“Silent Epidemic”. A child with diabetes is already in every school in Poland

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Diabetes mellitus is the most common civilization disease of the 5st century. Over half a billion people worldwide suffer from it. About 1 percent. from this group has type XNUMX diabetes, commonly known as insulin-dependent diabetes. The disease is most often diagnosed in children and adolescents. He stays with them for life, determining and absorbing every moment of their lives. It requires continuous and frequent glycemic control (checking blood sugar levels), administration of insulin with every meal and a XNUMX/XNUMX base. A child with a pen or insulin pump and glucometer is practically in every school in Poland. Dr. Marta Wysocka-Mincewicz, head of the diabetology department of the Children’s Memorial Health Institute, says how the pandemic influenced the lives of diabetics and what we can do to prevent the next generation of children from contracting this disease.

1. The number of patients with type 1 diabetes is the fastest of all those struggling with diabetes
2. The disease is most often diagnosed among adolescents aged 12-15 years, but more and more adults also suffer from the disease
3. – The pandemic increased the incidence of patients with type 1 diabetes. Patients go to hospital in a worse general condition – says the diabetologist
4. On November 14, we celebrate the World Diabetes Day
5. You can find more such stories on the TvoiLokony home page

Aleksandra Myczkowska-Utrata, Słodziaki Foundation: What is the level of diabetes in Poland?

Dr. Marta Wysocka-MincewiczDiabetes mellitus is currently the third most frequent chronic disease in childhood. The incidence in Poland is approx. 20 per 100 thousand. people and increases by approx. 20 percent. annually! The number of patients with type 1 diabetes is the fastest. Type 2 diabetes occurs sporadically in the pediatric population. However, with the obesity epidemic progressing, this situation may change.

What is the percentage of type 1 in the total number of diabetics?

Type 1 diabetes is only around 5 percent. total number of diabetic patients. However, it is definitely more absorbing, demanding and long-lasting – patients most often start to fall ill as children or very young adults. It requires more health care, greater patient concentration, better education and preparation for independent life.

At what age is type 1 diabetes most often diagnosed? Has anything changed in this regard in recent years?

The age group in which type 1 diabetes is most commonly diagnosed is adolescents between the ages of 12 and 15. However, the incidence of the disease in the group of pre-school children is growing rapidly. We observe more cases in siblings and children of parents with type 1 diabetes and in young adults. The age of diagnosis of this type of diabetes in adults is also shifting. In the past, there were no patients over 35-40 years of age, and recently, type 1 diabetes was diagnosed in a patient over 45 years of age.

Further part under the video.

What has the pandemic changed about diabetes? Are there more cases or are the cases more difficult?

It seems that the pandemic has increased the incidence of patients with type 1 diabetes. Patients are hospitalized in a worse general condition. This last observation was most noticeable during the first wave of the pandemic. There are many studies in the world literature on increasing the number of cases during a pandemic, however, we will have reliably confirmed statistical data from all over Poland available in the coming months.

Has the pandemic disturbed the diagnosis of diabetes? How did this affect the children who ended up in your ward?

The pandemic, especially at the beginning, significantly reduced patients’ access to health care. Therefore, children with newly diagnosed diabetes came to the hospital with more advanced dehydration and ketoacidosis. Often life-threatening.

Parent training is currently problematic. Initially, after the outbreak of the pandemic, the lack of visiting opportunities, and now difficulties in walking, prevent patients from having management training to adapt to life with type 1 diabetes after hospitalization. At the same time, the availability of the diabetes clinic for patients has decreased due to the extended duration of visits and saving children for a specific hour, which was necessary to reduce the number of people staying in the waiting room. This situation accelerated the work on the use of telemedicine in diabetology. Children who use insulin pumps and glycemic sensors (Dexcom, Guardian, Free Style Libre) are now increasingly able to import data on diabetes control and send them to the doctor to correct insulin therapy settings.

Is it recommended to vaccinate children with diabetes?

Definitely yes. According to the recommendations of the World Societies and the Polish Diabetes Society, children with diabetes should be vaccinated against both influenza and SARS-CoV-2 infection as they are more at risk of complications.

What do you think will affect diabetes therapy in the coming years?

It seems to me that one of the most important lines of research are drugs of secondary prevention of diabetes, which prolong the period of remission and reduce the need for insulin. One of the most promising is teplizumab and a therapy invented in the center in Gdańsk, based on the use of the patient’s expanded regulatory T lymphocytes. Perhaps in the future it will be possible to find a combination of drugs that will best prevent, or even completely inhibit, the destruction of β-cells of the pancreatic islets. It is extremely important to maintain your own insulin secretion as long as possible.

We are also constantly waiting for the improvement in the effectiveness, dissemination and availability of pancreatic islet cell transplants. Initially, the biggest problem was to develop an immunosuppressive treatment that would prevent rejection of the graft while also not harming the graft. Later it turned out that the transplant was very quickly destroyed by the autoimmune process. Therefore, designs of coated artificial pancreatic islets have been developed to limit the access of antibodies that destroy the β cells of the pancreatic islets. Unfortunately, the coating reduced the free access of glucose and the leakage of insulin from the artificial island.

Type 1 diabetes is a disease that requires regularity, regularity and constant attention and self-control, so I believe that closed-loop technology will develop in the near future, taking the burden off the patient significantly. Closed loop means that insulin is administered according to a computer algorithm according to the level of glucose measured by the sensor and maintains the correct glucose level without the participation and attention of the patient. It seems that another very important direction of research are more and more accurate sensors that measure the level of blood glucose more precisely. It will also improve the functioning of both pump therapy and closed-loop systems.

1. Glucometers are available from Medonet Market

What are you waiting for as a doctor?

What am I waiting for and what do I dream about? I am looking forward to finding the cause of the development of type 1 diabetes. I believe that finding it will give the opportunity to work on preventing this epidemic.

I also dream about the communities of patients to unite and influence governments and legal regulations so as to force companies to ensure compatibility of sensors and all equipment for insulin pumps.

I would like Poland to change the method of reimbursement of insulin pumps so that each patient receives a certain amount of money and can decide with the doctor about the type of insulin pump.

I would also like to change the method of reimbursement so that patients not using the pump or all of its options have to return it to the center. This is especially important in a situation where the patient, after receiving the reimbursed pump, decides to buy a more modern model himself, and the pump for state money lies in a drawer, instead of working for another patient.

I also dream that the absurdities of reimbursement, which prevent me from prescribing modern drugs as reimbursed to patients with type 2 diabetes, will be discontinued. 2 or GLP-1 analogues).

And what can we do ourselves so that we and our children live a little healthier?

The last issue I would like to address is the growing pandemic of childhood obesity. It is the duty of all of us to look after each child and fight – this is the fight – with the prevalence of stillness and overeating on unhealthy snacks. It seems to me that all the products we buy are processed in such a way as to digest them faster, which makes them more “sugar-rich” and thus fattening.

We sometimes laugh with my patients that we have to turn into bunnies and eat mostly lettuce, raw carrots, cabbage, spinach, broccoli and zucchini and all the other green vegetables to be healthy.

Interviewed by Aleksandra Myczkowska-Utrata with Słodziaki Foundation

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