These days, a person dies from diabetes every seven seconds. My name's Andreas Vigelso and I'm a scientist at the Centre for Healthy Ageing at the University of Copenhagen. My field of research is on how age, obesity, and inactive lifestyle may lead to type 2 diabetes. The purpose of this lecture is to present to you with the challenge that we are facing with diabetes, that is one of the fastest growing diseases in the world. I have described the physiology and the complications of the disease. I will also focus on the prevention and the treatment. Worldwide, almost 400 million individuals have diabetes. This means that 1 in 12 people in the world today have the disease. This number is expected to increase by almost 200 million to about 592 million in 2035, that is one new case every third second. Today, we are also challenged by the fact that one in two people with diabetes actually do not know that they have it. These numbers make a strong case for devoting more resources to finding a cure. Over all, there are several forms of diabetes, but now, I will focus on type 1 and type 2 diabetes because the remaining types of diabetes are not that common. But before I go into the details of diabetes, I will give you a brief Introduction to the physiology behind the disease. First of all, remember that our food is built of the three basic nutrients, that is carbohydrates, fat, and proteins. When we eat our food, the carbohydrates are broken down in our digestive system to glucose. Glucose is an important fuel in our body. In a normal process, the glucose travels from the intestine to our blood, and then to all our cells. All cells need glucose to produce energy, but skeletal muscle is quantitatively the most important tissue as it removes up to 80% of the glucose from our diet. However, glucose can't enter the muscle cells without the help of insulin, that is a hormone that is produced in the pancreas. Insulin is released when it senses glucose in the blood and it works as a key that opens the door to the muscle cells, so that glucose can enter. As I mentioned, there are two forms of diabetes, type 1 and type 2. In type 1 diabetes, the pancreas has lost the ability to produce insulin and therefore, we cannot unlock the door to let the glucose into the cells. In type 2 diabetes however, the opposite is the case. We produce insulin, but the door to the muscle cell does not open when insulin tries to unlock it. The muscle has become resistant to insulin. We call this state insulin resistance, low insulin sensitivity, or pre-diabetes. Let's illustrate this is another way. When a healthy person eats a meal, the blood glucose will begin to rise rapidly. Then the insulin will help your cells to remove the glucose and the glucose level will fall to a normal level and you'll become hungry again. But in a person with insulin resistance, the blood glucose goes up and only falls slowly. And in a patient with diabetes, the blood glucose rises and stays at a high level for a long time. In the following, I will concentrate on insulin resistance and type 2 diabetes because it covers more than 80% of the diabetes cases. Moreover in the future, the increase in individuals with diabetes will primarily be in type 2 diabetes and therefore, it represents a great challenge to the modern health care systems. The disease used to be mostly diagnosed when you get older, but it's now more and more often seen in young individuals and even teenagers may get it. Once you have insulin resistance, your body will start producing more insulin in order to compensate for the inability of insulin to unlock the doors in the muscle cells. In other words, you are maintaining a normal insulin sensitivity only because you overproduce insulin. Now, the next problem appears. The insulin producing pancreas sometimes cannot keep up with this overproduction and will start to fail and almost stop producing insulin and the blood glucose will then increase further and type 2 diabetes is a reality. Therefore, the function of your pancreas is important for whether insulin resistance turns into type 2 diabetes or you stay insulin resistant. Let's return to the high blood glucose. Having this constant high level of glucose in the blood can do a lot of damage to your body. You can actually compare this to sending the inside of your body into a constant sand storm. This damages the small blood vessels in for example, your eyes, in your kidneys or may damage your nerves. Therefore, the most typical complications for long time high glucose includes blindness, kidney failure, and amputations. So what can we do to prevent these diseases? Insulin resistance and type 2 diabetes is partly due to genes. In fact, if both your parents have type 2 diabetes, there is 80% risk that you'll get it too. But it's more important to note that type 2 diabetes also is highly related to obesity and an inactive lifestyle. While it's of course not possible to do anything about your genes, you can always change your lifestyle. And most importantly, this change should take place as early as possible. In the future, we must have a special focus on identifying those individuals who are at high risk of getting diabetes, and those who have signs of insulin resistance as early as possible. To illustrate the impact of changed lifestyle at an early stage, scientists from Finland identified a large group of persons with insulin resistance. These persons were then randomized to a lifestyle intervention that aimed at weight-loss and increasing their physical activity, or they were assigned to a control group that received only general lifestyle information. These groups were then followed for nine years and they found that for every five persons treated with intensive lifestyle intervention, one case of type two diabetes was prevented. This is in fact better than most medications can do in most diseases. This is just one example of what is possible by changing lifestyle. The problem is of course that it's very difficult to make people adapt a new lifestyle. This was an example of insulin resistance, but is it too late if you have type 2 diabetes? No, it's never too late. Even patients with full blown type 2 diabetes can benefit from increasing their daily activity level and by losing weight. This has been shown repeatedly. This is illustrated in a study that included young healthy men, healthy older men and older patients with type 2 diabetes. Of course, the young men had a better insulin sensitivity than the healthy older men, whom again was higher than the patient with diabetes. Then they all trained for ten weeks, and they all improved their insulin sensitivity. Note that the patients with type 2 diabetes almost increased to the same level as an untrained, healthy person at the same age. Therefore, even ten weeks of training is very beneficial to reverse type 2 diabetes. Therefore, training and lifestyle intervention should focus on increasing the daily activity level and should aim to find types of training with a high compliance. Glucose lowering medication is a huge global market. The sales of anti diabetic medication are worldwide, the second largest selling class of drugs. Actually, only drugs used in cancer treatment is selling more. In 2014, the market was more than 60 billion U.S. dollars. Therefore, there is a massive interest in the pharmaceutical industry to make new drugs. This is not only drugs that could cure the disease, but also drugs that could prevent insulin resistance from turning into diabetes because this group is at least the same size as the normal people that are actually suffering from type 2 diabetes. To sum up my main points, diabetes is a worldwide problem on the rise, with 1 in 12 having the disease, and half of them don't know they have it. Type 2 diabetes is the result of years of insulin resistance where primarily, your muscles don't respond to insulin. Type 2 diabetes is highly related to genes, but is also highly related to obesity and inactivity. The primary prevention of type 2 diabetes should be food changing lifestyle, because a changed lifestyle is the best medicine. The primary challenges are fast identification of individuals with diabetes and insulin resistance, and to implement changes in lifestyle that actually work. And before you go, give this fact a thought. During this lecture, more than 50 persons have died from diabetes, and there may be more than 100 new cases. Thank you for watching.
