Prof. Edward Franek: The XNUMXst century will be dominated by two great epidemics of non-communicable diseases – diabetes and smoking

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Today is the 71st edition of World Health Day, organized annually by the World Health Organization on its anniversary. The aim is to draw attention to particularly pressing health problems. According to WHO, the XNUMXst century will be marked by two great epidemics – diabetes and tobacco smoking. We talk to Professor Edward Frank, head of the Department of Internal Diseases, Endocrinology and Diabetology of the Central Clinical Hospital of the Ministry of Interior and Administration in Warsaw, about the impact of both diseases on the condition of humanity, and especially of Poles.

1. The number of obese people in Poland is increasing, which entails an increase in the incidence of diabetes and, consequently, an increase in the number of complications
2. Prof. Edward Franek: Air pollution causes some people to exacerbate their lung disease so severe that it requires hospitalization
3. Clinical studies show that approx. 40 percent. diabetics have never smoked, and the same number have quit smoking
4. Study begins to assess cardiovascular risk factors in diabetics who use electronic cigarettes or tobacco heaters instead of smoking
5. You can find more such stories on the TvoiLokony home page

Monika Zieleniewska, MedTvoiLokony: WHO estimates that the current century will be the century of two great epidemics: diabetes and smoking. Do you share this position, professor?

Prof. Edward Franek: Of course, when we say “epidemic” we are thinking primarily of the COVID-19 epidemic. But diabetes and tobacco smoking are definitely two big epidemics, or rather pandemics (or global epidemics) of noncommunicable diseases that will dominate the XNUMXst century if nothing changes. I would add a third to them: it is the obesity epidemic.

But obesity itself does not carry such an increased risk of developing cardiovascular diseases as, for example, a heart attack or stroke. This risk increases greatly only when diabetes joins obesity. However, diabetes develops very frequently in obese people, so you could say that a significant increase in cardiovascular risk is delayed in them, but sooner or later it will occur.

Of course, smoking is independent of obesity and diabetes, and the cardiovascular risk, not to mention cancer, is greatly increased in smokers, especially if someone with diabetes smokes. Undoubtedly, the elimination of the risk factor of smoking and exposure to harmful and carcinogenic substances of cigarette smoke – including, let’s not forget, passive exposure – would have a positive effect on the health of many diabetic patients.

How does smoking relate to diabetes or the patient’s risk of developing it? Is there any correlation here, has there been any research?

Smoking is listed among the risk factors for the development of diabetes. Recently, there has been a piece of work that talks about an increased risk of developing diabetes in people whose mothers smoked during pregnancy. But it has a stronger influence on the complications of diabetes than on its development itself.

According to the statistics of the World Health Organization, more than 6 percent. the global population has diabetes. It is about 470 million people, of which 3 million are in Poland. So statistically, every eleventh Pole has diabetes. These numbers are growing every year. Is there any hope of improvement?

I’m afraid not. Most of these patients are patients with type 2 diabetes associated with obesity and insulin resistance. Unfortunately, the prevalence of obesity in Poland is increasing, as shown, among others, by NATPOL research. This entails an increase in the incidence of diabetes and, consequently, an increase in the incidence of diabetes complications. Thus, the situation in this respect will worsen rather than improve. This is true for our country as well as for the rest of the world.

How does the treatment of diabetic patients in Poland look like during the coronavirus pandemic?

I would say not too well. Although diabetes clinics were not completely closed to patients, the number of visits has certainly decreased. This is especially true of actual visits, as some of them have, of course, been replaced by telepaths. I do not have data on the frequency of hospitalizations due to diabetes or on the issues of diabetes control in Poland, but looking at what is happening, I think that both diabetes control has deteriorated in many patients, and these patients are less often hospitalized to improve this state of affairs. .

The problem is that this bad adjustment will have a negative impact on the frequency of diabetes complications not immediately. The complication will be delayed, even considerably. Therefore, I would expect the incidence of diabetes complications and sequelae to increase already this year, but more in the next and the following years.

You were a professor and a member of an international research team that conducted research on hospitalization of patients due to air pollution. What are the findings of this study?

International is a bit of a buzzard name, because although it was also an Italian, the team was actually Polish and the research concerned Poland, or actually five cities in Poland, namely Białystok, Bielsko-Biała, Gdańsk, Kraków and Warsaw.

Unfortunately, Poland is one of the European countries with the highest air pollution. As a result, the impact of this pollution on health can be investigated, which is obviously not possible in countries where the air is clean.

Our research has shown that the negative health effects of air pollution can occur quickly. It turned out that concentration peaks of various harmful dusts and compounds in the air cause a short-term increase in the frequency of hospitalizations for respiratory diseases. This increase is somewhat delayed, taking place a few days after the peak air pollution. In other words, air pollution causes some people to worsen their lung disease so badly that it requires hospitalization.

Fortunately, such a strong correlation could not be shown for other groups of diseases, e.g. for cardiovascular diseases, although some tendencies in this direction could be found. It is worth mentioning that the situation could be much worse if we were to evaluate the long-term health effects of air pollution. Such assessments are still planned and other research techniques are needed for them, but as other publications show, such an impact certainly exists.

WHO warns that about 7 million people die in the world every year as a result of air pollution. The same number of deaths is reported by WHO in the case of smoking. Do these two areas have more in common than just the mortality statistic? For example, are the toxins present in polluted air comparable to those found in cigarette smoke?

Toxins and dust contained in polluted air are also most often found in cigarette smoke, although their concentrations may vary. Cigarettes also contribute to the formation of smog, and although their share in outdoor air pollution is small, they can be the main source of it indoors. Obviously, cigarette smoke inhaled by the smoker himself contains much higher concentrations of toxic substances compared to the concentrations in the air inhaled by passive smokers.

What are the options for reducing health risks in patients who are heavy smokers and diabetics?

First, there are many other additional factors that may influence the risk of smoking in diabetic smokers. Some of them are not modified, e.g. age, but many others can be removed or their intensity can be reduced. I mean, for example, the treatment of hypertension or lipid disorders. Such treatment will improve the prognosis, even if nothing is done about smoking or diabetes management.

Secondly, you have to try to correct diabetes, remembering both non-pharmacological diet and exercise, as well as pharmacological treatment. Good diabetes control is beneficial for the patient, as is the control of hypertension and dyslipemia.

Third, finally, the patient must be persuaded to quit smoking. It is possible, and many patients do quit smoking, but not necessarily forever. Data from large clinical trials show that approximately 40 percent. Diabetics have never smoked, but just as many have quit smoking. Therefore, it is worth persuading people to quit smoking, it is also worth remembering about preparations containing nicotine, which make it easier for the patient. In recent years, electronic cigarettes and tobacco heaters have also appeared, which, like nicotine preparations, can potentially reduce the harmfulness of smoking in tobacco-smoking patients by reducing exposure to many toxic compounds present in cigarette smoke or by completely eliminating them, as in the case of tar. It is not clear what the long-term effect of their use on cardiovascular risk is compared to that of regular cigarettes, but we have just started enrolling in an international study coordinated by the University of Catania to assess what is happening with cardiovascular risk factors. in people with diabetes who use electronic cigarettes or tobacco heaters instead of continuing to smoke.

This is probably a unique study?

We include in this study patients who do not want to quit smoking, but are ready to try to replace ordinary cigarettes with alternative products. This is quite a unique study, because so far there is little data on this subject, especially long-term data. For now, we know only that in the standardized alternative products providing nicotine, which in our study we define as NC NDS (Non-Combustible Nicotine Delivery Systems), there is no smoking of tobacco or the formation of smoke, and smoke is the main habitat of harmful and potentially harmful substances. harmful. These products emit much less toxins and in lower concentrations than cigarettes in which tobacco is burned.

The question is, of course, whether the reduction in the number and concentration levels of toxic and carcinogenic substances in alternative nicotine-providing products translates into a reduction in health risks for smokers who switch to such products. We assume that this may be the case and that this risk reduction is taking place. But science needs hard facts to prove anything. Our research is therefore an attempt to find an answer to such a question.

An interesting report has recently appeared on the attitudes of Poles towards the coronavirus pandemic. «Risk, trust, infectious diseases. Polish women and Poles about the pandemic ». The data from this report are quite disturbing, because 8 out of 10 Poles trust their families the most in health matters, and only then in health care: nurses (63%) and doctors, along with friends and acquaintances (58%). Where did this result come from? What can we do to make doctors once again the most reliable source of verified information in the field of health?

Well, with the coronavirus, the situation is that many people just close their eyes to the epidemic and don’t want to see the truth. He interprets facts in his own way and allows single facts, sometimes made up, to shape his worldview. Such people are often loud, visible on normal and social media. Finally, a person who doesn’t know anything about it doesn’t know what to believe anymore. This is also because false messages are often simple and clear, and the truth is neither black nor white, and sometimes it is not known what it is. However, distrust of doctors was already before the epidemic and is therefore a more general phenomenon.

How can I fix it? Well, first, the doctors themselves and the rest of the health service have to do a little bit of it. And that’s not reducing the side effects of treatment – which is impossible – or medical errors – which is very difficult. It is about good organization of work, about showing willingness to help other people, about respect and courtesy towards the sick person and the family.

Secondly, the role of the mass media is important, as they focus on showing the negative aspects of health care, which are, however, the exception and not the rule. This distorts the picture of reality. If, for example, a surgeon leaves a gauze pad in the patient’s stomach or, God forbid, scissors, they will write about it everywhere. However, almost 2,5 million different procedures are performed in Poland every year. Does anyone write that during one operation a gauze pad was left in the stomach, and during 2 million 499 thousand. 999 operations have not been? If he doesn’t, he only writes half the truth. The truth is that such mistakes are rare, but unfortunately they will. There will always be mistakes and accidents in the world. Sensationalizing them as well as presenting them as a rule is misleading and negative. But I’m afraid it will be difficult to change.

The editorial board recommends:

1. How to quit smoking The position of the Polish Society of Civilization Diseases
2. How can health risks be reduced in active smokers?
3. Smoking is a disease!
4. Type 2 diabetes – causes, symptoms, treatment, complications and prevention [EXPLANED]

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