November 14th is World Diabetes Day. Birthday was selected as the date Frederick Banting, winner of the Nobel Prize in Physiology or Medicine for the discovery of insulin. Despite some successes in the fight against this non-communicable epidemic of the 21st century, the problems associated with the disease are much greater. And they are by no means only of a medical nature.
About what prevents to change the situation with diabetes for the better, told specialist in the field of clinical endocrinology, professor, director of the endocrinology clinic of the First State Medical University. I. M. Sechenova, Corresponding Member of the Russian Academy of Sciences, Doctor of Medical Sciences Valentin Fadeev.
Why is the incidence on the rise?
Elena Nechaenko, : — Valentin Viktorovich, every tenth adult in our country has diabetes. Why has type 2 diabetes become an epidemic in recent years?
Valentin Fadeev: This disease is not simple. Even doctors do not fully understand why such a record increase in this disease in the last 50 years. After all, the point here is not to improve diagnostics: it is primitively simple – it is enough to determine the level of glucose in the blood. The simplest explanation is a significant increase in obesity in post-industrial society. To feed the growing population of the planet, it was necessary to have the advantage of producing those foods that are easy to grow. As a result, refined carbohydrates (wheat and cereals) began to dominate in the human diet of the 20th-21st centuries, which, to their credit, allow us to feed the modern 8 billion people, but do not make them healthier.
So it’s all about the wrong diet?
— This is the most popular, but by no means proven theory. After all, the high prevalence of obesity (today every fifth adult Russian is overweight) cannot fully explain the progressive increase in the incidence, since type 2 diabetes does not develop in all overweight people, but only in 20% of obese patients.
Nevertheless, the fight against excess weight is not only the prevention of the disease, but also a therapeutic method. Reducing body weight allows you to control this disease very effectively, at least it will be easier for the patient to maintain an acceptable level of glucose in the blood. Another question is that the problem is not limited to a decrease in blood glucose levels alone – everything is much more complicated! Patients die not from high blood sugar, but from atherosclerosis, that is, damage to blood vessels, and the level of glucose in the blood itself is not so significant for this.
Four pillars of therapy
– Tell us how to treat type 2 diabetes mellitus?
To do this, we can do four key things:
- prescribe a hypoglycemic drug that will help lower blood glucose levels;
- normalize and clearly control the level of blood pressure;
- prescribe statin therapy and control LDL cholesterol (called “bad cholesterol”);
- systematically reduce body weight or, at least, not increase it.
Everything seems to be clear, but the problem is that we are dealing with a person to whom, as has long been known, nothing human is alien. Well, the second problem is the catastrophic shortage of doctors. Primary medical care, qualified medical care, alas, have long ceased to be available. The shortage of nurses is an even more comprehensive problem; staffing a large clinic with nurses is sometimes even more difficult than with doctors…
– How so? After all, the flow of applicants to medical universities is increasing year by year. Yes, and there are enough certified doctors in the country. Or not?
– If we talk about the training of medical personnel, then it begins at school, with the USE imposed on us, which is a terrible mixture of the worst examples of the Western educational system with Russian vigorous corrupt tar. I will give only one quote, belonging to the famous and Japanese-born physicist, popularizer of science Michio Kaku. He said, “How is it that the US scientific elite has not yet collapsed if we are producing a generation of idiots? The answer is simple: 50% of American scientists were not born in America. In my program, one of the largest in the US, there are 100% of such scientists!”
And then the story started at school goes into the dark forest of higher education. If the goal of the higher medical school is to train highly qualified doctors who are able to provide quality medical care to real patients, then we are still moving from this goal in exactly the opposite direction! I once asked one confused and nervous young resident: “How will you work, because you have to provide assistance to the sick, including emergency?”. I will never forget the answer: “You know, professor, I was taught that I should not provide assistance, but offer a medical service!” …
— But let’s not throw off the responsibility from the patients themselves. After all, patients do not really like to strictly follow medical recommendations, right?
– After the recommendations on diet and the expansion of physical activity, which are given by the endocrinologist at a 15-minute appointment, sometimes once a year, almost no one loses weight! Out of 100 such people, only five will lose weight and, most importantly, will not gain it back after a sharp decrease on the background of some kind of diet! Even the treatment of opioid addiction is much more effective: about 20% of patients are cured or go into long-term remission. Among people with high degrees of obesity reduce and maintain weight no more than 2%.
No more than 30% of patients (and this applies not only to diabetics) really and consistently follow the doctor’s recommendations for the constant intake of medications and, no less important, the recommendations for regular follow-up visits to the doctor …
Why is that? One black medical anecdote comes to mind: “A fat man sentenced to death in an electric chair is brought to the execution room, but he does not fit into this chair. There is nothing to do, he is put on a strict diet for several months, only crackers and water. They bring him to the execution again, but again he does not fit into the electric chair. They ask him: “Man, how is it that you haven’t eaten anything for three months and haven’t lost weight?” To this the condemned replies: “You know, the problem is that I have no motivation to lose weight …”
Hope for the young!
– How to increase the motivation of patients to take care of their health and follow the recommendations of doctors in a disciplined manner? What do you see as the way out?
– Only in raising the cultural level of the general mass of our patients, changing the value system, setting priorities correctly so that the perception of one’s health becomes the most significant in life for people. All this, in principle, could improve the state of public health and raise the level of medical care. If we recall the beginning of perestroika in the USSR, when the streets were lined with stalls selling everything from vodka and sausage to condoms, underwear and kitchen utensils. The hungry people bought all this, and were happy! If our current fellow citizens are returned at that time, few will dare to purchase in such an extravagant way. Why have these all-purpose stalls with suspicious personalities behind their counters disappeared? Because the consumer has outgrown them! The cultural level has risen! I would like to believe that this will be the case with medical care. Maybe it’s time to stop consulting with sellers in pharmacies, with esotericists and shamans that have spawned like crows? But so far our cultural level has affected only consumer goods, but, alas, not our attitude towards ourselves! I’m not talking about the fact that a significant part of the diseases due to the changed attitude towards oneself may not develop at all!
On the other hand, if according to official statistics, 20 million of our fellow citizens are below the poverty line, what do you want from them? What is their motivation to think about their health when they solve the problem of a roof over their head and food in the refrigerator. Alas, everything that I said about motivation, the system of values and other high matters concerns well-fed people, moreover, not the first generation, but the tenth!
I have many suggestions to improve the situation. But if you choose only one, I would remember my great-grandmother, who survived two world wars and one civil war. She said that the child needs to be brought up while he lies across the bed, and when he has already laid down along, it is already too late to do this! So raise your children in such a way that, as one of my colleagues used to say, everything in them is perfect: face, clothes, soul, and thoughts!