Diabetes mellitus in the world. How dangerous is diabetes? Health care costs for diabetes

The prevalence of diabetes mellitus, according to the latest statistics, is growing every year.

Diabetes mellitus is a disease with so-called chronic hyperglycemia. The main reason for its manifestation has not yet been precisely studied and clarified. At the same time, medical specialists indicate factors that contribute to the manifestation of the disease. These include genetic defects, diseases of the pancreas in chronic form, excessive expression of certain hormones thyroid gland or exposure to toxic or infectious constituents.

Diabetes mellitus in the world during long period time was considered one of the main reasons for the development cardiovascular pathologies. During its development, various arterial, dural or cerebral complications may appear.

What does the situation in the development of pathology in the world indicate?

Diabetes statistics indicate that the prevalence of diabetes in the world is constantly increasing. For example, in France alone, the number of people with this diagnosis is almost three million people, while about ninety percent of them are patients with diabetes mellitus second type. It should be noted that almost three million people exist without knowing their diagnosis. The absence of visible symptoms in the early stages of diabetes is a key problem and danger of the pathology.

Abdominal obesity affects almost ten million people worldwide, which carries with it a threat and increased risk of diabetes. In addition, the possibility of developing cardiovascular diseases increases precisely in patients with type 2 diabetes.

Looking at the mortality statistics for diabetics, it can be noted that more than fifty percent of cases (the exact percentage varies from 65 to 80) are complications that develop as a result of cardiovascular pathologies, heart attack or stroke.

Diabetes incidence statistics highlight the following ten countries with the largest number person diagnosed with:

1. The first place in this sad ranking is occupied by China (almost one hundred million people).
2. In India, the number of sick patients is 65 million
3. USA – 24.4 million population
4. Brazil – almost 12 million
5. The number of people suffering from diabetes in Russia is almost 11 million.
6. Mexico and Indonesia – 8.5 million people each
7. Germany and Egypt – 7.5 million people
8. Japan - 7.0 million.

Statistics show further development pathological process, including 2017, the number of patients with diabetes is growing steadily.

One of the negative trends is that previously there were practically no cases of type 2 diabetes in children. Today, medical experts note this pathology and in childhood.

Last year, the World Health Organization provided the following information on the status of diabetes worldwide:

• As of 1980, the number of patients worldwide was approximately one hundred eight million.
• by the beginning of 2014, their number had increased to 422 million - almost four times
• At the same time, among the adult population, the incidence began to occur almost twice as often
• In 2012 alone, almost three million people died from complications of type 1 and type 2 diabetes.
• Diabetes statistics show that mortality rates are higher in low-income countries.

A nation study shows that by the beginning of 2030, diabetes will cause one in seven deaths on the planet.

Statistical data on the situation in the Russian Federation

Sugar level

Diabetes mellitus in Russia is becoming more and more common. Today, the Russian Federation is one of the five leading countries with such disappointing statistics.

According to official information, the number of people with diabetes in Russia is approximately eleven million people. According to experts, many people do not even suspect that they have this pathology. Thus, the actual numbers could roughly double.

About three hundred thousand people suffer from type 1 diabetes. These people, both adults and children, need constant insulin injections. Their life consists of a schedule of measuring blood glucose levels and maintaining the required level with the help of injections. Type 1 diabetes requires high discipline from the patient and compliance certain rules throughout life.

IN Russian Federation approximately thirty percent of the healthcare budget is allocated Money for the treatment of pathology.

Not long ago, Russian cinema produced a film about people who suffer from diabetes. The film adaptation shows to what extent the pathology is manifested in the country, what measures are being taken to combat it and how treatment is carried out.

Main actors actors performing in the film former USSR and the modern Russian Federation, who were also diagnosed with diabetes.

Development of pathology depending on the form of diabetes

The most common form of diabetes mellitus is non-insulin-dependent. People of a more mature age - after forty years - can get this disease. It should be noted that used to have diabetes the second type was considered a pathology of pensioners. As time passed over the years, cases began to be observed more and more often when the disease began to develop not only in at a young age, but also in children and adolescents.

In addition, a characteristic feature of this form of pathology is that more than 80 percent of people with diabetes have a pronounced degree of obesity (especially in the waist and abdomen). Excess weight only increases the risk of developing such a pathological process.

One of characteristic properties The non-insulin-dependent form of the disease is that the disease begins to develop without showing itself in any way. That is why it is unknown how many people are completely unaware of their diagnosis.

As a rule, type 2 diabetes mellitus can be detected in the early stages by chance - during preventive examination or during diagnostic procedures to identify other diseases.

As a rule, it begins to develop in children or adolescence. Its prevalence is approximately ten percent of all registered diagnoses of this pathology.

One of the main factors in the manifestation of the insulin-dependent form of the disease is the influence of hereditary predisposition. If the pathology is detected early at a young age, insulin-dependent people can live up to 60-70 years.

Wherein prerequisite is to ensure full control and compliance with all medical recommendations.

The course and consequences of diabetes mellitus

Medical statistics show that the most common cases of developing the disease are in women.

Diabetes is called chronic illness, which consists of impaired sugar metabolism and the development of early and late complications. Statistics on diabetes mellitus claim that this pathology is in third place in terms of frequency of occurrence throughout the world. The first two occupy malignant tumors, as well as heart and vascular diseases. Therefore, timely detection and treatment of the disease is very important.

The incidence of diabetes mellitus is 5-6% of total number population, as statistics indicate. It should be noted that these data are somewhat understated, since they relate only to officially registered cases of disease. In fact, there are many more patients, it’s just that sometimes it is hidden and may not be detected immediately. Especially it concerns non-insulin dependent type diseases.

There is an increase in this type of pathology every year. The number of patients with this diagnosis doubles every decade. In 2011, there were approximately 366 million people who suffered from this type 1 or 2 disease. To compare, in 1994 there were only 110 million, and in 2000 the number of patients was 170 million people. According to experts, in 2015 there will be about 400 million diabetics (mostly people aged 20 to 60 years).

Statistics on the incidence of diabetes in Russia indicate that in 2011 there were about 3.6 million patients in this country, and more than 750,000 constantly require insulin replacement therapy. But in fact, according to WHO, the true numbers are three to four times higher.

Every year, about 4 million people die as a result of complications, mainly as a result of heart and vascular diseases. In this type of patients, the mortality rate from this pathology is three times higher than in others.

Most often, people with middle and low incomes suffer from this pathology, and according to recent data, the incidence of this disease in the working population is much higher than previously thought. For this reason, the treatment of this disease is a health problem not only for each patient, but also for the state as a whole.

Statistics say that women and men suffer from it with the same frequency.

By country of the world

The prevalence of diabetes in different countries looks like this:

• Russian Federation 4%;

• USA 15%;

• Western Europe 5%;

• Middle East and North Africa about 9%;

• Latin America 15%.

Although the prevalence of diabetes in Russia is much lower than in the United States, experts say that the numbers are already beginning to approach the epidemiological threshold.

The largest number of patients is registered in India. There their number is 50 million people. In second place is China (43 million). There are about 27 million of them in the United States.

First and second type

The first type of disease primarily affects young people and children. Moreover, women are more likely to suffer from it. This kind of disease is registered in 10% of the total number of cases. This type of disease occurs with equal frequency in all countries.

The second type (non-insulin dependent) occurs in people over 40 years of age, and 85% of them suffer from obesity. This variant of the disease develops slowly and is often discovered completely by accident, most often during a medical examination or treatment for another disease. The number of patients with this type of diabetes prevails in economically prosperous countries, such as the United States, Sweden, Germany, and Austria.

Diabetes statistics in Russia indicate that type 2 diabetes is last years much younger. Sometimes there are cases of pathology developing in childhood and adolescence.

Thus, in Japan, the number of children with type 2 diabetes is already greater than that of type 1. Statistics on diabetes in Russia indicate that certain proportions remain the same. Thus, in 2011, there were 560 cases of type 2 diabetes in children and adolescents, while about 25,000 children were diagnosed with type 1 diabetes. But even with such figures, we can talk about the emerging growth of the non-insulin-dependent form among young people.

With timely detection and treatment of the disease at a young age, the patient's life expectancy can be up to 60-70 years. But this is only under conditions of constant monitoring and compensation.

High risk of developing the disease

Diabetes is highly likely to develop in the following individuals:

1. Women who have a hereditary predisposition to the occurrence of type 2 diabetes and at the same time use large quantities potato. They are 15% more likely to get sick than those who do not abuse this product. If these are French fries, then the degree of danger increases by 25%.

1. The predominance of animal proteins in the menu more than doubles the risk of developing type 2 diabetes.

1. Every extra kilos body weight increases the risk by 5%

Complications of diabetes

The danger of diabetes is the development of complications. Statistics show that diabetes mellitus ends in death in 50% of patients as a result of the development of heart failure , heart attack, gangrene, chronic renal failure. Every year, more than one million people lose a lower limb, and 700,000 lose their sight completely.

The situation with diabetes in the world and in Russia

Increasing incidence of diabetes mellitus in the world

Diabetes mellitus is a global medical, social and humanitarian problem of the 21st century, which has affected the entire world community today. This currently incurable chronic disease requires medical care throughout the patient's life. Diabetes can lead to the development serious complications requiring expensive treatment.

According to World Organization Health Care (WHO), every 10 seconds, 1 patient with diabetes dies in the world, that is, more than 3.5 million patients die annually - more than from AIDS and hepatitis.

Diabetes ranks third in the list of causes of death, second only to cardiovascular diseases and cancer.

However, diabetes is often not mentioned in cases where the immediate cause of death was one of its later complications: myocardial infarction, stroke or renal failure. Diabetes mellitus is steadily getting younger, affecting more and more people of working age every year.

Diabetes mellitus - first non-communicable disease, according to which a special UN Resolution was adopted, calling on all states to “take emergency measures to combat diabetes and develop national strategies for the prevention and treatment of this disease.” These strategies must be based on effective primary prevention diabetes mellitus, early diagnosis diseases and the use of the most modern treatment methods.

Compared to other more common serious diseases, diabetes, especially type II diabetes, is a hidden threat. In the early stages of development, it does not manifest itself in any way, since it does not have severe symptoms, and people live for years without knowing that they are sick. Lack of adequate treatment leads to the development severe complications- often the diagnosis is made only when irreversible changes have occurred in the human body. According to experts, for every registered patient with type II diabetes, there are 3-4 undiagnosed ones.

Diabetes is an extremely costly disease. According to the International Diabetes Federation (IDF), the estimated cost of combating diabetes in the world in 2010 will be 76 billion, and by 2030 it will increase to 90 billion.

Only the direct costs of fighting diabetes and its complications amount to developed countries at least 10-15% of healthcare budgets.

As for the indirect costs associated with diabetes (loss of labor productivity due to temporary disability, disability, early retirement, premature death), then they are difficult to assess.

The situation with diabetes in Russia

Russia has long and successfully implemented in practice the recommendations of the UN Resolution on diabetes mellitus regarding the development of national strategies to combat this disease. A distinctive feature of the domestic public policy in this area is comprehensive and systems approach to solving this extremely important problem. But at the same time, the increase in the incidence of diabetes in Russia, as well as throughout the world, has not yet been stopped.

Officially, more than 3 million patients are registered in the country, but according to estimates by the International Diabetes Federation (IDF), their number is at least 9 million

Even more ominous data were obtained in 2006 based on the results of medical examination of 6.7 million Russians working in the social sphere as part of the national project “Health”. Diabetes mellitus was detected in more than 475 thousand people, i.e. in 7.1% of those who underwent medical examination.

The results of the general medical examination of the Russian population in 2006-2008 were published in 2009. confirmed that the incidence of diabetes in our country continues to grow at an alarming rate. Among newly identified cases of disease, diabetes mellitus ranks first by a large margin.

In addition, about 6 million more Russians are in a state of prediabetes, i.e., with a high degree of probability they may get sick in a few years if they do not change their lifestyle. That is why today it is extremely important to pay attention to the issues of prevention, early diagnosis, and informing the population about this disease.

Diabetes mellitus and its complications

What is diabetes?

Diabetes mellitus - severe endocrine disease, associated with a deficiency or absence of the hormone insulin in the patient’s body or a violation of the body’s ability to use it, which leads to high content sugar (glucose) in the blood.

Insulin is produced by beta cells of the pancreas. U healthy person The metabolic process occurs as follows. Carbohydrates that enter the body with food are broken down into simple sugars. Glucose is absorbed into the blood, and this serves as a signal for beta cells to produce insulin. Insulin is carried through the bloodstream and “unlocks the doors” of the cells of the internal organs, allowing glucose to enter them.

If the pancreas is unable to produce insulin due to the death of beta cells, then after eating a meal rich in carbohydrates, the level of glucose in the blood rises, but it cannot enter the cells. As a result, the cells “starve” and the blood sugar level in the body remains constantly high.

This condition (hyperglycemia) can lead to diabetic coma and death. The only way Treatment in this situation is the administration of insulin. This is type I diabetes, which usually affects children, adolescents and people under the age of 30.

In type II diabetes mellitus, part of the insulin produced in the body is not able to play the role of a “key”. Thus, due to a lack of insulin, blood sugar levels remain above normal, which over time leads to the development of complications. Previously, type II diabetes mainly affected older people, but in recent years it has increasingly affected people of working age and even children (primarily overweight).

The method of treating type II diabetes depends on the patient’s condition: sometimes a diet alone or a diet with glucose-lowering medications is sufficient. The most progressive and prevents the development of complications at present is mixed therapy (diabetic tablets and insulin) or a complete switch to insulin. However, in all cases, diet and increased physical activity are necessary.

Complications of diabetes

As mentioned above, without insulin, glucose does not enter the cells. But there are so-called insulin-independent tissues that take sugar from the blood regardless of the presence of insulin. If there is too much sugar in the blood, it penetrates into these tissues in excess.

Small blood vessels and peripheral nervous system suffer from this in the first place. Penetrating into their walls, glucose is converted into substances that are toxic to these tissues. As a result, organs that contain many small vessels and nerve endings.

The network of small blood vessels and peripheral nerve endings is most developed in the retina and kidneys, and nerve endings They are suitable for all organs (including the heart and brain), but there are especially many of them in the legs. It is these organs that are most susceptible to diabetic complications, which cause early disability and high mortality rates.

The risk of stroke and heart disease in patients with diabetes is 2-3 times higher, blindness - 10-25 times, nephropathy - 12-15 times, and gangrene lower limbs almost 20 times higher than in the general population.

Modern options for diabetes compensation

Science still does not know why pancreatic beta cells begin to die or produce insufficient insulin. The answer to this question will certainly be greatest achievement medicine. In the meantime, diabetes cannot be completely cured, but it can be compensated for, that is, to ensure that the patient’s blood glucose is as close as possible to normal levels. If the patient maintains blood sugar within acceptable values, then he can avoid the development of diabetic complications.

One of the first doctors who, back in the 1920s, pointed out the extremely important role of compensation was the American Elliot Proctor Joslin.

The American Joslin Foundation awards diabetic patients who have lived 50 and 75 years without complications with a medal with the inscription “Victory”.

Today, to fully compensate for diabetes, we have the entire necessary set of medications. This is a whole range of human genetically engineered insulins, as well as the most modern analogues human insulin, both long-acting and mixed-acting and ultra-short-acting. Insulin can be administered using disposable syringes with a needle, the injection of which is almost invisible, or syringe pens, which can be used to inject through clothing in any situation. A convenient means of administering insulin is an insulin pump - a programmable insulin dispenser that continuously delivers it to the human body.

A new generation of oral hypoglycemic drugs has also been developed. At the same time, of course, for effective compensation of diabetes, the requirement to adhere to the rules of a healthy lifestyle remains in force - first of all, diet and physical activity. A useful tool for disease control is a glucometer, which allows you to quickly measure blood sugar levels and choose the right dose drug prescribed by the doctor.

Today, with the help of insulin medications, people with diabetes, with adequate compensation for their disease, can live a full life. However, this was not always the case. A radical remedy for effective compensation of diabetes - insulin - was discovered less than a hundred years ago.

The medicine that changed the world

The discovery of insulin is one of the most ambitious discoveries in the history of world science, a real revolutionary breakthrough in medicine and pharmacology.

The extreme demand for the new drug is emphasized by the fact that its introduction into medical practice happened at an unprecedented speed - in this it can only be compared with antibiotics.

Only three months passed from the brilliant insight to testing the drug on animals. Eight months later, the first patient was saved from death with the help of insulin, and two years later pharmaceutical companies were already producing insulin on an industrial scale.

The exceptional importance of the work related to the production of insulin and further research on its molecule is confirmed by the fact that six Nobel Prizes were awarded for this work (see below).

Pre-insulin era

Diabetes mellitus has been known since ancient times. Doctors were familiar with diabetes Ancient Egypt, Mesopotamia, Ancient Greece, Ancient Rome, medieval Europe and the East. Cases of the disease were described by Celsus, Galen, Aretaeus, Avicenna, Paracelsus and other great physicians of past times.

The term "diabetes" (from the Greek diabaino - "passing through") was introduced in medical practice Aretaeus. “Diabetes is a terrible suffering, dissolving the flesh and limbs into urine,” he wrote. “Patients excrete water in a continuous stream, as if through open water pipes. Life is short, unpleasant and painful, thirst is insatiable, fluid intake is excessive and disproportionate a huge number urine due to even more diabetes. Nothing can stop them from drinking fluids and passing urine. If they refuse to take fluids for a short time, their mouth dries out, their skin and mucous membranes become dry; Patients become nauseated, agitated, and die within a short period of time.”

The anatomical description of the pancreas was first made in 1642, although at that time doctors did not associate diabetes with this particular organ of the human body. In 1776, the English doctor Dobson found out that the sweetish taste of patients’ urine was due to the presence of sugar in it, and from that date the disease began to be called diabetes mellitus. In 1788, it was hypothesized that diabetes was associated with disorders of the pancreas. Then the need for a special diet for diabetic patients was substantiated, an increase in sugar in their blood was discovered, and a method for determining sugar in urine was developed.

However, the methods and means for maintaining the lives of patients remained the same as thousands of years ago - fasting, strict diet, physical labor and some sugar-lowering plants. Therefore, people with diabetes continued to die, as happened in ancient times or in the Middle Ages. This continued until the beginning of the 20th century, when animal insulin was first isolated.

In the nineteenth century, the science of glands arose internal secretion, which was called endocrinology. Its foundations were laid by the great French physiologist Claude Bernard. In 1869 in Berlin, 22-year-old medical student Paul Langerhans, while studying the structure of the pancreas, drew attention to previously unknown cells forming groups evenly distributed throughout the gland, later called the islets of Langerhans. At the end of the 19th century, doctors Minkowski and Mehring discovered a connection between the function of the pancreas and diabetes, and the Russian scientist Leonid Sobolev experimentally proved that the islets of Langerhans produce a certain hormone that regulates blood sugar. After all these discoveries, the main thing remained - to isolate insulin from the pancreas of animals and use it to treat people.

Frederick Banting
History of the discovery of insulin

The first who managed to isolate insulin and successfully use it to treat patients was the Canadian physiologist Frederick Banting. The young scientist was prompted to try to create a cure for diabetes by tragic events - two of his friends died from diabetes.

Even before Banting, many researchers, understanding the role of the pancreas in the development of diabetes, tried to isolate from it a substance that affects blood sugar levels, but all their attempts ended in failure. These failures were due to the fact that pancreatic enzymes managed to decompose insulin protein molecules before they could be isolated from the gland tissue extract.

A surgeon by training, Frederick Banting decided to use his skills to help surgical intervention achieve pancreatic atrophy and protect the islets of Langerhans from the effects of its enzymes, and only then isolate the desired extract. During laboratory research supervised by Professor John McLeod, on July 27, 1921, an extract from the atrophied pancreas of an experimental dog was administered to another dog who was in a diabetic coma. This caused her blood and urine sugar levels to drop.

Next, Banting and his assistant Charles Best managed to isolate an extract of insulin (from the Latin insula - “island”) from the pancreas of newborn calves, which had not yet produced digestive enzymes, but a sufficient amount of this hormone has already been synthesized. It was enough to keep an experimental dog alive for 70 days. Banting and Best presented the results of their research at the end of 1921 at a meeting of the Physiological Journal Club of the University of Toronto and at a meeting of the American Physiological Society in New Haven.

To ensure fine purification of insulin, which began to be obtained from the pancreas of large cattle, John McLeod recruited the famous biochemist James Collip to work. And at the beginning of 1922, Banting and Best began the first clinical trials insulin in humans.

Frederick Banting, who discovered insulin, became a national hero in Canada. In 1923, the University of Toronto awarded him a Doctor of Science degree, elected him a professor, and opened a new department specifically to continue work on the discovery. The Canadian Parliament gave him a lifetime pension, and in 1930 Banting became director of the research institute and was elected a fellow of the Royal Society in London. In 1934 he received the title of knight of Great Britain. At the outbreak of World War II, Banting volunteered for the army, where he became a medical aid organizer. On February 22, 1941, the plane in which fifty-year-old Major and World War I veteran Sir Frederick Banting was flying from Canada to England crashed over the snowy desert of Newfoundland. Monuments to Banting stand in his homeland, in the Canadian town of London (Ontario), and in a memorial park near Musgrave Harbor, not far from the site of his death. November 14, Frederick Banting's birthday, is celebrated today as World Diabetes Day.

Starting insulin use

The first injection of insulin into a human was given on January 11, 1922. He was 14-year-old volunteer Leonard Thompson, who was dying of diabetes. The injection was not entirely successful: the extract was not sufficiently purified, which led to the development of allergies. After working hard to improve the drug, the boy received a second insulin injection on January 23rd, which brought him back to life. Leonard Thompson, the first person saved by insulin, lived until 1935.

Soon, Banting saved his friend, doctor Joe Gilchrist, from approaching death, as well as a teenage girl whom her mother, a doctor by profession, brought from the USA, having accidentally learned about a new drug. Right on the station platform, Bunting gave an injection to the girl, who by this time was already in a coma. As a result, she was able to live for more than sixty years.

The news of the successful use of insulin became an international sensation. Banting and his colleagues literally resurrected hundreds of diabetic patients with severe complications. They wrote him many letters asking for salvation from the disease, and they came to his laboratory.

Although the insulin preparation was not sufficiently standardized - there were no means of self-control, there was no data on the accuracy of dosages, which often led to hypoglycemic reactions - the widespread introduction of insulin into medical practice began.

Banting sold the insulin patent to the University of Toronto for a nominal sum, after which the university began licensing its production to various pharmaceutical companies.

The first companies to receive permission to produce the drug were Lily (USA) and Novo Nordisk (Denmark), which now occupy leading positions in the field of diabetes treatment.

In 1923, F. Banting and J. McLeod were awarded the Nobel Prize in Physiology or Medicine, which they shared with C. Best and J. Collip.

The history of the creation of the Novo Nordisk company, which today is a world leader in the treatment of diabetes and whose insulin preparations are recognized as reference, is interesting. In 1922, the 1920 Nobel Prize in Medicine laureate, the Dane August Krogh, was invited to give a course of lectures at Yale University. While traveling with his wife Maria, a physician and metabolic researcher who had diabetes, he learned of the discovery of insulin and planned his trip to visit colleagues in Toronto.

After the insulin injection, Maria Krogh's condition improved significantly. Inspired, Krogh received a license to use the insulin purification method and in December 1922 began its production at a plant near Copenhagen (Denmark).

Further improvement of animal insulin preparations

For more than 60 years, the starting materials for the production of insulin were the pancreas of cattle and pigs, from which beef or pork insulin was produced, respectively. Immediately after the discovery of insulin, the question arose of improving it and establishing industrial production. Since the first extracts contained many impurities and caused side effects, the most important task was purification of the drug.

In 1926, medical scientist at the University of Baltimore J. Abel managed to isolate insulin in crystalline form. Crystallization made it possible to increase the purity of soluble insulin and make it suitable for obtaining various modifications. Since the early 1930s. crystallization has become common in insulin production, reducing the incidence of allergic reactions for insulin.

Further efforts of the researchers were aimed at reducing the content of impurities in the drug in order to reduce the risk of the appearance of antibodies to insulin in the patient’s body. This led to the creation of monocomponent insulin. It was found that when treating with highly purified insulins, the dose of the drug can be reduced.

The first insulin preparations were only short acting Therefore, there was an urgent need to create extended-release drugs. In 1936, in Denmark, H. K. Hagedorn obtained the first long-acting insulin preparation using the protein protamine. As the recognized authority in diabetology E. Johnson (USA) wrote a year later, “protamine is the most significant step forward in the field of diabetes treatment since the discovery of insulin.”

D. A. Scott and F. M. Fisher from Toronto, adding protamine and zinc to insulin at the same time, obtained a longer-acting drug - protamine-zinc-insulin. Based on these studies, in 1946, a group of scientists led by H. K. Hagedorn created insulin NPH ("neutral protamine Hagedorn"), which to this day remains one of the most common insulin preparations in the world.

In 1951-1952 Dr. R. Mjeller discovered that the action of insulin could be prolonged by mixing insulin with zinc without protamine. This is how the Lente series of insulins was created, which included three drugs with of different durations actions. This allowed doctors to prescribe individual insulin dosing regimens to suit each patient's needs. An additional benefit of these insulins was that there were fewer allergic reactions.

In the first years of production of the drug, the pH of all insulins was acidic, since only this ensured the protection of insulin from destruction by impurities of pancreatic enzymes. However, this generation of "acid" insulins had insufficient stability and contained a large number of impurities. It was not until 1961 that the first neutral soluble insulin was created.

Human (genetically engineered) insulin

The next fundamental step forward was the creation of insulin preparations that were identical in molecular structure and properties to a person’s own insulin. In 1981, the Novo Nordisk company, for the first time in the world, began serial production of human semi-synthetic insulin, obtained by chemical modification of porcine insulin. An alternative to this method has become a biosynthetic method using genetic engineering technology of recombinant DNA. In 1982, Eli Lilly became the first in the world to produce human insulin using genetic engineering. Using this technology, the gene responsible for the synthesis of human insulin is introduced into the DNA of the non-pathogenic bacterium Escherichia coli.

In 1985, Novo Nordisk introduced human insulin, produced using genetic engineering technology using yeast cells as a producing base.

The biosynthetic or genetic engineering method is currently the main one in production human insulin, since it allows not only to obtain insulin that is identical to the hormone produced in the human body, but also to avoid difficulties associated with a lack of raw materials.

Since 2000, genetically engineered insulins have been recommended for use in all countries of the world.

A new era in diabetology - insulin analogues

A new important milestone in the treatment of diabetes was the development of insulin analogues, the use of which in medical practice significantly expanded the possibilities of treating diabetes mellitus and led to an improvement in the quality of life and better compensation for the disease. Insulin analogues are a genetically engineered form of human insulin in which the insulin molecule is slightly modified to correct the onset and duration of insulin action. Compensation for diabetes with the help of insulin analogues allows one to achieve almost the same regulation of carbohydrate metabolism as is typical for a healthy person.

Although analogues are somewhat more expensive than conventional insulins, their advantages - better compensation for diabetes, a significant reduction in the frequency of severe hypoglycemic conditions, improved quality of life for patients, ease of use - more than cover the economic costs.

According to experts from the Ministry of Health and social development RF treatment of patients with diabetes costs 3-10 times less than annual care for patients with already developed serious complications of the disease.

Currently, 59% of all diabetic patients in the world receive analogues, and in Europe - more than 70%. Insulin analogues are being actively introduced into medical practice and in Russia, although the average prevalence of use of insulin analogues in the country is only 34%. At the same time, today 100% of children with diabetes are provided with them.

Nobel Prizes and insulin

In 1923, the Nobel Prize in Physiology or Medicine was awarded to F. Banting and J. MacLeod, which they shared with C. Best and J. Collip. Moreover, the discoverers of insulin were nominated for this most prestigious award in the world of science just a year after the first publication on the isolation of insulin.

In 1958 for the definition chemical structure insulin Nobel Prize received by F. Sanger, whose technique became the general principle for studying the structure of proteins. Subsequently, he was able to establish the sequence of fragments in the structure of the famous double helix of DNA, for which he was awarded the second Nobel Prize in 1980 (together with W. Gilbert and P. Berg). It was this work of F. Sanger that formed the basis of the technology, which was called “genetic engineering”.

The American biochemist V. Du Vigneault, who studied insulin for several years, learned about the work of F. Sanger, and decided to use his technique to decipher the structure and synthesis of molecules of other hormones. This work of the scientist was awarded the Nobel Prize in 1955, and actually opened the way to the synthesis of insulin.

In 1960, the American biochemist R. Yalow invented an immunochemical method for measuring insulin in the blood, for which she was awarded the Nobel Prize. Yalow's invention made it possible to evaluate insulin secretion in different forms of diabetes mellitus.

In 1972, the English biophysicist D. Crowfoot-Hodgkin (winner of the 1964 Nobel Prize for determining the structures of biologically active substances using X-rays) established the three-dimensional structure of the unusually complex complex of the insulin molecule.

In 1981, Canadian biochemist M. Smith was invited to become a scientific co-founder of the new biotechnology company Zimos. One of the company's first contracts was concluded with the Danish pharmaceutical company Novo to develop technology for the production of human insulin in yeast culture. As a result of joint efforts, insulin obtained from new technology, went on sale in 1982.

In 1993, M. Smith, together with K. Mullis, received the Nobel Prize for a series of works in this area. Currently, genetically engineered insulin is actively replacing animal insulin.

Diabetes and lifestyle

In almost all countries of the world, healthcare is focused primarily on providing medical care to an already sick person. But it is obvious that it is much more effective and economically profitable to preserve human health or identify the disease at an early stage before it appears. serious symptoms, reducing the risks of disability and premature mortality.

According to the World Health Organization (WHO), only 25% of human health depends on the quality of medical services. The rest is determined by the quality and lifestyle, the level of sanitary culture.

Today, the issues of preventive medicine, human responsibility for own health allocated by the top leadership of Russia as one of the priority areas in medicine. So, in "Strategy national security RF until 2020", approved by Decree of the President of the Russian Federation D.A. Medvedev dated May 12, 2009 No. 537, in the section "Healthcare" it is stated that the state policy of the Russian Federation in the field of healthcare and the health of the nation should be aimed at prevention and preventing the increase in the level of socially dangerous diseases, strengthening the preventive focus of healthcare, and focusing on preserving human health.

“The Russian Federation defines the main directions of ensuring national security in the field of healthcare and the health of the nation in the medium term as strengthening the preventive focus of healthcare, focusing on preserving human health...”

National Security Strategy of the Russian Federation until 2020

Due to this effective prevention diabetes management should be a well-developed and streamlined system. This system should include:

• effective outreach to the population;
• primary prevention of diabetes;
• secondary prevention of diabetes;
• timely diagnosis;
• adequate treatment using the most modern methods.

Primary prevention of diabetes includes promoting a healthy lifestyle, which primarily means a balanced diet combined with moderate physical activity. At the same time, the risk of developing type II diabetes is minimized. Secondary prevention involves constant control and compensation for diabetes in already ill people in order to prevent the development of complications. Therefore, early diagnosis of the disease is very important for its timely detection and adequate treatment.

In 80% of cases, type II diabetes can be prevented, as well as the development of its severe complications can be prevented or significantly delayed. Thus, the results of the UKPDS study, published in 1998, which lasted almost 20 years, proved that reducing the level of glycated hemoglobin by just 1% leads to a 30-35% reduction in complications from the eyes, kidneys and nerves, and also reduces the risk development of myocardial infarction by 18%, stroke by 15%, and reduces diabetes-related mortality by 25%.

A study on diabetes prevention, The Diabetes Prevention Program, conducted by American specialists in 2002, showed that in people with prediabetes, the development of type II diabetes mellitus can be prevented by making changes in diet and increasing the level of physical activity in combination with drug therapy. Daily 30 minutes of moderate-intensity exercise and a 5-10% reduction in body weight reduce the risk of developing diabetes by 58%. Study participants over 60 years of age were able to reduce this risk by 71%.

Outreach

Until now, mostly only specialists know about the threat of a diabetes epidemic, as well as the need and possibilities for its prevention. The call of the UN Resolution to increase people's awareness of diabetes and its complications is caused by the fact that the vast majority of the world's population does not have elementary ideas about this disease and how it can be prevented. Unique Feature Diabetes is that its primary prevention necessarily includes following a healthy lifestyle. Thus, by promoting diabetes prevention, we promote a healthy lifestyle, and vice versa. Today it is important not only to improve the quality medical care, but also to promote the formation in people of personal responsibility for their own health, teach them the skills of a healthy lifestyle and disease prevention.

The rapid increase in the incidence of type II diabetes mellitus is associated primarily with the costs of modern civilization, such as urbanization, a sedentary lifestyle, stress, and changes in dietary patterns (the widespread spread of fast food). Today, people tend to have an indifferent attitude towards their health, which is clearly expressed, especially in our country, in a reluctance to exercise and in indulgence in excessive drinking and smoking.

Live by conquering diabetes!

The fight against diabetes means for a person a restructuring of his lifestyle and daily painstaking work on himself. Diabetes cannot yet be cured, but a person can win this fight, live a long, fulfilling life, and be realized in his field of activity. However, this struggle requires high organization and self-discipline; Unfortunately, not everyone is capable of this.

The best support for people with diabetes, and especially young people, is the stories of those who have overcome their disease. Among them are famous politicians, scientists, writers, travelers, popular actors and even famous athletes who, despite diabetes, not only lived to an advanced age, but also reached the highest peaks in their field.

Such leaders of the USSR as N.S. suffered from diabetes. Khrushchev, Yu.V. Andropov. Among the leaders of foreign states and famous politicians, we can name the Presidents of Egypt Gamal Abdel Nasser and Anwar Sadat, the President of Syria Hafiz Assad, the Prime Minister of Israel Menahem Begin, the Yugoslav leader Joseph Broz Tito, the former Chilean dictator Pinochet. Inventor Thomas Alva Edison and aircraft designer Andrei Tupolev, writers Edgar Allan Poe, Herbert Wells and Ernst Hemingway, artist Paul Cezanne also suffered from this disease.

The most famous people with diabetes for Russians among artists will remain Fyodor Chaliapin, Yuri Nikulin, Faina Ranevskaya, Lyudmila Zykina, Vyacheslav Nevinny. For Americans, British, Italians, equal figures will be Ella Fitzgerald, Elvis Presley, Marcello Mastroianni. Movie stars Sharon Stone, Holy Berry and many others suffer from diabetes.

Today, people with diabetes become Olympic champions, participate in thousand-kilometer bicycle marathons, conquer the highest mountain peaks, and land at the North Pole. They are able to overcome the most unimaginable obstacles, proving that they can lead a full life.

A striking example of a professional athlete with diabetes is Canadian hockey player Bobby Clarke. He is one of the few professionals who made no secret of his illness. Clark fell ill with type I diabetes at the age of thirteen, but did not give up his studies and became a professional hockey player, a star in the National Hockey League, and won the Stanley Cup twice. Clark monitors his illness seriously. Thus, he was one of the first people with diabetes to regularly use a glucometer. According to Clark, it was sports and strict control of diabetes that helped him overcome the disease.

Bibliography

1. IDF Diabetes Atlas 2009
2. International Diabetes Federation, The human, social and economic impact of diabetes, www.idf.org
3. C. Savona-Ventura, C.E. Mogensen. History of diabetes mellitus, Elsevier Masson, 2009
4. Suntsov Yu. I., Dedov I. I., Shestakova M. V. Screening for complications of diabetes mellitus as a method for assessing the quality of medical care for patients. M., 2008
5. Dedov I. I., Shestakova M. V. Algorithms for specialized medical care for patients with diabetes mellitus, M., 2009
6. Materials for the preparation of the Report to the Government of the Russian Federation "On the progress of implementation of federal target programs and the implementation of the Federal targeted investment program for 2008"
7. Materials of the Report to the Government of the Russian Federation "On the progress of implementation of federal target programs and the implementation of the Federal Targeted Investment Program for 2007"
8. Decree of the Government of the Russian Federation No. 280 of May 10, 2007 “On the federal target program “Prevention and fight against social significant diseases(2007-2011)"
9. Astamirova X., Akhmanov M., Great Encyclopedia of Diabetes. EKSMO, 2003
10. Chubenko A., History of one molecule. "Popular Mechanics", No. 11, 2005
11. Levitsky M.M., Insulin is the most popular molecule of the 20th century. Publishing House "First of September", No. 8, 2008

Every 10th person over the age of 25 suffers from it.

It is no coincidence that the epidemic of diabetes mellitus (DM) in the world is talked about. There are already 10 million patients with this diagnosis in Russia, and how many more people live and simply do not know that they are sick. After all, diabetes may not manifest itself for years or even decades.

Of course, the earlier such a disease is detected, the less likely that she will give severe and even fatal dangerous complications. The head of the Department of Endocrinology and Diabetology of the Russian Academy of Sciences told MK about how not to miss diabetes mellitus. medical academy postgraduate education of the Ministry of Health of Russia, Doctor of Medical Sciences, Professor Alexander AMETOV.

Three new cases every 10 minutes

- Alexander Sergeevich, why is diabetes called an epidemic - it’s not the flu?

Let me note right away that this is not an infectious epidemic. Since about 1990, the number of people with diabetes has more than doubled over a 10-year period in both developed and developing countries. Then this term appeared - non-infectious epidemic. It was often used to draw attention to the problem. According to the latest data, there are now 387 million people on the planet suffering from diabetes. And according to forecasts of the World Diabetes Association, by 2030 there will be 550 million such patients. Currently, diabetes is being diagnosed on the planet at a rate of 3 new cases every 10 minutes.

- What factors make the greatest contribution to the increase in the incidence of diabetes mellitus?

Diabetes is of the first and second types: that is, congenital and acquired. 90 percent of patients suffer from type 2 diabetes, the main factor of which is age. Diabetes usually occurs in people over 45–50 years of age. Aging of the body causes a deterioration in insulin secretion and its absorption at the tissue level. Although now the disease is becoming “younger” and is being diagnosed in much younger people. It is also believed that this disease has a 100% genetic basis, but, unfortunately, the primary genetic defect is currently unknown. It is possible that diabetes is not caused by one genetic defect, but by a combination of genetic factors.

Obesity is also a serious prerequisite for diabetes. By the way, obesity, according to the World Health Organization, is the second non-infectious epidemic. When experts talk about obesity, they don't just mean excess weight, but also visceral obesity at the level of organs and tissues.

Another reason is a violation of intrauterine nutrition. If a person was born weighing less than 2.5 kg, then at the age of 50–60 years and older his risk of developing type 2 diabetes increases three to five times compared to those who were born at a normal weight.

Heredity also plays an important role. If your parents or other close relatives had diabetes, your risk of getting the disease increases three to six times.

Test blood sugar once a year

Diabetes for a long time leaks hidden. How to suspect him? How to get examined, what tests to take?

First of all, those people I mentioned should be examined: over 45–50 years old, with obesity, heredity. Unfortunately, this is not done in our country. But there is a well-known example from Germany, when all residents of the country over 50 years old were sent New Year’s greetings, enclosing test strips to determine blood sugar levels in the envelope. This was, first of all, to draw attention to the problem. After all, diabetes takes 10–15 years to develop! Government programs on early detection (screening) and prevention of diabetes must be provided. Now in Russia, unfortunately, they do not exist. But by spending very little money on examination, the state would save huge amounts of money on the treatment of diabetics. Because the earlier diabetes or certain disorders are detected carbohydrate metabolism, the sooner doctors will be able to prevent the development of complications in the patient against the background of elevated glucose levels, complications that lead to disability, and premature death of the patient. A blood sugar test should be taken at least once a year. Especially people with a family history of diabetes and overweight. Everyone should know about this! And I am very glad that your much-read newspaper is interested in the problem of diabetes.

- How do you feel about the treatment of diabetes mellitus with stem cells?

To talk seriously about this method, a lot more needs to be done. First of all, pass the appropriate law on the possibility of using this technology in the treatment of patients with diabetes and other diseases. Stem cell treatment is not yet permitted in our country. But it was our Russian scientists who were the first to propose this method, and today the whole world knows about it.

- Could insulin be replaced with something in the future?

What for? It doesn't need to be replaced. It is more correct to talk about additional medications, relieving related problems. For example, now there is very effective drugs, capable of reducing mortality by 38 percent among diabetic patients with serious concomitant heart and vascular problems. Believe me, this is a lot. But, I repeat once again, the main thing is to start therapy on time, making a diagnosis earlier.

EXPERT OPINION

Valentin FADEEV, Head of the Department of Endocrinology, First Moscow State Medical University named after. I.M. Sechenova, Deputy Director for Research, Federal State Budgetary Institution "Endocrinological" science Center Ministry of Health of the Russian Federation":

The prevalence of diabetes can truly be compared to an epidemic. Every 10 adults over 25 years old are sick with it, and this figure is growing progressively right before our eyes. All this is true for Russia, where diabetes is one of the key health problems. Today this is the most common reason blindness, renal failure and limb amputations. Diabetes is rightly called a cardiovascular disease, since more than 70% of patients with this disease die from myocardial infarction, disorders cerebral circulation and heart failure. The risk of death from cardiovascular disease in diabetes mellitus is comparable to that for people who have already had a myocardial infarction. About 80% of patients with diabetes have arterial hypertension and almost 100% increase in cholesterol levels. It is impossible to overestimate the importance of diabetes mellitus as a key priority of modern healthcare, and its underestimation is inevitable with catastrophic consequences in terms of disability, mortality and colossal costs for treating its complications.

Diabetes mellitus is one of the most difficult diseases for a patient, because with it the matter is not limited to the need to regularly take some pills, which, by the way, a significant portion of people do not do with all other diseases. Diabetes requires lifestyle changes, which is perhaps the most difficult, including because by the time the disease appears, usually after 50 years, it is very difficult to change anything about yourself. You need to change your diet, sometimes radically, your diet and lifestyle, and only this is a guaranteed guarantee of good control of the disease. Continuing the overeating and unhealthy diet habitual for most people will inevitably lead to progression of the disease and escalation of glucose-lowering therapy, up to the inevitable prescription of insulin for half of the patients.

Statistics on diabetes patients allows you to find out how many people suffer from this disease. For doctors, this calculation is important for analyzing the quality of medical care provided to such citizens, as well as for finding new ways to combat the disease.

World problem

Statistics of patients with diabetes mellitus in the world in 1980 numbered about 108 million people. In 2014, the figures increased to 422 million people. Among adult citizens, 4.7% of the total population of the planet previously suffered from this disease. In 2016, the figure increased to 8.5%. As you can see, the incidence rate has doubled over the years.

According to WHO, millions of people die every year from this disease and its complications. More than 3 million people died in 2012. The highest is recorded in countries where the population has low incomes and low levels of income. About 80% of the deaths lived in Africa and the Middle East. According to data for 2017, every 8 seconds in the world one person dies from this disease.

The figure below shows the statistics of diabetic patients in the world. Here you can see which countries had the most people affected by this disease in 2010. Forecasts for the future are also given.

According to experts, the development of the sugar industry by 2030 will lead to a twofold increase in the number of patients compared to 2010. This disease will become one of humanity's major diseases.

Diabetes type 1 and 2

Diabetes is a disease that occurs due to a lack of the hormone insulin in the body, which causes high blood sugar levels.

Statistics on diabetes patients show that about 10–15% of people do not even suspect that they have begun to develop the disease.

Manifestations of the disease:

1. Deterioration of vision.
2. Constant thirst.
3. Frequent urination.
4. A feeling of hunger that does not go away even after eating.
5. Numbness in arms and legs.
6. Fatigue for no reason.
7. Long-term healing of skin damage, even small ones.

There are several types of the disease. The main types are the first and second. They are the most common. In the first type, the body does not produce enough insulin. In the second, insulin is produced, but is blocked by hormones of adipose tissue. Type 1 diabetes is not as common as type 2 diabetes. Below is a graph that clearly shows how many people with type 2 diabetes exceed type 1.

Previously, type 2 diabetes occurred exclusively in adults. Today it even strikes.

Russian indicators

Statistics of patients with diabetes mellitus in Russia makes up about 17% of the entire country. The graph below shows how the number of people getting sick increased from 2011 to 2015. Over five years, the number of people suffering from this disease has increased by 5.6%.

According to medical estimates, more than 200 thousand people diagnosed with diabetes die every year in the Russian Federation. Many of them did not receive qualified help. This led to the fact that the disease provoked a number of complications, even leading to complete destruction of the body.

People who suffer similar disease, often become for the remaining years or are waiting for them fatal outcome. It is impossible to predict in advance what awaits the patient. Exacerbation and complications do not depend on age. They can occur at 25, 45 or 75 years. The probability is the same in all age categories. Sooner or later the disease takes its toll.

Indicators for Ukraine

The statistics of patients with diabetes mellitus in Ukraine includes more than 1 million patients. This figure is increasing every year. For the period from 2011 to 2015. they increased by 20%. Every year, 19 thousand patients are diagnosed with type 1 diabetes. In 2016, more than 200 thousand people were registered as needing insulin therapy.

The number of people suffering from this disease among children of all age groups is growing rapidly. Over the past nine years, their number has almost doubled. Today, diabetes ranks 4th in Ukraine in terms of the frequency of its diagnosis in citizens under 18 years of age. This is the most common cause of disability in Ukrainian children. There are especially many registered sick boys and girls under the age of 6 years.

Type 1 diabetes is most common among the younger generation. Type 2 disease is less common. But, nevertheless, he is progressing. The reason lies in the increasing number of cases of childhood. The prevalence of the disease varies in different regions.

The largest percentage of children with diabetes is in Kyiv and the Kharkov region. On average, rates are higher in areas where industry is developed. In Ukraine, diagnostics of all types of diseases is not yet well developed; official statistics do not reflect the real state of affairs. According to doctors' forecasts, by 2025 there will be about 10 thousand sick children in Ukraine out of the total number.

Belarusian statistics

According to estimates, in Belarus, as well as throughout the world, there is an increase in the number of people with diabetes. Twenty years ago in Minsk, 18 thousand people were diagnosed with this disease. Today, 51 thousand people are already registered in the capital. There are more than 40 thousand such patients in the Brest region. Moreover, over the last nine months of 2016, almost 3 thousand sick people were registered. This is only among the adult population.

In total, about 300 thousand citizens of Belarus suffering from this disease were registered in dispensaries in 2016. The statistics of people with diabetes in the world is growing every year. This is truly a problem for all of humanity, reaching epidemic proportions. So far, doctors have not found an effective method to combat this disease.