Friday, February 15, 2008

TYPE II DIABETES: UNEXPECTED RESULTS


Great debate and controversy originate these days, the results of some scientific studies conducted on a large scale, in type II diabetics. I) On one side: "Effect of a Multifactoral Intervention on Mortality in Type 2 Diabetes." Danish Clinical Trials (last issue of NEJM), in which a group of Type II diabetics (out of 160 patients), followed by 14.3 years, had fewer cardiovascular events and deaths when glucose levels remained close to normal healthy people, used intensively multiple drug and continued to change behavioral patterns, following different ways from groups that were not adhered to these regulations II) On the other hand, an American study (proposed by The Heart, Lung and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases), conducted in 10000 Type II diabetics, for 13 years, in which contrary to the results of the work mentioned above, type II diabetics who had blood glucose levels close to those of healthy people, exhibited more cardiovascular deaths than that people that followed rules and controls more lax. To surprise of many of us the tracking of these patients has been suspended (!we demand an explanation).

In spite of the output in the first study, we think hypothetically that in chronic diabetic patients, although the high level of glucose, conditioned known chronic complications, at the same time conditions significant changes in the total body homeostasis of diabetics. It is as if the body is to accommodate to a new level of glucose to function relatively better. This means that 120 or 130 mg/100 ml glucose, would be better, offset by the adverse effects of a lack of insulin or the difficulty of proper utilization of glucose. Trying to equalize the levels of glucose in normal people, is a contradiction because this approach, did not change their homeostasis. The approach of treating type II diabetics, should vary. The issue is not restoring only the sugar level to normal, but to match altered homeostasis of diabetics with appropriate levels of sugar (as custom), using self transplantation of stem cells and releases insulin guided by appropriate answers of the diabetics themselves.
DIABETES TIPO II: RESULTADOS IMPREVISTOS
Gran debate y controversia originan estos días, los resultados de ciertos estudios cientificos realizados a gran escala, en diabéticos de tipo II. I) De un lado :”Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes”. Danish Clinical Trials (último numero de NEJM), en el que un grupo de diabeticos de tipo II (de un total de 160 pacientes), tratados y seguidos por 14,3 años, presentaron menos eventos y muertes cardiovasculares cuando mantuvieron niveles de glucosa cercanos a los valores normales de personas sanas, emplearon intensivamente múltiples drogas y siguieron pautas de modificación conductual, distintas a los grupos que no se adhirieron a estas reglas II) De otro lado, un estudio americano (propuesto por The Heart, Lung and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases), realizado en 10 000 diabéticos de tipo II, durante 13 años, en los que contrariamente a los resultados del trabajo mencionado anteriormente, los diabéticos de tipo II, que tuvieron niveles de glucosa cercanos a los de personas normales, exhibieron mas muertes cardiovasculares que los que siguieron reglas y controles mas laxos. Para sorpresa de muchos el seguimiento de estos últimos pacientes, ha sido suspendido (!exijo una explicación¡).
Nosotros pensamos hipotéticamente, que en pacientes diabéticos crónicos, aunque el nivel elevado de glucosa, condiciona complicaciones crónicas conocidas, condiciona al mismo tiempo, cambios importantes en la homeostasis total del organismo del diabético. Es como si el organismo se acomodase a un nuevo nivel de glucosa para funcionar relativamente mejor. Es decir que 120 o, 130 mg/100 ml de glucosa, serian lo mejor .por contrarrestar los efectos nocivos de la falta de insulina o las dificultades para un adecuado aprovechamiento de la glucosa. Tratar de igualar los niveles de glucosa de las personas normales, es un contrasentido porque en ellos sus homeostasis no variaron. El enfoque del tratamiento de los diabéticos de tipo II, debe variar. El asunto no es restaurar el nivel de azúcar a lo normal, sino concordar las homeostasis alteradas de los diabéticos con apropiados niveles de azúcar (en forma personalizada), empleando autotrasplantes de células madre y liberaciones de insulina –sin altibajos- guiándose por respuestas adecuadas de los propios diabéticos.

No comments: