Nov 19 ESI Facebook Live Newer Technologies and Latest Therapies in Diabetes Management
Endocri Endocrin Verma sir. He is a associate professor at MGM Medical College, Indore. A warm welcome sir. Lastly, last faculty Doctor Shrinath P Shetty. He is
a consultant endocrinologist at KMC Hospital, Mangalore. A warm welcome to all of you sir. So discussion topic diabetes newer technologies or neurotherapies every Saturday diabetes discuss type of diabetes lifestyle Diabetes and changes we are seeing newer aspects of how we are managing diabetes. So first point insulin syringe and what we are seeing even with the size of the needles.
All of these are changing on a you know on a rapid pace. So, the size is not you can't even see it. In the end, it is absolutely painless. So, these are small little important changes diabetes it is definitely going to be beneficial for our end users.
Next point glucometer so and you needed to ah you know the the way in which glucometer card calibration accuracy and so now what we are seeing is more accurate glucometers easy to use and ah the the way in which these glucometer function automatically because Bluetooth connectivity so these are small changes that we are seeing in our day to day. diabetes what all we are using with diabetes it is making a big difference ah for our users ah who are you know taking either insulin or using the glucometers so these are small but very important ah ah changes which are giving them benefit they are able to understand their condition much more better because of the information that they are getting and ah and the ease of use and the ease of management has improved with the small ah improvement in technology. Thank you sir. Rightly said by doctor Abhijit Technical improvements ah diabetes management instruments we would have been knowing in a better way how difficult it has to use them. Or like rightly said. So
Sushant sir you are here. So ah just a basic ah ideas what is the importance of newer diabetes technologies and neurotherapies and management of diabetes. In Indian scenario. On other words it is really the need of the art. Basic medicines available diabetic people sugar. 300 highest.
timing range complications animal sources And ah and how that insulin was working. So in the ah so in this 100 years so lot of work has gone in ah to this whole technology of how this insulin was ah first from wherever we getting it from and then the whole aspect human insolence was the next breakthrough of the insulin. What the human insulins did for us is ah side effects animal incidence and how the body was reacting to the insulin when when it was injected also was ah we were seeing ah better results. Then further ah advancement was in analog incidence. So insulin structure so the scientist were looking at creating now from human incident to recreating this whole process of this insulin creation into ah ah artificial formulation and simple ah in the insulin once they were making this insulin in the labs they were adding components to the insulin so that the how the insulin was working inside the body was different. So a lot has changed over the 100 years.
So now when you talk about newer incidents newer incidents advantage so immune insulins ah and the cost advantage of human insulin important Indian scenario cost and so it makes a difference but what is the advantage newer incidents so the way in which it works so we are having ultra fast acting incidents. So, the, so the when, when the insulin is rejected, the way it is quickly reacting and, and the whole profile in which the insulin works, is starting to mimic own body incidence ah, mimic and when you look at now further ah insulins insulins vessel incidence or short acting So insulins technology ah advancements molecule structure insulins ah introduce so the behaviour of this insulin is becoming different. So ah ah long acting insulins used to work for twenty-four hours. So
like insulin, blood gene. Now when the now we are getting even ultra long acting incidents which can work for 48 hours. So what advantage are these insulins giving us? Ah basil insulin variability next short acting insulins as I mentioned ultra fast acting and even super fast acting incidents are going to be coming in the in the next few ah few years. So these insulins give us that flexibility. So, so, before we eat and you know when we talk about fast acting insulins. So, in cases in
certain conditions ah like elderly population or in people ah having kidney problem. So the insulins used to act a long ah you know a longer duration. With the shorter acting insulin the the duration of action is much more less. So the chances of you going into hypoglycemia is also much less. Then the convenience with this ultra fast active insulin is you can also give it ah after eating food as well. And what they
have done seen in studies that you know the overall A one C control ah and with the short acting incident is almost similar. So and quite a lot quite often people using insulin most common ah side effect hypoglycemia hypoglycemia so advantage so lesser chances of hypoglycemia, better action of the insulin which is mimicking the own body's insulin. So, these are two advantage that we are seeing with these new generation incidents. Then the third ah bigger advantage is quite a lot of times insulin so the the number of times we have seen patients the they will not be using ah insulin as frequently as we have told them because again adherence to therapy ah because again they may be working ah they may be having some kind of ah challenge. So the so now we are
getting weekly once ah insulins as well. So the technology is changing in which we are getting this kind of changes. And the next other advantage we are starting to get with the insulin technology is ah inhaled insulins. Now that is again ah US market ah ah certain ah major insulin manufacturers and major pharmaceutical companies India also are planning to bring this ah inhaled insulin. So this inhaled insulin is a short acting insulin. It is given
with the meals. And ah and so this again prevents us from ah you know giving us ah multiple ah injections when we are giving before the meal. So it can it can replace ah that invariably. In NDL students again there is a small challenge. Ah ah we need to be looking at lung functions. We need to be testing for lung functions. Ah so that is one ah
aspect. Oral insulin again it came as well as the research is still ongoing. So these are some of the basic ah ah advantages ah and newer advances that we are seeing with regard to insulin and ah and definitely it is the whole way in which this ah technology is ah advancing is been rapid in the past 10 years. Ah and even the insulin delivery ah also has changed. When you talk about our simple insulin pens now we have auto pens which come in. We have needleless
fence that are there. So these are advantages that we are starting to see with change in technology and it is definitely going to benefit all our patients using insulin. Thank you sir. Thank you Doctor
Abhijit. So I think the rightly said though main advantages advantages chances of hypoglycemia and glycemic variability and your analog state. Or cause as an Indian contest cost matter patients in long term they are cost effective advantages HBOMC reduction cost difference resident family and Diabetes sensitive and critical management Therapies or diabetes technologies health care pregnancy diabetes improvements loss ah overall management in fact ah devices this is which is connected to CGMS. So CGMS ah alert sugar so that ah you could stop the pump.
it could alert both when it was going high and both when it's going low. and there are ah hybrid pumps ah ah it pump rate. So you can give an extra bonus which you can decide. ah or reservoir, insulin. So
cost wise expensive Indian budget but there are people using it. But over time I think ah cost come use material. As of now not many centres are using this Thank you sir. Thank you Doctor Shrinath. So this type in this technology is upcoming India but even as a doctor we are not friendly with this technology. But it is very helpful for type 1 diabetes patients, right? Please sir. So I would like to
another question now to doctor Abhijit sir. Sir, ah this is something new interesting technology specially for type one diabetes. Parents ah they want to know the permanent cure of diabetes for the children. And success of stem cell transplantation sir. So what is your advice to parents regarding success of this techniques in Indian contest? So with first point let us get the message very clear. This is an experimental
ah technology it is still not mainstream and we are all as doctors we are extremely hopeful that this will become mainstream in in time. So now let us first explain now what are the ah you know what are the therapies available for us with with regard to ah either stem cells or looking at eyelid, cell transplant. So eyelid cells are your cells that that are there in your pancreas. So these eyelid cells how what ah what the researchers have done. They have taken it from ah donor and they have now what are the challenges? So when you put a cell from another ah another body your own body has cells which fight these cells. So, so
that is again ah that was a one of the major you know issues when we have when we talk about transplant. So what have the scientist done? They have taken these cells from ah from a donor. They have purified it and then they have injected the cells into the liver through the portal vein. So, Now when this ah purified eyelid sense from another body has come inside. Then these cells start to produce insulin ah and ah and we have started to see some kind of advantage with this kind of technology. Now what
are the challenges of this kind of technology? First we should have ah enough and plenty donors for us to get these kind of cells. Then the technology in which your ah what we use once we inject these cells. Your body starts to fight the cells immediately. So we use
medication called immunosuppressants. And now what the scientist are looking at it. How can we make these immunosuppressants better? How can we make it more ah safer without much side effects? These immunosuppressants we used to use steroids as well.
Now the again steroids will cause variations. So now we need to have a a type of medication which do not have ah such kind of long term effects which can affect the liver. Ah which can affect the kidneys as well. So these are challenges now what the scientist are looking ah to ah to help after we have injected these ah cells that are coming in. Next point is once the cells are purified, the way in which the purification happens of the cells, the extraction and the protection this cells will have one, once they inject it. So
now that is where the research focus is happening. So there are two main focuses, one is the ah ah how we are extracting and processing the cells and injecting then the next part of it is the immunosuppressant therapy is where lot of research work is going on. The next option we have all heard about stem cell therapy. Again, now this is very very early, very experimental. So what the stem cell therapy, what is the hope that we are getting from this stem cell therapy? It is to take certain types of cells which are again it can come from ah fetal blood, it can come from mesenchymal cells, it can come from your bone marrow.
So, what these, what that, what the scientist are looking at is to reprogram these cells to behave like our insulin ah pancreatic cells. So again this these are all experimental therapies. We still need more time before it becomes mainstream. There are lot of centres in America, not lot few select centres and when you talk about the registry ah with regard to this kind of research ah ah we have around more than around thousand members who have gone through such kind of experimental therapies. And what research has seen is after they have given this therapy people have been off insulin for about three 5 years. So again we need a lot more learnings to get from ah from this kind of therapy. And this
is still earliest but it is it is still exciting. As Shashank sir had mentioned ah monoclonal antibodies. So now this is a medication which will prevent the progression. So once these antibodies that are destroying the pancreatic cells. Once we
use these therapies it is preventing that destruction from happening. So there are lot of changes that are happening and ah it is definitely exciting times for sure these will become mainstream in the next ah four to 5 years. That is ah that is the whole aspect with regard to this technology. Thank you sir. Thank you doctor Abhijit. As we
are running with the time I quickly now wrap up with the remaining portions to so Doctor Rajesh sir kindly brief us about ah and this is a very ah latest technologies. Social media platforms. Like we have lot of apps and QR code scans and all that things in our day to day practice for Diabetes Management. So how it has helped us in actually diabetes management kindly ah guide us for that. social media platforms ah ah they could be very much helpful ah for the ah managing diabetes patients. Applications commonly smartwatch doctors patients use smart watches or step counters step applications physical activity patients step counting daily ten thousand Sou apaixonado and pipeline. Ah which can
prove breakthrough in diabetes management. Ah so just give a glimpse of that course. So, you are mute. Shashank sir already there is a new drug which is an antibody ah type 1 diabetes prevent that is one ah drug. Then ah once weekly insulin ah insulin Ico deck hai. Then ah there is a
GLP 1 or GIP analog combined. Ah weight loss or obesity ah tackle or diabetes and then a lot of smart devices. You know smartphone non painful method saliva sugar so these are things in the pipeline. Ah and there are some methods ah you know ah capillaries ah circulation question from you. my side. Even after all this
discussion we have done so far. Technologies and all this thing. Ah if you talk about studies we find that Indian diabetic patients are still lagging with an average HBA one C we still have around nine, 8. 5 something like that. So what is the basic like you know deficiencies which needed to be corrected at the ground level? Okay Technologies are the other thing but deficiencies diabetic population average HBA one C handsome level First of all ah congratulations to you Mona and ah this wonderful team of Abhijit, Shrinath and Rajesh congratulations to all of you all for a wonderful exposition. Thank you sir. Each one of you
all have made some very nice points. Mona ji have touched upon a very germant point. That despite of ah our Indian jugaard having affordable accessible medicines. We are still faltering with the A one C of 8. 5 or 9%. And many reasons are there for that. I'll answer in English now because I think I was talking in Rashtra Basha before that.
Number one is that first of all we should not be ashamed. Ah all over the world including America and Europe, their events are at eight point five. Because human beings are the same everywhere. See the
biggest problem in diabetes is it's a silent disease. There are no symptoms. And they only wake up when they go to our cardiology colleagues or nephrology colleagues dialysis heart attack bypass surgery we have to tell them that the real insurance in diabetes is keeping your and they have their own Okay, they, whatever you may do, they will have their own brain and they will have their own family member or a friend who will poke and talk them okay. So,
that is the first thing. So, I have a simple approach for this. A, B, C, D, E, F. A for A one C, keep it below 7%. B for
blood pressure, keep it below. 120 over 30, 18. C for cholesterol, LDL cholesterol of seventy B for diet, E for exercise, F for feet. If you do this simple formula for every diabetic and adhere to it, it's very unlikely complications kidney neurological and then of course if you use all modern medicine and keep that number to 7%. They need to
be happy. Also effectiveness we need to be more effective in getting the numbers in a very right way. US or Europe technological judicial double A platform sharing their views. So, I
thank you all of you. A very, a very thankful. Thank you, sir.