JOur years and months follow one another to raise awareness among citizens about the major health problems in our society and to collect donations: colorectal cancer, Pink October for breast cancer, oral health, liver diseases, stroke, COPD, depression, etc. Chronic pathologies relentlessly overwhelm hospitals, practices, pharmacies.
This Tuesday, November 14 is an opportunity to honor World Diabetes Day, in order to encourage screening and management of this disease which affects longevity and above all degrades quality of life.
Insulin was discovered in 1921. This revolution was immediately followed by the first injections of pancreatic extracts and then insulin extracted from beef and pork pancreases. These treatments made it possible to save children suffering from coma linked to type 1 diabetes, that is to say caused by an absolute deficiency of insulin.
The considerable impact of type 2 diabetes
However, more than 9 out of 10 diabetics suffer from type 2 diabetes, known as “fatty”. This corresponds to a relative insulin deficiency, that is to say that the pancreas remains capable of producing the vital hormone, but rendered ineffective due to the reduced sensitivity of the target organs. In total, more than 3 million people were treated in France (i.e. around 5% of the population), more than 60 million in Europe.
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The situation is alarming in the United States where its prevalence is 8%, and disastrous in Mexico with 17% of the population affected. Its prevalence is even underestimated, since it is estimated that many cases of diabetes go undiagnosed. Diabetes is also a powerful marker of socio-economic inequality with increased prevalence in the most disadvantaged areas. The financial cost of diabetes has become staggering with more than 5,000 euros on average each year per patient. The impact on disability and work is considerable.
For a long time, medical students were taught that “fatty” diabetes struck middle-aged, overweight patients, although a minority of patients presented with a normal body mass index, Tofi syndrome (“Tofi syndrome”). Thin outside, fat inside “). This type 2 affects increasingly younger patients, even during adolescence. This is a new fact. Diabetes during pregnancy, gestational, is also on the rise. We suspected that it was possible to prevent it, but most of the time, the doctor waited for the blood sugar to cross the famous thresholds to provide some dietary advice and start the treatment maintained “for life” in order to delay complications.
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These complications of excess sugar in the blood are well known and concern the target organs: heart (infarction, heart failure), large vessels (arteritis with the risk of amputation), central nervous system (stroke) and peripheral (neuropathy diabetic leading to plantar perforator pain), eye (diabetic retinopathy leading to blindness), kidney (kidney failure leading to dialysis and transplantation), not to mention the increased risk of infections and poor healing after surgery. The vulnerability of the diabetic patient was particularly revealed to the public during the Covid-19 pandemic.
The weight loss solution
It has long been known that treatment for this form of diabetes relies on weight loss to restore insulin sensitivity. The care pathways therefore include physical activity, therapeutic education, Asalee cooperation protocols, dietary education, all coordinated by the diabetes centers and the sports and health centers.
Obviously, drug treatment can be added to this. The historical treatment for type 2 diabetes is metformin, the function of which is to restore insulin sensitivity. This treatment costs between 4 and 8 euros per month.
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All of these measures allowed satisfactory control of the pathology. Experience has proven that it is even possible to cure type 2 diabetes, that is to say, to return to normal blood sugar levels without medication, once the weight returns to an acceptable value.
Then, in the 2000s, the new medical doctrine arrived, based on the principle of non-exclusion, which means that diabetic patients also have the right to a “normal” life including its proportion of junk food. This turning point marks the starting point of a loss of control of the pathology, making new, more powerful molecules “necessary” in order to control blood sugar levels unbalanced by an unsuitable diet, and so-called “functional” insulin therapy, including the principle is to adapt insulin doses to food, and not the other way around as was the practice that prevailed until then.
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Thus, there have been numerous therapeutic innovations since then, with the recent craze for GLP-1 agonists (such as the famous Ozempic® also promoting satiety and thus weight loss), gliptins or gliflozins (causing urinary leakage of glucose). Obesity surgery is now part of the therapeutic arsenal. Almost all human and financial resources are allocated to curative treatment.
Remedies: unprocessed diet and activity
However, the determinants of type 2 diabetes are widely known. The “Seven Countries Study”, led by Ancel Keys in the 1950s, established in stone the responsibility of lipids in weight gain and coronary mortality. This biased study still prevails among the general public but also in medical schools. In the meantime, we have understood that it is the excess of fast sugars and particularly fructose, which is the cause of a dysfunction of our energy plants, the mitochondria, in the liver and skeletal muscles, and weight gain which lowers insulin sensitivity. This insulin resistance, or glucose intolerance, forces the body to produce more insulin, which increases weight gain. Fructose, present in equal parts with glucose in sugar, is powerfully addictive and causes hepatic fat overload, “NASH”. The metabolism of alcohol is very similar.
The “low fat” promoted by doctors has thus caused a nutritional transition, giving the food industry a free hand to flood the shelves of our supermarkets with sugars. The PURE (Prospective Urban Rural Epidemiology) study by Salim Yusuf of McMaster University, establishing the link between mortality and consumption of carbohydrates and not that of fatty acids, has not yet modified academic algorithms.
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The famous health and diet rules which help to stop insulin resistance leading to diabetes are well known. Simple messages are enough.
First, it’s about promoting an unprocessed diet, rich in fiber (and therefore vegetables), and not containing fast sugars. Complex carbohydrates are allowed, in the form of whole grains. Legumes have the triple advantage of providing fiber and protein but few carbohydrates. We can clearly see the gulf between such recommendations and current diabetogenic eating habits based on an ultra-processed diet, fast foods (McDonald’s, KFC, kebabs, sushi shops, etc.), sodas, fruit juices, “cereals” for breakfast. lunch and prepared meals offered by the industry.
Two, at least 30 minutes of active walking daily. Here again, the contrast is striking with the physical inactivity which dominates current society, symbolized by the electric scooter, the consequence of which is that many adolescents walk less than 10 minutes per day. In 1971, a middle school student ran 800 meters in 3 minutes; 4 minutes were necessary in 2011. Such a 25% drop in physical fitness is not without consequences on the incidence of obesity and diabetes.
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Taking into account all of these data, the effectiveness of prevention at zero cost, the current health policy, based not on the cure of the pathology but on the control of its consequences and comorbidities (high blood pressure , dyslipidemia, etc.) with the help of expensive molecules, is nonsense, a dead end. Alongside access to healthcare, access to healthy food should be promoted to the detriment of junk food through taxation. Walking, bicycles and public transport must massively replace individual motorized transport in urban areas, which would also have the merit of reducing atmospheric pollution which is the cause of 40,000 deaths per year in France. Prevention, upstream of diseases, improves not only human health but also that of the planet.
*By Pierre Vladimir Ennezat, cardiologist, CHU Henri-Mondor AP-HP, Créteil and Guillaume Sarre, sports doctor, Grenoble