As the number of people with diabetes grows worldwide, the disease takes an ever-increasing proportion of healthcare budgets. Diabetes is projected to become one of the world's main disablers and killers within the next two decades. According to the International Diabetes Federation, with 48 million diabetes sufferers, Europe has the highest incidence of diabetes worldwide. In 2003, 7.8% of Europe's population had diabetes. Among the 40-59 age group the prevalence of diabetes is at its highest. With Europe's ageing society, the number of diabetes cases is expected to increase. In fact, the IDF expects the occurrence of diabetes to increase to 10.9% of Europe's population by 2025.
Medical technology can play a vital role in patient care and demonstrates a significant potential for increased patient safety, improved quality of life and reduction in healthcare costs. This technology includes insulin delivery products such as syringes, insulin pens, insulin automatic injectors, insulin patches and external/implantable pumps.
Modern medical technology also enables the diabetic patient to easily and precisely control blood glucose levels. This can substantially reduce the risk of developing complications and slow the progression of the disease.
Screening and early treatment for retinopathy is also very cost-effective, given the devastating direct, indirect and intangible costs of blindness. Screening for protein in urine is another valid preventive measure to avoid or slow down the inevitable progression to kidney failure.
Effective foot-care reduces both the frequency and length of hospital stays and the incidence of amputation in diabetes patients by as much as 50%. New products include bio-engineered artificial skin, biosynthetic dressings and wound healing.
Obesity and inactivity are largely to blame for the diabetes epidemic. Globally, it is estimated that there are currently 1.1 billion people who are overweight (Body Mass Index > 25) and this total is expected to rise to over 1.5 billion by 2015[1]. In Europe alone, 10-20% of men and 15-25% of women are obese (Body Mass Index > 30). As a result, the prevalence of type 2 diabetes is also soaring. New data from the International Diabetes Federation show that 53.2 million people now live with diabetes in Europe. This is projected to rise to 9,1 by 2025[2] without appropriate action.
The International Diabetes Federation indicates that diabetes is more frequent in developed countries than in developing countries. However, the latter will be affected more by its expected rise. As these countries abandon their traditional habits and diets, and take on a more and more Western lifestyle, their share in the total number of diabetics will increase accordingly. Additionally, people in developing countries are moving from rural areas - characterised by a low concentration of diabetes - to urban areas - characterised by a high prevalence.
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People with Type 1 diabetes produce insufficient insulin because their body's immune system attacks and destroys the insulin producing beta cells located in the pancreas. The onset of type 1 or "juvenile" diabetes usually occurs before the age of 40 and people with this type of the disorder constitute about 10% of all diabetics. Type 2 diabetics produce enough insulin but the cells insufficiently respond to its effect. This type of diabetes used to be more frequent in people above the age of 40 but recent years have shown a soaring number of people with Type 2 diabetes, including young people. About 90% of all diabetics suffer from this type of diabetes. The onset of type 2 diabetes is often hereditary.
Once diabetes is diagnosed it is imperative that measures are taken. The disorder mainly affects the blood vessels which gradually narrow because of uncontrolled blood glucose levels resulting in angiopathy. In the case of macroangiopathy, which can occur in anyone, the main blood vessels of the body narrow and calcify. Microangiopathy however only occurs when the small blood vessels get clogged to such an extent that they start leaking proteins. Thanks to a balanced lifestyle and new treatments however most complications can be reduced.
The International Diabetes Federation reports that the most common short term complications consist of hypoglycaemia (level of blood sugar too low), ketoacidosis (production of acidic waste while breaking down fat) and lactic acidosis (storage of lactic acid in the body). If the disorder is left uncontrolled it can lead to long term complications such as reduced vision because of cataract, glaucoma or poor blood circulation in the blood vessels of the retina (see Medical Technology Focus on Eye surgery), blindness, dental infection, cardiovascular disease (75% of all deaths in Europe caused by diabetes[3]), renal failure, nerve damage and foot ulceration, sometimes resulting in amputation. According to the WHO, the disorder accounts for 4 million deaths per year worldwide.
Early diagnosis, accurate monitoring and effective treatments can considerably contribute not only to improving the longevity and quality of life of patients with diabetes, but also to reducing the financial burden generated by the disease.
Nowadays, the diabetic can choose from a wide variety of self monitoring tools such as blood glucose test strips, blood glucose monitors, lancets and biosensors. Because patients can perform these tests easily and in the comfort of their home, there is no need for hospital intake.
Data from the United States show that early detection and treatment of diabetic eye disease with laser therapy can reduce development of severe vision loss by an estimated 50% to 60%[4].
According the authors of a recent study conducted on behalf of the European Commission by Pammolli et al[5], "When measured in the long-term and considering patients' quality of life as a relevant effectiveness measure, the introduction of different innovations in medicine and in-vitro diagnostic can prove to be associated with lower costs".
The study refers in particular to a trial conducted from 1983 to 1993, which shows that keeping blood glucose levels as close to normal as possible slows the onset and progression of eye, kidney and nerve disease caused by diabetes dramatically. The trial revealed that intensive control of glucose levels can lead to a reduction of 76% in new eye disease risk; 54% in early kidney disease; and 60% in nerve damage risk. Another trial completed over a period of 20 years, also referred to in the Pammolli et al study, reveals that heart disease risk could be reduced by 56%, and stroke risk, by 44% through the use of such innovations.
Controlling blood glucose levels is achieved quite simply with relatively inexpensive technology. By comparison, surgery and other treatments required in case of complications are complex and costly, not to mention their impact on the patient's quality of life and activity/productivity.
The traditional way to deliver insulin to the body is via a syringe. Insulin syringes are particularly comfortable when 2 types of insulin such as rapid acting and intermediate acting insulin have to be mixed. Developments in medical technology have made it possible to produce evermore smaller and shorter needles (usually around 12 mm).
Using an insulin pen should make insulin delivery less complicated than using a syringe. The pens come in all shapes and sizes and can be pre-filled single use pens or reusable pens that can be refilled with cartridges.
The advantages of choosing an insulin pen over a traditional syringe are:
Their main disadvantage is that pens are usually restricted to full or half unit dosing.
An insulin pump is a medical device composed of a hypodermically used needle attached to a pump which delivers small doses of rapid acting insulin throughout the day. It resembles most closely the normal delivery of insulin in the human body. This method of insulin delivery can influence the blood glucose regularisation beneficially. Certain groups of patients for whom the insulin pump system is particularly interesting[6]:
After food intake, the body produces insulin to assist in the digestion process. The main advantage of the insulin pump is the ability to mimic this process at the press of a button, after which the pump delivers an extra amount of insulin. Additionally, the system allows for a very precise control of insulin delivery enabling the patient to achieve a balanced blood sugar level almost continuously. Lastly, the pump provides new levels of freedom with regards to the eating pattern of the patient. The diabetic who injects insulin several times a day must schedule meals to match the insulin's response curve. Conversely, an insulin pump adjusts the dosage for the desired amount of food allowing the patient to eat more or less whenever he or she wants.
The main disadvantage of insulin delivery via an insulin pump is that the needle has to be replaced regularly. Leaving it in the same place for more than three days can lead to irritation and possible infections. Also, over time the needle injections cause little, coloured scars. All in all however, the insulin pump offers many advantages over traditional insulin delivery methods.
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The treatment of the diabetic ulcer can involve special woundcare products, bioengineered skin (see Medical Technology Focus on Tissue engineering), diabetic shoes and inserts, contact casting, antibiotics, and surgery if need be.
Already at the end the 19th century doctors experimented with transplanting parts of a donor pancreas into a diabetic. Up until 1995 however, the results of the transplants were mixed. That is why, in 1999 a group of scientists set out tackle and overcome the problems of regular pancreas transplants. They came up with the Edmonton-protocol, a procedure whereby islet-cells that contain insulin-producing beta-cells are transplanted from a donor pancreas into the liver of the diabetic patient, rather than in the pancreas. Both diabetics and scientists have hailed this discovery as the biggest step forward in the fight against type 1 diabetes since the advent of insulin.
Our Jennifer was just seven when, nine years ago, she suddenly fell ill from diabetes type 1. It was in summer when our Jenny was examined and diagnosed by our GP. Previous to this, there had been some days when Jenny had suffered from nausea, headache and similar symptoms, but nothing which for us at that time pointed towards diabetes - not even in retrospect. We thought it was summer 'flu or sunstroke. Our GP, who knows our whole family well, very soon suspected diabetes
He confirmed this based on an initial urine sample. The decisive factor for his suspicion was certainly that our daughter had the (characteristic) smell of acetone, which we had not noticed, however, although the doctor did. Certainly, he was more aware because one of us two parents (her father) also had diabetes type 1 and was under his care. Even so, we were quite shocked at our daughter's diagnosis. We had not expected this. At that time our daughter had finished Year 1 and had just learned reading and arithmetic and was now supposed to learn to deal with this illness as independently as possible!
She was first put on insulin in a 14 day hospital stay in a local hospital, which followed immediately after the diagnosis. It is very hard to see a small child being confronted with a needle from one day to the next. In Jenny's case she knew about this already from seeing it in her father's case, but to be given injections herself and then to have to learn to inject herself was something rather different. Jenny received intensive insulin therapy, initially with two sorts of insulin (short term and long term insulin), and later a third sort was included. For us it was altogether astonishing how quickly Jenny was able to inject herself independently. She soon noticed that she could only stay with friends if she was able to inject and test herself. She did both with a very high level of discipline and understanding for her age. The restrictions on her diet were much more difficult for her. In spite of all our efforts it was clear how complex the illness could be in a growing girl. Growth and all the changes it brings had a continual influence on her diabetes. It is worth mentioning that we had a long lasting and also troublesome problem with the need to inject Jenny again late in the evening - when she had long been asleep - so as to control the increase in the mornings. Every evening it was torture - and not just for Jenny. Jenny has had an insulin pump for two and a half years now, which has eliminated the problem of the late evening injections, but also the injections which were necessary in the early morning. Anyone who knows how long young people can stay in bed in the mornings at the weekend and in the holidays values this component highly. For our daughter the pump therapy is a great relief and an improvement in her daily life - even if there have been repeated phases when considerable technical difficulties have arisen. The most important thing is that she feels more at ease with the pump and less restricted. There are still highs and lows in her diabetes readings and some unexplained values. But we all try to react calmly. After all, Jenny will have to live with diabetes for many years to come.
(Source: Health First Europe)
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World Diabetes Day is the main global awareness campaign for diabetes, organised by the International Diabetes Federation (IDF) and supported by the World Health Organization (WHO). This day is celebrated every year on the 14th of November - the birthday of Frederick Banting who co-discovered insulin in 1921 - in more than 150 countries to raise awareness of diabetes and to honour people with diabetes all over the world. This year, World Diabetes Day focused on diabetes in the disadvantaged and the vulnerable. Click here to read more.
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[1] http://www.euro.who.int/obesity
[2] http://www.unitefordiabetes.org/press/releases/wake_up_call_to_halt_global_diabetes_epidemic.html
[3] Schnell O., The links between diabetes and cardiovascular disease, "http://www.sciarc.de/pdf/Link_Diabetes_CVD.pdf
[4] Centers for Disease Control and Prevention 2005, US National Diabetes Fact Sheet
[5] "Medical Devices - Competitiveness and Impact on Public Health Expenditure", CERM, July 2005
[6]Flemish Diabetes Association
