Development of drugs against diabetes not standing still. What is fundamentally new suggests today's science? This tells the head of the Department of Endocrinology and the Diabettology of the Russian Medical Academy of Postgraduate Education of the Ministry of Health of the Russian Federation,.M.N., Professor Alexander Ametov.
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- What awaits us in the near future?
- The most interesting, in my opinion, is the appearance of a fundamentally new drug to control glucose - exonatida. It is created using genetic engineering and is intended for those who are sick-type sick diabetes. Conductive research is now held - the results are quite good. And in the coming year or two this drug will already be actively used.
- What it differs from the usual insulin?
- No matter how loud it sounds, but Exonatid is a new word in the treatment of diabetes. It allows not only to maintain a normal level of glucose, but also to improve the functions of beta cells. Those most that are responsible for insulin production. Unlike previous drugs, exonatid acts during the day. So it can be accessed only once a day. This will greatly facilitate the life of diabetics, which, as a rule, live from the injection to the injection.
And besides, a new medicine has a unique ability to burn fat. This is important, since excess weight and obesity are found in 85-90% of people with type II diabetes. And to cope with this problem is extremely difficult.
- And what can you please those who suffer type I diabetes?
- In this direction, new products even more. These are improved drugs, unusual insulin forms, such as insulin in tablets and insulin for inhalations, unique glucose control systems and even beta cells and pancreatic transplantation.
- Let's in order. What is this modern drugs and what is their uniqueness?
- Now new high-speed insulin preparations have already appeared - Lizpro and Aspart. They are unusual in that they allow us to get closer to normal physiological processes. Normally, in a healthy person, insulin begins to be produced in 2-3 seconds after meals. Diabetic has problems with this, so he needs to enter insulin. Previously, it was necessary to do 20-40 minutes before meals. With the advent of high-speed drugs, the need for advanced reception disappears. They start to activate after 10 seconds. Therefore, they need to enter them directly during food.
By the way, new forms of insulin appeared, such as before and dreaming did not have to. And now they already exist. For example, insulin for intake and administration through the nose, insulin for inhalation and insulin in the form of spray.
- What they are unique?
- The most promising currently is insulin for inhalations. It is introduced through the lungs with special inhalers. His benefits are a rapid effect and lack of negative impact on the liver. It is quite universal and can be used in diabetes as the I and II types. In the first case - as an independent medication, or simultaneously with injections. In the second - in combination with sugar drugs. Inhalation insulin is most often powder, packaged in bags, which can be stored at room temperature. Which is definitely very convenient.
No less convenient to use and nasal insulin - drops, injected into the nose. Over the creation of such a form, specialists have been working hard enough. But in recent years, achievements have appeared in this area. Interesting fact - the rate of action of insulin when administered through the nose turns out to be higher than when subcutaneous injection. But at the same time, it is removed much faster. Still remains unclear how to extend his action. And is it possible to apply it if there are additional unfavorable conditions. For example, nasopharynx diseases, low and high air humidity, hot and cold weather.
Nevertheless, in the future, nasal insulin can be used to give a patient to temporarily relax from injections. In many ways, researchers are calculated on the creation of oral, t.E. Accessed through the mouth, insulin forms. These are various tablets, syrups, jelly. Such attempts were before, but until they were crowned with success. The fact is that the intestinal environment is destroying effect on insulin. And the reception of such tablets and syrups is meaningless.
But currently there are new data. Recent studies conducted by famous Russian scientists.BUT. Plate, showed: insulin preparations treated with a special hydrogel, reduce blood glucose levels. This discovery allows you to hope that soon the tablet will appear from diabetes.
- And what kind of unique glucose level control systems?
- Now we have already begun to use new CGMS devices that allow you to precisely track the change in blood glucose level. They give testimony 288 times a day. So, the doctors have a real opportunity to quickly and correctly pick up the treatment of the treatment that each specific person needs.
One of the new products is a feedback system. Such a miracle of technology at some stages may well replace the doctor. She herself removes readings, displays them to the computer monitor and even prescribes insulin dosage and time of its reception.
- You talk about such interesting and necessary things. But really to the Russians to use them?
- Sure. All these developments are held not only abroad, but also in Russia. Something already is - high-speed drugs and CGMS systems. Something will be very soon, for example, a feedback system is expected in 1-2 years. Latest control studies are now completed. And some new items, in particular, tableted insulin - later. But in any case, all this, as they say, «On the approach». And in the next 10 years I will definitely have.
- And if we talk about more distant terms, which is most promising and deserves attention?
- First of all, transplantology. High hopes are associated with beta cells now. It mainly concerns people with type I diabetes. Already there are observations of American scientists. It is significant that 84% of diabetics, which were transplanted by donor beta cells, did not need insulin preparations after that. These are good results, especially for transplantology.
In this field of medicine, the main problem is to achieve unemployed by the body of alien elements. It is not easy to do, as it is necessary for constant treatment with drugs depressing immunity. Otherwise alien «agent» just not survive his «Skip» Own immunity. That is why, as well as due to high cost, few pancreatic transplants are made. Over the past 15 years, about 300 such operations have been held in the world. Mostly US and Canada specialists.
Pancreas transplantation has many advantages and many minuses. And this is not a panacea from diabetes, but only one of the ways to combat it. And, I must say, quite complicated and rarely found. This is jewelry, «piece goods». About some large-scale application of the method so far. And in general, any treatment is only 10, well, maybe 20% of the fight against diabetes.
- How? And then then the main?
- The main thing is the power and physical activity. And medicines are only support. Let the necessary, but far from the only one. And, unfortunately, drugs are not omnipotent. No «Magic» insulin, which will immediately solve all the problems. Sugar diabetes is a lifestyle. And you need to be able to exist with him, manage it. Need to armared knowledge to not be confused in any situation. After all, everything changes in life. Today it may be calmly and familiar, and tomorrow is a new job, other rhythm, other loads. We must know how to behave in any situation: how to eat, what kind of sport is to do how to be treated. Only in this case can live a full-fledged life, for many years while maintaining disability and well-being.
- Is it possible to protect yourself from diabetes? What is being taken on prevention?
- It has been proven that diabetes development is preceded by certain processes in the body. There are four stages of prediabet, each of which is responsible for its process. The main task of prevention is to recognize these stages and be able to influence them. Specialized programs are being developed and launched. Now we have already reached some results, but at the moment there are conclusions and give specific recommendations for the prevention of diabetes even early.
By and large, glucose control is prevention. But prevention is not a disease as such, but its complications. It is known that diabetes leads to vascular, neurological and many other violations. Competent control over the level of glucose helps significantly reduce the risk of their appearance. Results received within the framework of the study «Control over diabetes and its complications», They proved it. With proper treatment, selected power modes and physical activity it is possible to reduce the risk of eye damage, kidney and nervous system by an average of 50%.
- It is known that medicine develops quite slowly. Why suddenly such a breakthrough in diabetology?
- It happened not suddenly and not now. Historically, diabetes recognized the first non-infective epidemic. And all the forces were thrown to fight him. The attention of the world community was drawn, solid funds were allocated to finance programs and developments.
And now the time has come when the results of this global work began to affect. In fact, what is happening today in diabetology is an excellent example of how to deal with chronic diseases. And if each of them we will solve the same simply and productive, the quality of life of those who have such health problems will be much higher. So people will become happier.
