Over 400,000 Israelis have diabetes, the vast majority of them with type 2 diabetes. Whether it is juvenile diabetes, pre-diabetes, or advanced diabetes with its many complications, the medical world continues to look for more effective ways to diagnose, treat and manage one of the most common chronic diseases in the world with the help of clinical trials.
Sugar is one of the most important substances in our body. Too low sugar levels (hypoglycemia) can lead to seizures and life-threatening. On the other hand, too high levels of sugar (hyperglycemia) cause long-term complications with damage to various organs.
Strict control is needed to maintain the balance of sugar in the body. This control is the responsibility of a hormone called insulin, which is secreted by the pancreas in response to too high sugar levels, for example immediately after a meal. Along with this, other hormones, such as glucagon, are the counter-control to raise the sugar level in other situations.
Diabetes is characterized by difficulty in balancing the high sugar levels (glycemic balance) in the body due to insulin-related disorders.
Type 1 diabetes, also called juvenile diabetes, is an autoimmune disease in which the body attacks the pancreatic cells that secrete the insulin, thus preventing the secretion of the hormone.
Type 2 diabetes, in which 90% of diabetics suffer, is caused by the resistance of the organs of the body to the effect of insulin so that the high sugar levels stay longer in the blood. Other types of diabetes caused by other effects are also known today.
Both types of diabetes are actually chronic diseases, requiring lifelong treatment. Some patients are required to monitor their blood sugar (glucose) levels; Others, in need of insulin therapy, are connected to a permanent subcutaneous pump. All of these are designed to achieve optimal glycemic balance, a not-so-simple goal in itself.
Patients who suffer from high blood sugar levels over time are at high risk for long-term complications, including damage to kidney functions, damage to the small nerves with an increased risk of injury, and retinal damage to the point of blindness. High blood sugar levels also damage the membranes of blood vessels, making it difficult to recover from surgery and increasing the risk of heart disease.
There is an increase in the incidence of diabetes – both type 1 and type 2.
“Juvenile diabetes” can also appear at later ages and is not necessarily related to lifestyle.
There is a hereditary predisposition to type 1 diabetes. If your parents have risk factors, you may be at increased risk of developing it.
Some of the risk factors for developing type 2 diabetes can be controlled, with exercise and diet for example.
When diabetes is also accompanied by high blood pressure and high levels of lipids in the blood, it is a health disorder called metabolic syndrome.
Type 1 and type 2 diabetes are actually chronic diseases, requiring lifelong treatment – Check your care options here.
The diagnosis of diabetes can be based on a number of blood tests which are usually done routinely. High sugar levels – fasting or during the day – can indicate a pre-diabetic condition or diabetes itself, depending on the sugar values measured.
Another important measure used not only to diagnose diabetes but also to monitor glycemic balance is glycated hemoglobin, also known as HbA1c. High blood sugar levels over time “stick” to the hemoglobin, which is found in our red blood cells. Because the blood cells change every few months, the glycated hemoglobin stays in the blood for a long time and therefore the HbA1c index can indicate the quality of the continuous glycemic balance – usually over 3 months. Therefore it is also used for therapeutic follow-up.
Follow-up of diabetics often includes a multidisciplinary team such as a dietitian, endocrinologist and family physician. Among other things, diabetics are also recommended to undergo periodic tests for kidney function, along with a retinal examination by an ophthalmologist. Examination of the feet for wounds and sensory impairment is also recommended.
Pros and Cons
Type 1 diabetes:
The best-known treatment for diabetes is insulin – a replacement hormone given by subcutaneous injections. Insulin is the primary treatment for type 1 diabetes, where hormone deficiency is the basis of the disease. Some patients with type 2 diabetes also need insulin treatment in the later stages of the disease.
The adjustment of the type of insulin and its dosages is done gradually and requires constant monitoring of glucose levels. Too low levels will prevent optimal balance; Too high levels can lead to a sharp and dangerous drop in sugar levels.
It is common for the treatment to combine long-term insulin such as TREGLUDEC® in low-level around the clock, along with short-term insulin such as Apidra® 3 times a day after each meal. This treatment regimen should mimic the pancreas’ natural insulin secretion. To avoid frequent injections, some patients prefer to use a regular subcutaneous pump that injects insulin at pre-set values during the day.
Type 2 diabetes:
For type 2 diabetes there are a variety of different pharmacological treatments. Each drug has advantages and disadvantages: some drugs may increase the chance of sharp sugar falls, others may be less effective and even dangerous for patients with kidney failure.
For most patients, the first line of treatment is done with metformin group drugs such as Glucomin® and Glucophage®. There are also newer drugs that have been found to be effective in balancing glycemic as well as reducing the risk of comorbid heart disease, which many diabetics suffer from, such as Byetta®.
The choice of the treatment regimen for patients with type 2 diabetes is largely based on the characteristics of the patient, the comorbidities, and the effectiveness of past treatments. Some patients “get out of balance” over the years and require additional medications. Today, some drugs come in one tablet such as JANUET®.
Along with pharmacological treatments, the overarching recommendation for both type 1 and 2 diabetics is to adhere to a healthy diet and exercise. These have been found to be associated with a reduced risk of developing diabetes in patients with pre-diabetes, and they reduce the chance of developing various complications after the development of the disease.
There are newer drugs that have been found to be effective in clinical trials, both in glycemic balance as well as in reducing the risk of comorbid heart disease, which many diabetics suffer from.
After exhausting all the treatment lines – what is the next step?
There are a number of therapeutic challenges for diabetics, ranging from early detection and prevention of pre-diabetic conditions to treatment of advanced complications of the disease.
Using new therapies and measures can improve glycemic balance with fewer side effects, and even prevent or improve some of the complications of the disease. Continuous monitoring of blood sugar levels can help identify latent events of sharp sugar falls, and provide the physician with extensive information on ongoing blood sugar levels, thereby improving the accuracy of the therapeutic regimen. This may be just the tip of the iceberg of the future of diabetes care.
Using new therapies and measures can improve glycemic balance with fewer side effects, and even prevent or improve some of the complications of the disease – Find your clinical trial here.
Clinical studies in Israel for diabetes
These solutions are already being tested today as part of clinical studies in many medical centers in Israel and are offered to patients free of charge and with ongoing medical follow-up. It is possible that one of these experiments may be suitable for you or your relatives who suffer from this chronic disease.
We at Optio help you find active clinical trials that can improve the treatment of your disease, and thus your quality of life. By filling out a short questionnaire by clicking on Match Me Clinical Trial, you can check if there is a clinical trial that can suit your needs or help you with another treatment.
If a suitable experiment is found, the Optio team will connect you and the research team, as well as help you better understand what participating in the study involves, what are the pros and cons of the experiment, and what is required of you during it, so you can decide if you want to participate.