Although sometimes statistics collect them with the same name, not all deaths seem the same. It is not the same to die suddenly, killed or in an accident, than to do it little by little, as everyone is dying, even if it is a little faster than expected. For that reason, there are diseases that do not arouse so much interest although the statistics shout cataclysm. The first week of October, in Berlin, the president of the International Diabetes Federation (IDF), Nam Han Cho, tried to draw attention to this ailment with a hyperbole. "This is the third world war," he said, comparing the more than a million and a half deaths from diabetes a year with the losses of a war.
Last week, experts from all over the world met in the German capital at the annual congress of the European Diabetes Association (EASD, for its acronym in English). There, some of the latest results were presented to combat the disease, such as new drugs that, in addition to reducing blood sugar levels, lower the cardiovascular risk of patients. Type 2 diabetes, associated with obesity and aging, can multiply by up to six the probability of dying from a stroke or heart attack. This risk factor has made the assessment of initial cardiovascular risk included in the treatment guidelines for diabetics agreed upon in this meeting by the EASD and its American counterpart, the ADA. The new drugs (GLP-1 and SGLT-2 agonists) have also been included in this guide as second-line treatments for some patients.
Diabetes multiplies the risk of cardiovascular disease and cancer
Mads Krogsgaard Thomsen, scientific director of Novo Nordisk, a pharmaceutical producer of these innovative drugs that invited this newspaper to the congress, regretted that the criteria of states and insurers to finance certain medicines sometimes have more emotional than objective criteria. "Everyone accepts the cost of cancer drugs, even if you only increase survival one year, because there is an emotional factor," he said. "The cost of one year of adjusted quality of life can be up to 100,000 dollars in the United Kingdom. For diabetes, it is only accepted that this cost reaches 30 or 40,000 euros, even though we achieve it with products that can be cost effective, "he concludes. During a presentation, for reasons similar to those put forward by Thomsen, two veteran researchers recognized the difficulty of attracting doctors with talents for the discipline and commented that, unlike what happens with cancer, people who die from this disease do not makes donations for organizations that fight it.
Diabetes is a disease associated with obesity and its gradual increase around the world threatens the sustainability of health systems. In 1980, 4.7% of the world population suffered from the disease. The figure reached 8.5% in 2014 and continues to grow, mainly in low and middle income countries. In addition to cardiovascular risk, diabetics have a 22% higher risk of cancer, a percentage that reaches 31%, according to a study presented in Berlin by Nasra Alam, University of Manchester (United Kingdom).
As in many diseases, the key to reducing its impact is not in the drugs once it manifests itself but in prevention. But applying it is not as easy as it seems. Eating less and better or exercising are the two fundamental measures to contain the disease. Quitting smoking would reduce cardiovascular risk in patients who already have it higher than the average and yet, according to the epidemiologist at the University of Edinburgh Helen Colhoun, a third of diabetics continue to smoke. Neil Poulter, professor of preventive cardiovascular medicine at Imperial College London, spoke about the dimensions of the epidemic, but he recalled that it is not irreversible. "The good news is that you can get rid of diabetes by starving yourself, if you work hard you can stop being diabetic, it's not inevitable," he said. Colhoun, however, pointed out that "although recommendations may seem easy, changing behaviors is difficult". "It does not just depend on you, it also depends on how society is organized," he added. In addition, an extreme diet can end in a rebound and the ups and downs of continuous weight are negative for diabetics.
To change the organization of society and facilitate the changes in individual habits needed to stop the diabetes epidemic, experts recognize the need to work with the food industry. "We should reduce the size of the rations," said Nam Han Cho, who lamented that in some of their campaigns for the promotion of healthy food spent "three million euros while the industry could spend 3,000 to promote unhealthy products." "Coca-Cola should be made to disappear on a tax basis," said Poulter. "Those drinks should be extremely expensive and children should not be exposed to them," he added. However, as the problems caused by diabetes are seen as something gradual and the urge to put certain junk foods in the mouth is peremptory, any measure to control this type of product will face opposition, not only in the industry. In the opinion of Kathryn Taubert, vice president of the American Heart Association, "it will take a generation to change this, it will not happen suddenly because people will oppose it and governments will lose popularity."