News on diabetes: interview with Prof. Emanuele Bosi

A smashing success in terms of participants marked the proceedings of the 9th ATTD (Advanced Technologies & Treatments for Diabetes) international conference held at MiCo (Fiera Milano Congressi) from 3-6 February last. Over 2,400 in all between physicians, endocrinologists, metabolism scholars, pharmacologists, technologists, engineers and researchers coming from all over the world – a number decidedly higher than the already considerable figure for the previous edition that took place last year in Paris – presented the results of the most innovative research and therapies in both the medical and surgical field, the new instrumentations and technical equipment, and the medicines, in addition to symposiums focused on training and clinicalpractice in the treatment of diabetes. A disease that in Italy strikes 5.4% of the population (3 million persons, sometimes with significant differences among the various geographical areas), with diabetes patients round the world destined to double in 2025, according to WHO (World Health Organization) estimates.

We discuss this with Prof. Emanuele Bosi, Chief Physician of General Medicine, Diabetes and Endocrine-Metabolism Division of the hospital “IRCCS Ospedale San Raffaele,” who at the Conference presented a new development of absolute importance.

MiCo: Professor, would you like to briefly illustrate it to us?

E.B.: It involves a small sensor, called Freestyle Libre, which makes it possible to constantly monitor the value of the patient’s glycaemia, without having to rely on pricking the finger many times a day as is the common practice. Designed for all Type 1, or youthful, diabetes patients who require a continuous monitoring of the concentration of glucose in the blood, it is easy to wear, is not bothersome and has a minimal visual impact. It is a product made by an American company, Abbott, which we have been using successfully for quite some time at San Raffaele. Modern technologies have appreciably improved the quality of the life of diabetes patients through theuse of ever increasingly more reliable and sophisticated microinfusers. We are dealing with portable instruments able to supply insulin on an on-going basis without the need for injections several times a day. These devices, with the commitment of the patients to utilize them properly, together with the information f the capillary blood sugar levels or of the sensors, thus allow a better control of glycaemia, that is the concentration of sugar in the blood, all day long. The most advanced models have a wireless communication system between the infuser and certain types of sensor and permit, for example, suspending the administration of insulin in the event that the sensor indicates that the glycaemia is dangerously dropping. Likewise presented at the meeting were prototypes of integrated systems that allow parents or companions to keep a close watch at a distance on children or adults with diabetes. These giant steps forward facilitate daily management and improve the quality of the life of persons with diabetes and of their families.

MiCo: Professor, what are the differences between Type1 and Type 2 diabetes, and what are the reasons for the dizzy increase in cases of diabetes?

E.B.: Type 2 diabetes, which is better known, is undergoing a pandemic expansion; it’s a planetary emergency because within a few years the number of persons so-afflicted has grown by hundreds of millions. The major cause of this increase is the conversion to Western lifestyles of entire continents (Africa) or subcontinents, such as China and India. The better conditions of life and the greater access to food have caused an excess of nutrition in populations that previously were accustomed to eating very little: this has increased obesity and consequently Type 2 diabetes. To prevent it, what is needed is a serious policy of food education and the proposal of correct lifestyle models. For young people (but also the not so young…) less TV, PlayStation and snacks, and more exercise.
The reasons are instead unknown for the increase in cases of Type 1 or insulin-dependent diabetes, of which we register a significant increase in recent years. Precisely owing to this, because at the moment the causes are unknown, the support offered by the new technologies becomes fundamental for improving the quality of the life of the persons who are afflicted by it. At San Raffaele we have been working intensely for years toward this objective with numerous researchers employed at the Diabetes Research Institute or DRI. We are searching for instruments to prevent Type 1 diabetes through the identification of individuals at risk, and we are part of a consortium of international organizations – “Trialnet” – dedicated to the study of Type1 diabetes, while our most innovative studies dedicated to the treatment include the transplant of islets of Langerhans and stem therapies.

MiCo: How does Italian diabetes research and clinical practice rate in the international context? And which are the centres of excellence of our country?

E.B.: Italian diabetes research falls into line with the most advanced research of other European countries and if we consider the traditional indicators in use in this competition – number of mentions, international financing, etc. – we occupy an upper echelon position. All this despite the fact that the funding, as is often the case, is meagre. Diabetes research proceeds successfully throughout Italy: in addition to us of San Raffaele, there are very competitive groups in Pisa, Verona, Padua, in Rome at the Biomedical Campus, and in Naples as regards the nutritional aspects.

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