Lancet calls for attention to diagnoses of type 1 diabetes – 06/02/2023 – Health

An editorial in The Lancet Regional Health Europe says there is a need to improve care for type 1 diabetes, especially in adults. The condition in many cases is associated with children, but studies have already shown that there is a high prevalence of the disorder also in older people around the world.

Type 1 diabetes is characterized by a deficiency in the production of insulin in the face of a process in which “the immune system fights the cells of the pancreas that produce insulin”, explains endocrinologist André Vianna, coordinator of the society’s diabetes education and campaign department. Brazilian Society of Diabetes (SBD).

In contrast, type 2 is one in which the body cannot use the insulin produced by the body. “The person even produces insulin, but it does not work properly, because there is resistance”, continues Vianna.

The number of cases of type 1 diabetes is less. According to the Ministry of Health, of the total number of patients with diabetes in Brazil, 5% to 10% suffer from this type. And in many cases type 1 diabetes is associated with children and adolescents – in the past it was even called juvenile diabetes.

That is why, according to the authors of The Lancet editorial, actions associated with the disease, such as diagnosis and treatment, are mainly aimed at younger people. And that’s where the problem lies, they say.

An article published in October 2022, for example, concluded that, in 2021, 8.4 million people were living with type 1 diabetes around the world. Of these, 64% were between 20 and 59 years old, while 19% were over 60 years old. Children and adolescents accounted for 18% of the total.

But, as there is the idea that the disease is more common in young people, the chance of an adult being misdiagnosed is high. “It is estimated that up to 40% of adults over 30 years of age with type 1 diabetes have been misdiagnosed with type 2 diabetes,” reports the Lancet editorial, referring to research published in October 2021.

The life expectancy of someone with type 1 diabetes is lower compared to type 2 diabetes. The first typology takes about eight years off the patient’s life, while the second reduces it by three years. This is also why the editorial advocates better clinical attention to the problem, in addition to more research on the subject.

“The global agenda, which is predominantly focused on the prevention and treatment of type 2 diabetes in adults, must be expanded to include type 1 diabetes, which has its own challenges, most notably its diagnosis and subsequent appropriate treatment,” the authors write. .

The point is reiterated by Levimar Araújo, president of the diabetes mellitus department at Sbem (Brazilian Society of Endocrinology and Metabolism). “We have a percentage [do diabetes tipo 1] that appears in adults, and this is confused.”

Conducting tests can prevent this type of problem. One of them is the autoantibody test, “which can demonstrate that the patient has the adult type 1 and not the 2”, says Araújo. There is another exam: the measurement of C-peptide. Through it, it is possible to observe the amount of insulin still produced by the person. If the amount is low, it is an indication that it is type 1 diabetes.

However, there are still problems in accessing these procedures. “They are slightly more expensive tests”, summarizes Vianna.

With the wrong diagnosis, the treatment also does not end up being adequate. While in type 2 diabetes some medications contribute to the patient’s condition, type 1 necessarily requires insulin replacement.

In some cases, the remedies may even appear to work for a patient with type 1 diabetes, but the effect is fleeting. “In the beginning, he will have even adequate control, but, over time, he will exhaust these cells [de produção da insulina] even faster”, says Araújo.

One explanation for the high incidence of type 1 diabetes in adults may have to do with the increased life expectancy of patients.

According to a report published in 2022 by the International Diabetes Federation (IDF), “Due to constant improvements in medical care and technology, there are now millions of adults living with Type 1 diabetes who were diagnosed as children. “.

The IDF document, however, draws attention to another fact: the new diagnoses of the disease in adults. Estimates indicate that, of all new cases detected in 2022, 62% were in people over 20 years old. “Onset of type 1 diabetes in adults is not uncommon,” summarize the report’s authors.

Diabetes in Brazil

The same IDF survey estimated that Brazil had more than 588,000 people with type 1 diabetes in 2022. Of these, 68% were adults aged between 20 and 59 years. Only the United States and India had a higher absolute number of diagnoses for the disorder.

In total cases, which includes type 2 diabetes, it is estimated that more than 15 million people lived with the disease in Brazil in 2021, indicates another IDF report. Calculations indicate that, in 2045, this number should rise to around 23 million.