A ‘paradigm shift’ in the diagnosis of diabetes: study

Updated 02 March 2018
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A ‘paradigm shift’ in the diagnosis of diabetes: study

PARIS: Scientists on Friday unveiled a revised classification for diabetes, one they said could lead to better treatments and help doctors more accurately predict life-threatening complications from the disease.
There are five distinct types of diabetes that can occur in adulthood, rather than the two currently recognized, they reported in The Lancet Diabetes & Endocrinology, a leading medical journal.
The findings are consistent with the growing trend toward “precision medicine,” which takes into account differences between individuals in managing disease.
In the same way that a patient requiring a transfusion must receive the right blood type, diabetes sub-types need different treatments, the study suggested.
Similarly, scientists have also identified distinct kinds of microbiome — the bacterial ecosystem in our digestive tract — that can react differently to the same medication, rendering it more or less effective.
“This is the first step toward personalized treatment of diabetes,” said senior author Leif Groop, an endocrinologist at Lund University in Sweden, adding that the new classification is a “paradigm shift” in how the disease is viewed.
People with diabetes have excessively high blood glucose, or blood sugar, which comes from food.
Some 420 million people around the world today suffer from diabetes, with the number expected to rise to 629 million by 2045, according to the International Diabetes Federation.
Currently, the disease is divided into two sub-types.
With type-1 — generally diagnosed in childhood and accounting for about 10 percent of cases — the body simply doesn’t make insulin, a hormone that helps regulate blood sugar levels.
For type-2, the body makes some insulin but not enough, which means glucose stays in the blood.
This form of the disease correlates highly with obesity and can, over time, lead to blindness, kidney damage, and heart disease or stroke. Acute cases may also require limb amputations.
It has long been known that type-2 diabetes is highly variable, but classification has remained unchanged for decades.
For the study, researchers monitored 13,270 newly diagnosed diabetes patients ranging in age from 18 to 97.
By isolating measurements of insulin resistence, insulin secretion, blood sugar levels, age, and the onset of illness, they distinguished five distinct clusters of the disease — three serious and two milder forms.
Among the severe types, a group of patients with insulin resistence — in which cells are unable to use insulin effectively — was at far higher risk of kidney disease.
“This group has the most to gain from the new diagnostics as they are the ones who are currently most incorrectly treated,” Groop said.
Another group facing serious complications was composed of relatively young, insulin-deficient patients.
The third “severe” group were people with auto-immune diabetes corresponding to the original “type-1” diagnosis.
The two other groups have milder types of the disease including one, which includes about 40 percent of the patients, beset with a form of diabetes related to advanced age.
“This will enable earlier treatment to prevent complications in patients who are most at risk of being affected,” said lead author Emma Ahlqvist, an associate professor at Lund University.
The results were checked against three other studies from Sweden and Finland.
“The outcome exceeded our expectations,” said Groop.
The researchers plan to launch similar studies in China and India.
 


Blood donation in the Middle East: The gift of life that is easy to give

Updated 14 June 2019
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Blood donation in the Middle East: The gift of life that is easy to give

  • World Blood Donor Day observed on June 14 to raise awareness of the life-saving importance of blood donation
  • Regular, voluntary donors are vital worldwide for adequate supply of safe blood and blood products

DUBAI: Blood donations in the Middle East have been described as “the gift of life” as the region struggles to cope with the demands posed by conflicts, humanitarian emergencies and the medical needs of a growing population.

International health experts have called on regular donors to step forward to mark World Blood Donor Day on June 14.

This year’s campaign focuses on blood donation and universal access to safe blood transfusion, and according to the World Health Organization (WHO), more donors are needed “to step forward to give the gift of life.”

Those who benefit most from blood donations include people suffering from thalassaemia, a blood disorder that affects hemoglobin and the red blood cell count, as well as victims of road accidents, cancer patients and sickle-cell disease patients.

Experts say while the Gulf Cooperation Council (GCC) countries have launched numerous initiatives to raise awareness of the lifesaving importance of blood donation, there is an increasing need across a wider region for regular donors.

“Many countries in the region face challenges in making sufficient blood available while also ensuring its quality and safety, especially during humanitarian emergencies and conflicts,” Dr. Ahmed Al-Mandhari, WHO regional director for the Eastern Mediterranean, told Arab News.

The GCC countries say they collect in total more than 10 whole blood donations per 1,000 population per year, or about 1 percent, Al-Mandhari said.

According to WHO, blood donations by 1 to 3 percent of the population are sufficient to meet a country’s needs. Even so, achieving self-sufficiency is a daunting challenge for many countries.

Al-Mandhari said that more than 90 percent of the blood is collected from voluntary, unpaid donors, aged from 18 to 44, with an increasing proportion of repeat donors. What is more, blood demand is unpredictable and even differs with each blood type. “For example O- blood can be given to patients with all blood types. But AB+ can only be given to patients with AB+,” he said.

Then there is the issue of short shelf life.

“To be ready to help patients in all hospitals, countries aim to stock usually six days’ worth of each blood type at all times,” Al-Mandhari said. “Since blood has a short shelf life — a 42-day window — and cannot be stockpiled, blood banks are forced to depend on donors to help maintain stocks.”

WHO’s most recent report on blood safety and availability points to “gaps in the key elements of national blood systems” in the Middle East.

A Saudi donor flashes the v-sign for victory as he gives blood in Jeddah. The Kingdom has one of the highest rates of repeat donors in the region. (AFP )

While GCC countries have taken steps to keep stocks at optimum levels, other countries in the Middle East are lagging behind international standards. The WHO report shows wide variations in annual blood-donation rates among countries, ranging from 0.7 per 1,000 population in Yemen to 29 per 1,000 population in Lebanon.

Al-Mandhari laid out the solution in a few easy steps: “Governments need to provide adequate resources, and put in place systems and infrastructure to increase the collection of blood from voluntary, regular unpaid blood donors, provide quality donor care, promote and implement appropriate clinical use of blood; and set up systems for oversight and surveillance across the blood-transfusion supply chain.”

On the positive side, Saudi Arabia recorded a rate of 13.8 per 1,000 population, with a healthy spread across all age groups. The country also has one of the highest rates of repeat donors (91 percent) in the region. According to the WHO report, the proportion of repeat, voluntary, non-remunerated blood donation in the Kingdom is 65.3 percent, which “will keep the prevalence of transfusion-transmissible infections among blood donors at much lower levels than in the general population.”

In recent years, Saudi health officials have introduced a number of measures to ensure adequate stocks in blood banks, including those run by the Ministry of Health and dedicated centers. These include a large facility at King Fahad Medical City (KFMC) and the country’s Central Blood Bank.

In the Kingdom, to be eligible for blood donation, donors must be aged over 17, weigh more than 50 kg, and have passed a brief medical examination. The health ministry recently launched Wateen, an app designed to ease blood-donation procedures and help ensure facilities across the Kingdom have adequate quantities of blood by 2020.

KFMC officials say that every day at least 2,000 units of blood components are needed to sustain a minimum supply for patients at the facility and other governmental and non-governmental hospitals in Riyadh. Donated blood components are essential for the management of cases involving cancer, sickle-cell disease, organ transplant, surgery, childbirth and trauma, to name just a few.

The situation is not very different in the other GCC countries, which also need more donors.

In the UAE, Dubai Blood Donation Center, which accounts for roughly half of the total blood collected in the emirates, frequently highlights the urgent need for donors. In 2018 alone, it ran 635 blood-donation campaigns, which resulted in 63,735 donors and a collection of 50,456 blood units.

While all blood types are needed, negative blood types are in greater demand due to their rarity. “There is a continuous demand for all blood types as blood lasts for only 42 days. So donors are always needed to come forward to replenish these stocks,” Dr. Mai Raouf, director of Dubai Blood Donation Center, said.

“People can donate blood every eight weeks, with each donation potentially saving up to three lives,” she told Arab News. 

Given that transfusion of blood and blood products save millions of lives every year, and the fact that “regular donors are the safest group of donors,” the importance of encouraging people to return to donate blood, rather than be one-time donors, can hardly be overemphasized, experts say.

“Without a system based on voluntary, unpaid blood donation, particularly regular voluntary donation, no country can provide sufficient blood for all patients who require transfusion,” Al-Mandhari said.

“WHO is calling on all countries in the region to celebrate and thank individuals who donate blood — and to encourage those who have not yet donated blood to start donating,” he said.