New nice guidance on preventing type 2 diabetes in high risk individuals

New nice guidance on preventing type 2 diabetes in high risk individuals

Diabetes is a chronic and very insidious disease. It can cause serious cardiovascular and neurological complications and lead to death.

But is it possible to prevent the development of pathological changes in the body? Prevention of diabetes mellitus + type 2 diabetes will completely prevent this disease or at least significantly delay its onset with a hereditary predisposition.
The sugar should be the norm!

Is it possible?

To understand whether the prevention of diabetes is effective, let’s look at the classification of the disease in more detail. In medicine, there are two types of it – the first and the second.
First type

DM-1 (insulin-dependent, juvenile) is characterized by irreversible destruction of pancreatic cells and the development of absolute insufficiency of the hormone-insulin. It may be autoimmune or idiopathic. As a rule, it is associated with genetic (sometimes hereditary) abnormalities and develops regardless of the action of environmental factors.

Pathogenesis of the disease

This form of the disease is characterized by a sudden onset, severe course and progressive development of complications. Glycemia in patients is controlled by regular insulin injections.

Please note! Most often, DM-1 is diagnosed in children and young people, but it can occur at any age.

Second type

DM-2 (insulin-dependent) diabetes can develop against the background of a slight decrease in insulin secretion. The main thing in the pathogenesis of the disease is the formation of resistance (insensitivity) of peripheral cell receptors to the hormone.
The mechanism of development of SD-2 is different

In addition to the hereditary predisposition, the influence of which is less pronounced than in DM-1, the following risk factors for the disease are distinguished:

obesity (especially abdominal type);
chronic pancreatitis, cysts, cancer, and other lesions of the pancreas;
frequent viral infections;
stress;
old age.

To prevent serious hormonal disorders, prevention will help: type 2 diabetes mellitus responds well to it.
Prevention of SD1

Type 1 diabetes accounts for less than 9-10%. In Russia, the incidence of mi is 14.7 cases for every hundred thousand.

How to prevent insulin-dependent diabetes: prevention of pathology is conditionally divided into primary, secondary, and tertiary.

Table 1: levels of preventive measures to prevent DM-1:

Level stage of development of pathologicelpervichny high risk of hyperglycemia at the genetic level to allow the development of autoimmune damage to the autoimmune process to pancreatic beta cells to prevent the manifestation of the diseasetretic pathway, expanded symptomatikabout complications, if possible to restore insulin secretion
Primary

Primary prevention of diabetes is most relevant for children and adolescents at high risk of the disease.

It can be evaluated when:

the specialized advice of genetics;
types of HLA haplotypes;
the presence of SD-1 in blood relatives.

Special tests will reveal a genetic predisposition to diabetes

Please note! The risk of getting LSD in the presence of this pathology in one of the parents or sibsa usually does not exceed 5-6%. At the same time, relatives with DM-2 are not taken into account, since these forms of hyperglycemia are inherited independently of each other.

The complexity of all preventive measures is the lack of information about the factors that trigger the autoimmune process in the body. Most of the research results (TEDDY, TRIGR, TrialNet Nip, etc.) are recommendations.

So, what is the primary prevention – type 1 diabetes can be prevented if:

Minimize the possibility of infection with Coxsackie b viruses, measles, chickenpox, mumps, and cmvi (there is evidence that these infections can trigger an autoimmune process).
Exclude cow’s milk protein from the diet of children under 2 years of age.
Breastfeed a child under 6 months of age.
Exclude gluten-containing foods from the diet of children under 1 year of age.
During pregnancy and lactation, consume a sufficient amount of omega-3 polyunsaturated FATS.

Breastfeeding protects the baby from many diseases

Secondary prevention of diabetes mellitus should be carried out by those patients whose body has already developed pathological autoimmune processes in relation to the Islands of Langerhans of the pancreas.

They can be determined by the presence of specific markers in laboratory blood tests:

ICA antibody to islet cells of the pancreas;
anti-GAD65 – antibody to glutamate decarboxylase the;
IAA-AT to the hormone-insulin;
IA-2beta-at to pancreatic tyrosine phosphatase, etc.

Important! Pathological antibodies appear in the blood of the disease several years before the manifestation of the disease.

There are a number of clinical studies of oral administration of insulin to individuals with high at titers at the age of 3-45 years in order to reduce autoimmune destruction of the pancreas.

Tertiary

The most widely used in medicine is tertiary prevention of this form of the disease. For maximum effectiveness, it should be started in the first weeks after diagnosis.

It is known that after the manifestation of the disease, about 10-20% of the pancreatic beta cells still retain their functional activity. The task of medical measures is to preserve the remaining foci and, if possible, activate its regeneration.
It is important to properly stimulate the work of the pancreas

Currently, the prevention of diabetes mellitus tertiary includes a number of areas:

Antigen-specific therapy, which consists in the use of autoantigens involved in the destruction of pancreatic cells.
Antigen-specific therapy, which includes drugs that block mediators of the autoimmune process. Among them, Rituximab, Anakinra etc.

In conclusion, it should be noted that despite the achievements of medical science, reliable and safe methods for preventing the development of DM-1 in patients with a genetic predisposition have not yet been developed.
Insulin injections are still the only way to effectively control glycemia in LSD

Prevention of SD2

This type accounts for up to 90-95% of all cases. Among the reasons for the sharp increase in its prevalence are:

  • urbanisation;
  • features of a city dweller’s lifestyle;
  • poor diet;
  • increasing prevalence of obesity.

“Sofa” lifestyle

Familiar to all physicians clinical feature of ISSD is a long and oligosymptomatic course. Most patients do not even know about pathological changes in the body and learn about their diagnosis by accident.

Do you know your blood glucose levels?

It is interesting. According to statistics, for every identified patient with DM2, there are 2-3 people with hyperglycemia who are unaware of problems with carbohydrate metabolism.

This is why screening preventive examinations are important in diagnostic endocrinology.
Test yourself: a risk group for diabetes

Especially attentive to their health shall be persons from risk groups at INSTT.

Factors that allow a patient to be assigned to this category include:

age over 40-45 years;
high BMI, abdominal obesity according to the type;
burdened hereditary history of diabetes;
hypodynamia;
impaired glucose tolerance;
gestational diabetes or birth of a large fetus (>4.5 kg) in the anamnesis;
Hypertension, diseases of the cardiovascular system;
dyslipidemia;
PCOS in women.

Primary

Since the etiology of DM-2 distinguishes both hereditary predisposition and environmental factors, it is possible to prevent (or postpone) the disease for a long time by adjusting the lifestyle.

The prevention memo for people with risk factors includes:

Correction of lifestyle and nutrition (all recommendations of the doctor should be followed by the patient for life):
normalization of body weight;
hypocaloric diet;
sharp restriction of easily digestible carbohydrates and fats in the diet;
the presence of fresh vegetables and fruits in the daily menu;
fractional power 4-5 R/day.;
careful chewing of food;
compliance with an adequate food regime;
expanding the level of physical activity;
support for relatives and medical staff.
According to the doctor’s indications – medical correction of obesity. The drugs of choice are:
Sibutramine;
Orlistat;
Metformin.
Medical treatment of atherosclerosis and dyslipidemia. The preferred means today are statins (Atorvastatin, Simvastatin).
Antihypertensive therapy:
Beta blockers;
Diuretics;
ACE inhibitors;
Calcium antagonist.

We take pills strictly according to the instructions

It is interesting. Alternative medicine has also proven itself well. The drug based on Jerusalem artichoke concentrate Noteo is widely known: prevention of diabetes is carried out by reducing sugar levels, strengthening the immune system, blood thinning, normalizing metabolism, improving intestinal function.

 

Badenoch
Douglas Badenoch
I am an information scientist with an interest in making knowledge from systematic research more accessible to people who need it. This means you. I've been attempting this in the area of Evidence-Based Health Care since 1995. So far the results have been mixed. For some reason we expected busy clinicians to search databases and appraise papers instead of seeing patients. We also expected publishers to make the research freely available to the people who paid for it.. Ha! Hence The National Elf service.

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