Modern approaches to the treatment of diabetes

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Modern approaches to the treatment of diabetes

1. Diagnosis and classification of diabetes: the basis for personalized treatment

Accurate diagnosis and determination of the type of diabetes are critical steps for developing an effective treatment plan. Modern diagnostic methods go beyond a simple measurement of blood glucose levels and include more complex tests that allow you to accurately determine the cause of hyperglycemia and, therefore, choose the most suitable therapy strategy.

  • Standard diagnostic methods:

    • Measurement of glucose levels in plasma on an empty stomach (GPN): It is measured after at least 8 hours of starvation. GPN level ≥ 7.0 mmol/l (126 mg/dl) indicates diabetes.
    • Coral glucosotolerant test (PGTT): The patient drinks a solution of glucose, and the level of glucose in the blood is measured after 2 hours. Level ≥ 11.1 mmol/l (200 mg/DL) indicates diabetes.
    • Random measurement of glucose levels in plasma: It is measured at any time of the day, regardless of food intake. Level ≥ 11.1 mmol/l (200 mg/DL) in the presence of diabetes symptoms indicates diabetes.
    • Glycated hemoglobin (HBA1C): Reflects the average level of glucose in the blood over the past 2-3 months. Level ≥ 6.5% indicates diabetes. HBA1C is a convenient indicator that does not require starvation.

  • Differential diagnosis of diabetes:

    • Type 1 diabetes (T1D): Autoimmune destruction of pancreatic beta cells, leading to absolute insulin deficiency. Diagnosis includes:
      • Measurement of the level of antibodies to beta cells: Anti-GAD (antibodies to glutamatdecarboxylase), anti-AIA-2 (antibodies to tyrosinfosphatase IA-2), anti-impulsul (IAA) and anti-ZNT8 (antibodies to zinc transporter 8). The presence of one or more of these antibodies confirms the autoimmune nature of the T1D.
      • C-peptide level measurement: C-peptide is formed with insulin synthesis. The low or absent level of C-peptide indicates a reduced or absent function of the beta cells.
    • Type 2 diabetes (T2D): Characterized by insulin resistance and relative insulin deficiency. Diagnosis includes:
      • Assessment of risk factors: Family history of diabetes, obesity, sedentary lifestyle, a history of gestational diabetes, hypertension, dyslipidemia.
      • Measurement of the level of insulin and C-peptide: It can help evaluate the function of beta cells and the degree of insulin resistance. However, the interpretation of these indicators can be complex and requires the accounting of other factors.
    • Gestational diabetes (GD): Diabetes, first detected during pregnancy. Diagnosis is carried out using PGTT between 24 and 28 weeks of pregnancy.
    • Other types of diabetes: They include monogenic forms of diabetes (Mody, Midd), diabetes caused by pancreatic diseases (pancreatitis, cystic fibrosis), endocrinopathy (Kushing, Acromegaly syndrome) and drugs (glucocorticoids). To diagnose these types of diabetes, genetic tests, visualizing pancreatic studies and the assessment of hormonal status may be required.

  • Personalized approach to diagnosis:

    • Determination of the severity of hyperglycemia: Based on the level of glucose in the blood and HBA1C.
    • Assessment of related diseases: Cardiovascular diseases, nephropathy, neuropathy, retinopathy, obesity, hypertension, dyslipidemia.
    • Accounting for age, gender, ethnicity and lifestyle of the patient.
    • Definition of treatment goals: Given the individual characteristics of the patient and his preferences.

2. Modern drugs for the treatment of type 2 diabetes: choice of optimal therapy

Type of type 2 diabetes (T2D) includes a change in lifestyle (diet and physical exercises) and pharmacotherapy. Modern drugs for the treatment of T2D have various mechanisms of action, which allows you to choose the most effective and safe therapy for each patient.

  • Metformin: It is a first line for the treatment of T2D. It reduces the products of glucose with the liver, increases sensitivity to insulin and improves the utilization of glucose with peripheral tissues. Metformin can also reduce the risk of cardiovascular diseases.

  • Derivatives of sulfonylmochevins (PSM): Stimulate the secretion of insulin with pancreatic beta-cells. Effective in reducing blood glucose, but can cause hypoglycemia and weight gain.

  • Glinides (Meglitinides): They also stimulate insulin secretion, but have a shorter action than PSM. Less risk of hypoglycemia than when using PSM.

  • ThazolidinDidiYi (SDD): Increase sensitivity to insulin in peripheral tissues, especially in adipose tissue and muscles. They can cause fluid delay, weight gain and risk of heart failure.

  • Dipeptidylpeptidase-4 (IDPP-4) inhibitors: Increte levels (GPP-1 and GIP) are increased, which stimulate insulin secretion and suppress the secretion of glucagon. It is well tolerated and rarely cause hypoglycemia.

  • Sodium-glucose coter carrier 2 (INGLT-2): Block reabsorption of glucose in the kidneys, which leads to the elimination of glucose in urine. Reduce blood glucose, blood pressure and weight. The risk of genital infections and diabetic ketoacidosis can increase.

  • Glucagono-like peptide-1 (ArgPP-1) receptor agonists: They stimulate insulin secretion, suppress the secretion of glucagon, slows down the emptying of the stomach and reduce appetite. Effective in reducing the level of glucose in blood and weight. Other gastrointestinal disorders can cause nausea.

  • Insulin: It is used for the treatment of T2D, when other drugs do not allow to achieve the target level of glucose in the blood. There are various types of insulin: short -acting insulin, insulin average duration of action, long -action insulin and mixed insulins.

  • The choice of optimal therapy:

    • Assessment of individual needs and preferences of the patient.
    • Accounting for related diseases and risk factors.
    • Evaluation of the effectiveness and safety of drugs.
    • Personalized approach to dose titration.
    • Regular monitoring of blood glucose and HBA1C.

  • Combined therapy: Often required to achieve the target level of glucose in the blood. Combined therapy may include:

    • Metformin + PSM
    • Metformin + IDPP-4
    • Metformin + artwork-2
    • Metformin + Argps-1
    • Metformin + insulin

3. Insulin therapy: modern approaches and technologies

Insulin therapy is vital for people with type 1 diabetes (T1D) and may be required for people with type 2 diabetes (T2D), when other treatment methods do not allow adequate control of glycemia. Modern approaches to insulin therapy seek to imitate the physiological secretion of insulin and minimize the risk of hypoglycemia.

  • Types of insulin:

    • Inculin in ultra -short action (analogues of insulin Lizpro, Aspart, Glulisin): He begins to operate 15 minutes after the injection, the peak of action after 1-2 hours, the duration of the action is 3-5 hours. It is used for sore insulin therapy before eating.
    • Short -acting insulin (ordinary human insulin): He begins to operate 30 minutes after the injection, the peak of action after 2-4 hours, the duration of the action is 5-8 hours. It is used for sore insulin therapy before eating.
    • Insulin of average duration of action (NPH-Insulin): It begins to operate 1-2 hours after the injection, the peak of action after 4-12 hours, the duration of the action is 12-18 hours. Used as basal insulin.
    • Long -action insulin (analogues of insulin Glargin, Detemir, Degludek): He begins to act 1-2 after injection, does not have a pronounced peak of action, the duration of the action is 24 hours or more. Used as basal insulin. Insulin Degludek has a duration of action up to 42 hours.
    • Mixed insulins: They contain a fixed combination of insulin short or ultra -short and insulin of the average duration of action. Convenient for people who prefer to do less injections, but less flexible than separate insulin injections.

  • Insulin therapy modes:

    • Basal-bolus mode: It is considered the most physiological regime of insulin therapy. It includes injections of long -acting insulin (basal insulin) to maintain a stable level of blood glucose between meals and injection of insulin ultra -short or short -acting (bolus insulin) before each meal for coating carbohydrates.
    • Twice a day of injection of mixed insulin: Injections of mixed insulin in the morning and evening. Less flexible than the basal-bolus regime, but can be suitable for people who prefer to do less injections.
    • Insulin pump (continuous subcutaneous insulin infusion – NPPI): It delivers ultra -short effect continuously under the skin. Allows you to more accurately imitate the physiological secretion of insulin and reduce the risk of hypoglycemia.

  • Technologies in insulin therapy:

    • Insulin pens: Convenient and discrete devices for the introduction of insulin.
    • Syringes: The traditional way of introducing insulin.
    • Continuous glucose monitoring systems (NMG): Measure the level of glucose in the blood every few minutes. Allow patients to see the dynamics of changes in blood glucose in real time and make more reasonable decisions on insulin therapy.
    • Inculine pumps with feedback (closed systems): Automatically adjust the dose of insulin based on NMG data. They allow you to maintain the level of glucose in the blood in the target range and reduce the risk of hypoglycemia. There are hybrid closed systems that require the patient to participate in the tuning of insulin pain before meals, and completely closed systems that automatically adjust basal and pain insulin.

  • Personalization Insulin therapy:

    • Teaching patients self -control of the level of glucose in the blood and dose correction of insulin.
    • Accounting for food habits, physical activity and other factors affecting the level of glucose in the blood.
    • Regular adjustment of the dose of insulin based on NMG data and self -control of the level of glucose in the blood.
    • An individual approach to determining the target level of glucose in the blood.

  • Hypoglycemia management:

    • Patient training to recognize symptoms of hypoglycemia.
    • Recommendations for the treatment of hypoglycemia (taking rapidly digestible carbohydrates).
    • Insulin dose adjustment to prevent hypoglycemia.
    • The use of glucagon in case of severe hypoglycemia.

4. Modern approaches to controlling glycemia: integration of technology and self -control

Effective control of glycemia is the cornerstone of diabetes. Modern approaches to controlling glycemia integrate advanced technologies, such as systems for continuous glucose monitoring (NMG) and insulin pumps, with active self -control from the patient and personalized management strategies.

  • Continuous glucose monitoring systems (NMG):

    • The principle of work: NMG uses a small sensor that is inserted under the skin and measures the level of glucose in the interstitial fluid. Data is transferred to a receiver or mobile device that displays the level of glucose in real time and provides information about the dynamics of changes in glucose (trends).
    • NMG types:
      • NMG with periodic scanning (Flash Glucose Monitoring – FGM): Require scanning the sensor to obtain glucose levels.
      • NMG in real time (Real -Time Continous Glucose Monitoring – RTCGM): Constantly transmit data on the level of glucose to the receiver or mobile device.
    • Advantages of NMG:
      • Continuous display of glucose in the blood.
      • Information about the dynamics of changes in glucose levels (trends).
      • Warnings about high and low glucose.
      • Improving glycemia control.
      • Reduction of risk of hypoglycemia.
      • The possibility of personalization of insulin therapy.
    • NMG restrictions:
      • They require calibration by measuring the level of glucose in the blood using a glucometer.
      • Can be inaccurate in some situations (for example, with a rapid change in glucose levels).
      • They can cause skin irritation.
      • Price.

  • Insulin pumps:

    • Advantages of insulin pumps:
      • The exact dosage of insulin.
      • The ability to configure the basal velocity of insulin.
      • The ability to introduce pain insulin before meals.
      • Reduction of risk of hypoglycemia.
      • Improving glycemia control.
      • A more flexible lifestyle.
    • Restrictions on insulin pumps:
      • They require training and self -control.
      • They can cause infections at the place of introduction of a catheter.
      • Can be faulty.
      • Price.

  • Self -control level of glucose in the blood (SCG):

    • The importance of SKG:
      • Allows patients to track the level of glucose in the blood and adjust the dose of insulin or other drugs.
      • Helps to identify and prevent hypoglycemia and hyperglycemia.
      • Allows patients to assess the effect of food, physical activity and other factors on the level of glucose in the blood.
    • SCG recommendations:
      • The frequency of SCG depends on the type of diabetes, treatment regimen and individual needs of the patient.
      • Patients receiving insulin therapy should measure the level of glucose in the blood several times a day, especially before meals, before bedtime and after physical activity.
      • Patients who do not receive insulin therapy can measure the level of glucose in the blood less often, for example, one or twice a day.
    • SCG technique:
      • Using a glucometer and test strips.
      • Properly applying blood drops to a test strip.
      • Proper storage of test strips.
      • Regular verification of the accuracy of the glucometer.

  • Personalized glycemia management strategies:

    • Determination of the target level of glucose in the blood, taking into account the individual characteristics of the patient (age, concomitant diseases, lifestyle).
    • Development of an individual nutrition plan, taking into account the preferences of the patient and energy needs.
    • Recommendations on physical activity, taking into account the capabilities of the patient.
    • The patient’s training is self -control of the level of glucose in the blood, the correction of the dose of insulin or other drugs and the management of hypoglycemia and hyperglycemia.
    • Regular observation by a doctor and adjusting the treatment plan if necessary.

5. New technologies in the treatment of diabetes: artificial pancreas and cell therapy

In recent years, significant progress has been observed in the development of new technologies for the treatment of diabetes, including artificial pancreas (closed systems) and cell therapy. These technologies have the potential to significantly improve glycemia control and the quality of life of people with diabetes.

  • Artificial pancreas (closed systems):

    • The principle of work: The artificial pancreas (IPS) is an automated system that imitates the function of the pancreas, continuously measuring the level of glucose in the blood and automatically adjusting the dose of insulin. IPG consists of three main components:
      • Continuous glucose monitoring system (NMG): It measures the level of glucose in the blood every few minutes.
      • Insulin pump: It delivers insulin under the skin.
      • Management algorithm: Analyzes NMG data and calculates the necessary dose of insulin.
    • Types of IPG:
      • Hybrid closed systems: Require the patient in tuning the insulin pain before meals.
      • Fully closed systems: Automatically regulate basal and sore insulin.
    • Advantages of IPZH:
      • Improving glycemia control.
      • Reducing the risk of hypoglycemia and hyperglycemia.
      • Reducing the burden of self -control.
      • Improving the quality of life.
    • Restrictions IPG:
      • They require training and self -control.
      • Can be inaccurate in some situations.
      • They can cause infections at the place of introduction of a catheter.
      • Price.

  • Cell therapy:

    • The principle of work: Cell therapy is aimed at restoring the function of the pancreatic beta cells that produce insulin. There are various approaches to cell therapy of diabetes, including:
      • Transplantation of islet cells: Transplantation of islet cells (cells of cells containing beta cells) from a donor to a person with type 1 diabetes.
      • Pancreatic transplantation: Transplanting the entire pancreas from the donor to a person with type 1 diabetes.
      • Regenerative medicine: Development of methods for stimulating the regeneration of their own beta cells of the body.
    • Advantages of cell therapy:
      • The possibility of cure for type 1 diabetes.
      • Improving glycemia control.
      • Reduction of risk of diabetes complications.
    • Cell therapy restrictions:
      • They require immunosuppressive therapy to prevent rejection of the graft.
      • The risk of complications associated with surgical intervention and immunosuppressive therapy.
      • A limited number of donor organs.
      • Price.

  • Other new technologies:

    • Long -length injection insulin (basal insulin once a week): Long -action insulins are developed, which can only be introduced once a week. This can simplify the treatment of diabetes and increase the adherence of patients to therapy.
    • Oral insulin: Occupation of insulin are developed, which can be more convenient for patients than injections.
    • Implanted glucose sensors: Implanted glucose sensors are developed, which can work for several months or even years, without requiring replacement.

6. The role of diet and physical exercises in the treatment of diabetes: personalized recommendations

Diet and physical exercises play a key role in the treatment of all types of diabetes. Modern approaches to the diet and physical exercises for the treatment of diabetes emphasize the importance of personalized recommendations that take into account individual needs and patient preferences.

  • Diet for diabetes:

    • General recommendations:
      • Balanced diet: Contains a sufficient amount of proteins, fats and carbohydrates.
      • Portations control: Eating moderate portions of food.
      • Regular meals: Avoid passes of meals.
      • Limiting sugar and simple carbohydrates: Avoid sweet drinks, sweets, pastries and other products with a high sugar content.
      • The use of complex carbohydrates: Choose whole grain products, vegetables and fruits.
      • The use of products with a high fiber content: Fiber slows down glucose absorption and improves glycemia control.
      • Eating of healthy fats: Choose unsaturated fats such as olive oil, avocados and nuts.
    • Personalized recommendations:
      • Accounting for individual energy needs: Depend on age, gender, level of physical activity and other factors.
      • Accounting for food preferences and cultural traditions.
      • Accounting for related diseases (for example, hypertension, dyslipidemia).
      • The patient’s training is calculating carbohydrates and determining the glycemic product index.
      • Development of an individual food plan using a nutritionist.
    • Special diets:
      • Mediterranean diet: It is rich in vegetables, fruits, whole grain products, fish and olive oil.
      • Low carbohydrate diet: Restriction of carbohydrate consumption to a certain level.
      • Ketogenic diet: Very low carbohydrate content and high fat content.

  • Exercises with diabetes:

    • General recommendations:
      • Regular physical activity: At least 150 minutes of moderate intensity or 75 minutes of high intensity per week.
      • Combining aerobic and strength exercises: Aerobic exercises (for example, walking, running, swimming) improve the cardiovascular system and control of glycemia. Power exercises (for example, weight lifting, exercises with their own weight) increase muscle mass and improve insulin sensitivity.
      • Warm up before training and a hitch after training.
      • Monitoring the level of glucose in the blood before, during and after training.
    • Personalized recommendations:
      • Accounting for individual possibilities and preferences of the patient.
      • Accounting for concomitant diseases (for example, cardiovascular diseases, neuropathy).
      • Development of an individual training plan with a doctor or fitness instructor.
      • Patient training in management of hypoglycemia associated with physical exercises.
    • Advantages of physical exercises in diabetes:
      • Improving glycemia control.
      • Reducing insulin resistance.
      • Decrease in blood pressure.
      • Improving lipid profile.
      • Weight loss.
      • Improving the cardiovascular system.
      • Improving mood and quality of life.

7. Diabetes complications management: modern prevention and treatment strategies

Diabetes can lead to various complications, including cardiovascular diseases, nephropathy, neuropathy, retinopathy and diabetic foot. Modern strategies for the prevention and treatment of complications of diabetes are aimed at early diagnosis, aggressive control of glycemia and risk factors, as well as the use of modern treatment methods.

  • Cardiovascular diseases (SVP):

    • Prevention:
      • Aggressive control of glycemia (HBA1c <7%).
      • Control of blood pressure (<130/80 mm Hg).
      • Lipid profile control (LDL <1.8 mmol/l).
      • Crossing smoking.
      • A healthy lifestyle (diet and physical exercises).
      • The use of anti -agents (aspirin) according to indications.
    • Treatment:
      • Statins to reduce LDL cholesterol.
      • ACE inhibitors or Angiotensin II receptor blockers to control blood pressure.
      • Beta blockers to reduce blood pressure and heart rate.
      • Anti -aggregates (aspirin, clopidogrel) for the prevention of thrombosis.
      • Surgical treatment (angioplasty, aorticronary bypass) if necessary.
      • Preparations that reduce the risk of cardiovascular events (INGLT-2, ArgPP-1).

  • Nephropathy:

    • Prevention:
      • Aggressive control of glycemia (HBA1c <7%).
      • Control of blood pressure (<130/80 mm Hg).
      • Protein consumption restriction.
      • Crossing smoking.
    • Treatment:
      • ACE inhibitors or Angiotensin II receptor blockers for slowing the progression of nephropathy.
      • Diuretics to reduce blood pressure and reduce edema.
      • Correction of anemia.
      • Dialysis or kidney transplantation at the terminal stage of renal failure.

  • Neuropathy:

    • Prevention:
      • Aggressive control of glycemia (HBA1c <7%).
      • Control of blood pressure.
      • Crossing smoking.
      • Avoid drinking alcohol.
    • Treatment:
      • Preparations to relieve pain (antidepressants, anticonvulsants, opioids).
      • Preparations for improving the function of nerves (alpha-lipoic acid, benfotiamine).
      • Physiotherapy.
      • Orthopedic shoes with a diabetic foot.

  • Retinopathy:

    • Prevention:
      • Aggressive control of glycemia (HBA1c <7%).
      • Control of blood pressure.
      • Regular examinations by an ophthalmologist (at least once a year).
    • Treatment:
      • Laser photocoagulation for the treatment of proliferative retinopathy.
      • Intravitreal injections of anti-VEGF drugs for the treatment of macular edema.
      • Vitrectomy during hemorrhage in a vitreous body or retinal detachment.

  • Diabetic foot:

    • Prevention:
      • Daily examination of the feet.
      • Proper care of the feet (washing, moisturizing).
      • Wearing comfortable shoes.
      • Avoid walking barefoot.
      • Regular examinations at the Podologist.
    • Treatment:
      • Antibiotic therapy for infections.
      • Surgical treatment (removal of necrotic tissues, amputation) if necessary.
      • Unloading of the affected area.
      • Using special bandages for wound healing.

8. Psychological aspects of diabetes: support and motivation

Diabetes is a chronic disease that requires constant self -control and can have a significant effect on the patient’s psychological state. Psychological aspects of the treatment of diabetes include support, motivation and training in stress and emotions.

  • Psychological problems associated with diabetes:

    • Depression: People with diabetes have an increased risk of depression. Depression can worsen glycemia control and reduce the commitment to treatment.
    • Anxiety: Anxiety can be caused by fear of hypoglycemia, complications of diabetes or inability to control the level of glucose in the blood.
    • Diabetic distress: This is emotional stress associated with the need for constant self -control and diabetes.
    • Disorders of food behavior: Some people with diabetes may experience eating disorders, such as bulimia or anorexia.
    • Feeling guilt and shame: A feeling of guilt and shame can occur due to the inability to maintain the level of glucose in the blood in the target range.
    • Reducing the quality of life: Diabetes can limit the possibilities of participation in social life, work and other activities.

  • Psychological support strategies:

    • Patient training: Providing the patient with information about diabetes, his treatment and complications. Education helps the patient understand his illness and make reasonable treatment decisions.
    • Support for family and friends: Support for family and friends can help the patient cope with emotional stress and increase the commitment to treatment.
    • Support groups: Participation in support groups allows patients to communicate with other people living with diabetes and share experience and knowledge.
    • Individual psychotherapy: Individual psychotherapy can help the patient cope with depression, anxiety, diabetic distress and other psychological problems.
    • Cognitive-behavioral therapy (KPT): KPT is an effective method of treating depression, anxiety and other psychological problems. KPT helps the patient change the negative thoughts and behavior that contribute to the development of these problems.
    • Minfulness: Mindfulness is the practice of a conscious presence in the present moment. Mindfulness can help the patient reduce stress, improve his mood and increase the commitment to treatment.
    • Motivation interviewing: Motivation interviewing is a consulting method that helps the patient determine his goals and find motivation to change behavior.

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