Diabetes


Every book about diabetes begins with the history of the disease.
You learn that it is an ancient disease, which Banting & Best were the discoverers of insulin and many other things.
However, it is known that the knowledge about diabetes experienced a dramatic evolution in recent years, not only about the pathological mechanisms of diseases, but also in relation to new therapeutic options, all based on the same pathophysiological mechanism of diabetes.
This fantastic progress in knowledge was indisputable source of good and bad news.
Starting with the lattest news, it is known that diabetes has emerged as an epidemic of serious proportions; its prevalence has increased dramatically, as a result of an aging population and negative changes in lifestyle .
Additionally, the disease is manifested in earlier ages.
Geneticists believe, today, that a group of genes spread throughout the genome, in varying combinations and a complex interaction with acquired factors lead to the onset of diabetes and its complications, whose impact varies from individual to individual.
Finally, it tends to disappear the classical distinction between diabetes type 1 or 2, and is now recognized the diabetes "type 1.5" (the latent autoimmune diabetes in adults) and was been diagnosed many cases of type 2 diabetes in adolescents and those with diabetes type MODY, where there is a genetic alteration, appeared, also, various forms of glucose intolerance, such as those found in pregnancy, polycystic ovary and steatohepatitis.
However, the evolution of knowledge has also brought good news.
For example, are now understood all the pathophysiological aspects of hyperglycemia and it is possible to know the blood sugar levels at any time, with cutting-edge mobile technologies.
Are understood, too, the cellular basis of insulin resistance that predicts, characterizes and precedes glucose intolerance.
There are thorog knowledge of the role of the endocrine pancreas in diabetes and also their role in sudden or progressive loss of beta cell function.
Are also known, the effects of gastrointestinal hormones in glycemic control, as well as the harmful effects of obesity and overweight in the control of diabetes.
Are advanced studies on the mechanisms of hypertrophy of the islets (neogenesis vs. replication).
This new knowledge led to intense activity in the pharmaceutical industry.
For over half a century, the only treatments available to hyperglycaemic conditions, were sulfas,  insulin and metoformina.
Now, the new drugs, seek to act in multiple pathophysiologic mechanisms of glucose metabolism.
Exciting new strategies are being examined: for example, activation of glicoquinase, blocking the action of glucagon, prevention of renal reabsorption of glucose, delayed gastric emptying, inhaled insulin and oral.
The possibility for the normalization of blood glucose for 24 hours does appear to be achieved in short, a fact comparable to that achieved with statins in relation to cholesterol.
There is, therefore, to keep alive the hope for a brighter future.
 
Victor Manuel do Carmo Nunes
Grupo ST05/12