D) accounts for the vast majority (around 90%) of diabetes worldwide. It can be effectively managed through education, adoption of healthy lifestyles, combined with medication as required. The pathogeny of T2D is extremely complex and comprises all the organs that work coordinately to maintain energy and glucose homeostasis. It is established that when the cross-talk between organs (pancreas, liver, muscle, adipose tissue, brain ,etc )is altered, then the main pathogenic events which are insulin secretory defects and insulin resistance appear as a hallmark of T2D. All current treatment for T2D are adressed to target molecular pathways in different tissues.
Type 1 diabetes (T1D) is the major cause of diabetes in childhood. Patients need an uninterrupted supply of insulin for life. The pathogeny of diabetes consists in alteration in the autoinmunity. The main cause is not yet been stablished. The advances in the treatment remain dissapointing . Although technology applied to diabetes is in continuos progress, patients are still using the same treatment as 100 years ago, when insulin was discovered.
Collectively, these results evidence the need for more clinical and preventive intervention programs and highlight the importance of carrying out more basic research in order to understand the underlying mechanisms of the disease.
Dr. Anna Novials is endocrinologist at Hospital Clinic de Barcelona and leader group of research at IDIBAPS. She received her PhD from the University of Barcelona, in 1989, focusing her studies on the chronic effect of glucotoxicity on pancreatic function in patients with type 2 diabetes. A postdoctoral stay at the University of Cambridge and collaborations with the University of Oxford enriched her scientific and technical knowledge of molecular biology, turning her research objectives toward the molecular mechanisms that affect pancreatic islet function in diabetes, which she would then develop at the Hospital Clinic de Barcelona, going on to lead her own research group.
From 1998 to 2008, Dr. Novials conducted her clinical activity at the Sardà Farriol Foundation in Barcelona, first as Head of the Diabetology Unit and later as Executive Director. Here she devoted her efforts to promoting educational tools to help patients adhere to exercise programs as part of their diabetes treatment plan. In 2008, she rejoined the IDIBAPS as leader of a clinical and basic research team. Since 2010, she has also served as an Executive Committee member of the Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM). Finally, Dr. Novials is the former President of the Spanish Diabetes Society and as served as member of the EASD-EU Committee of the European Association for the Study of Diabetes to advocate for diabetes research.
This clinical colloquia will take place online at the GoToMeeting platform