#MSPEndocrinología l Conéctate ahora y descubre cómo la investigación médica está revolucionando el tratamiento de la diabetes tipo 2. El Dr. Dominic Reeds, experto en medicina y nutrición de la Universidad de Washington, comparte datos sorprendentes sobre cómo la ciencia está mejorando el control de la enfermedad y transformando vidas
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00:00En MSP convertimos la ciencia en noticia. Con más de 20 años hemos sido líderes en medicina,
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00:47Bienvenidos a este nuevo espacio de la revista Medicina y Salud Pública, revista que lleva
00:53por más de 20 años visibilizando temas de ciencia, salud y medicina. Mi nombre es Laura Guillo y
00:59el día de hoy hablaremos sobre la diabetes en el marco del foro anual de investigación y educación de recinto
01:06de ciencias médicas de Puerto Rico. So let me switch to English. Today we are honored to speak with a
01:12distinguished guest, Dr. Dominic Reitz, that will help us break down what diabetes is, what recent
01:19advancements are making a difference, and what the future might hold for treatment and care.
01:24Dr. Reitz is a professor of medicine in the division of geriatrics and nutritional science
01:30at Washington University School of Medicine. And he also serves as the director of the Burns
01:37Jewish Nutrition Support Service. So Dr. Reitz, thank you for joining us today.
01:42My pleasure.
01:42It's a pleasure for us as well. Doctor, I would like to begin by providing a bit of context on the topic.
01:51Can you explain in simple terms what type 2 diabetes is?
01:56Absolutely. So type 2 diabetes is an incredibly common disease affecting nearly one in three adults.
02:03And the main sign of diabetes from a blood work side of things is that the level of sugar in
02:12the blood is too high. And when the sugar level in the blood gets too high it causes damage to a lot
02:18of organs. It can cause, it's the leading cause of blindness, it's a leading cause of kidney failure,
02:23and it's a leading cause of heart attacks.
02:25Perfect. And are there any common symptoms that people should be aware of?
02:32Absolutely. So one of the more common symptoms are people start becoming very thirsty,
02:38they start having to go to the bathroom a lot more frequently than they used to
02:42and normally have to. And this is because the sugar level in the blood gets high
02:47and it comes out in the urine and it pulls lots of fluid with it. So people often get very thirsty.
02:53The other thing that people will notice sometimes is that they will suddenly start losing weight,
02:57even though they don't want to. They will maybe lose 10, 20 pounds.
03:01Often the vision will be blurry and you're not able to fix it with glasses. And the reason for this is
03:08that the sugar gets into the eyes and makes them swell just a little bit so you can't fix it. And so
03:15going to the bathroom a lot, being very thirsty, suddenly losing weight, having blurred vision,
03:21those are the main symptoms. The big problem with diabetes is that people don't know they have it.
03:26So we call it a silent killer. You can't tell if your sugar is high most of the time,
03:32but those are the more common symptoms that we see. It's so important to know those symptoms. So
03:38we can, if we notice, we can go to a specialist, right? Today, you will lead a conference at the
03:45University of Puerto Rico about the role of research in improving health of diabetes, of type 2 diabetes.
03:53Tell us more details about what your conference is going to be, doctor, please.
03:58Absolutely. So when we think of type 2 diabetes, what we normally think of are people who are
04:05overweight, who live in Western countries, who are often wealthy, and they're not physically active.
04:13And what I'm going to show today is that most people who have type 2 diabetes live in low and
04:19middle income countries. They are not obese or overweight. And the cause of diabetes is very
04:27different from one population to another population. And so the only way we know that these populations
04:34are different is by doing some very basic research. And this research involves using nurses, community
04:40health workers, pharmacists, nurses, physicians. It's a big team that has to do this. And the reason that
04:48we need to find out what the different causes are of diabetes is that gives us some ideas on how
04:53we can prevent it. And it also tells us how we should be treating it. One of the bigger advances that's
05:02occurred in the last few years with type 2 diabetes is treating people who are overweight with type 2 diabetes.
05:10With these drugs, GLP-1 drugs that you see advertised on TV all the time, drugs like Victoza, Ozempic,
05:18we see them on commercials all the time. And these drugs are very effective at getting people to lose
05:24weight. They're very effective at treating and preventing type 2 diabetes. And they clearly reduce the risk of
05:32heart damage and kidney damage. And so these drugs are particularly helpful because they not only improve the
05:39blood sugar, but they reduce all of the problems that diabetes causes in the body. So heart failure
05:46and kidney failure. And it also treats the underlying cause, which is people being slightly overweight or
05:53obese. That said, when we look at people with type 2 diabetes, we always think of people who are obese as
06:00having, being more likely to get type 2 diabetes. And that's true. But 80% of people who are obese
06:09never develop type 2 diabetes. And yet when you look at type 2 diabetes in America, most of the people
06:16with type 2 diabetes are slightly overweight to obese. And so the drugs which are being used to treat type
06:232 diabetes now, the other class of drugs are the so-called Flozins or SGLT2 inhibitors. And what they do
06:31is they make people pee out extra sugar. And by peeing out that sugar, it reduces the amount of fluid in
06:38the body. It reduces the amount of sugar in the body. And these drugs also seem to reduce the risk of
06:43kidney damage and heart failure. And they seem to reduce people's body weight. So we have two very
06:49strong drugs in our armamentarium that could improve cardiovascular risk and treat diabetes very effectively.
06:57Talking about those advances, what recent advances do you consider most promising in the diagnosis of type 2 diabetes, doctor?
07:11So screening for type 2 diabetes is very important. Everybody over the age of 45 should be screened for type 2 diabetes.
07:21This is a very simple test to do. And this can either be done by pricking a finger or by taking a small
07:28amount of blood. And what we look at is something called an HbA1c. And what this represents is the
07:36amount of sugar stuck to the red blood cells that circulate in our body. The higher the blood sugar,
07:42the more sugar gets stuck to these red blood cells and the higher this HbA1c number gets.
07:47If your blood sugars are lower, then the A1c number is lower. And so an A1c in Latino populations and white
07:58populations and in African American populations is very effective at diagnosing type 2 diabetes. Or it's also
08:08important at identifying people who are higher risk of getting type 2 diabetes, what we call
08:16pre-diabetes. So this A1c number, if it is six and a half or higher, it means you have type 2 diabetes. And
08:24that's a good to know because then you can be treated and you can be stopped from having all of the
08:29complications. If your A1c number is between 5.8 and 6.5, this means you have pre-diabetes and you have a much
08:38higher risk of going on to develop type 2 diabetes. This is also a very important thing to know because
08:45we know from the diabetes prevention study, which was done more than 40 years ago, that losing even
08:52small amounts of weight, as little as six to eight pounds, and exercising three or more days a week for
08:5820 minutes a day or more, can reduce your risk of getting type 2 diabetes by 60%, which is better
09:05than most medications. And so with simple lifestyle changes, some activity, some weight loss, and we're
09:13not talking about losing 100 pounds, we're talking about losing six pounds, you can reduce your risk of
09:19getting type 2 diabetes by 50%. There is no medication that even comes close to that. Now, this A1c number
09:27is good in some populations, but what we found is in African populations, it's not very good at all. It
09:34misses about 70% of people with type 2 diabetes. And so this just goes to show that we need to have
09:41clinical research in these areas, looking at particular populations, because the causes of type 2
09:48diabetes are different. Therefore, the management and prevention of type 2 diabetes is different,
09:54and the diagnosis may even be different. How does untreated or let's say poorly managed
10:02diabetes affect the body in the long term? So in the long term, type 2 diabetes is incredibly bad for
10:10you. Your likelihood of having a heart attack if you have type 2 diabetes is the same as if you've
10:17already had a heart attack. So you have a nearly 30% chance over the next 10 years of having a heart
10:24attack if you have type 2 diabetes and is badly controlled. With the levels of sugar in the blood
10:32being too high, it also causes kidney damage. And so one of the leading causes of kidney failure and
10:38needing to go on dialysis is type 2 diabetes. And again, this is something that is almost preventable
10:45by putting people on the right medications and controlling the diabetes. So people get very
10:51worried that they have type 2 diabetes. But this is a very treatable disease. This is a disease you
10:56want to know that you have. The other big problem that we see with type 2 diabetes, the two big ones,
11:03are we see people going blind because it causes damage to the small blood vessels in the back of the eye.
11:10And when the eye doesn't get enough blood, it grows new blood vessels. And these new blood vessels are
11:16very fragile. They tend to break. They tend to bleed. And this causes blindness. Again, this is something
11:23that if you see an ophthalmologist and they look in the back of your eye, they can see what's going on.
11:28They can treat the disease with a number of different interventions and prevent diabetes-related blindness.
11:36And the other system that gets badly affected by type 2 diabetes is the nervous system. And so what
11:42people get is they get numbness in their feet and then it can slowly but surely it works its way up.
11:48And so the problem with this is that if you cut your foot, normally you notice I have a cut in my foot
11:55and you treat it. But if you have type 2 diabetes, you may not feel it because your immune system is not
12:01working as well from the diabetes or the blood supply is not so good from the diabetes, those infections
12:07can become very, very severe to the point that treating them with antibiotics doesn't work and you end up
12:13needing to actually amputate the limbs. You may have to amputate part of the foot or even most of the leg.
12:21And so diabetes is one of the leading causes of amputation. So even though you wouldn't have thought it,
12:26type 2 diabetes just having a little bit too much sugar in your bloodstream is bad for almost every
12:32organ system. Doctor, I would like to know how is technology or maybe artificial intelligence
12:39helping or improving the research about type 2 diabetes? Absolutely. So artificial intelligence
12:47has turned out to be something that's extremely helpful with working with people with type 2 diabetes
12:53and it's done this in many ways. So one way that it can do this is it can look at very large genetic
13:00studies and it can help us identify different genes and different mutations or variations within the
13:07chromosomes that may be associated with having a higher risk of type 2 diabetes. And you may go,
13:13okay, so now I know I have this gene. But by knowing that gene, you have an idea as to which pathway
13:19may be dysfunctional with type 2 diabetes and which may be leading you to develop type 2 diabetes. So
13:27we've already identified some mutations which cause the pancreas to just not make as much insulin as it
13:34should and this goes on to lead to type 2 diabetes. The other enormous change that's happened in the last
13:41four or five years with type 2 diabetes is the use of what we call closed loop systems. And so normally when
13:47we think of type 2 diabetes we're thinking of people pricking their finger and checking their blood
13:52sugar all the time and this being very painful. There are some technologies now which are extremely
14:00advanced with very small devices that you literally just stick on the skin and they have a little
14:06sambler on them and they can tell you your blood sugar every single minute of every single day for weeks
14:11at a time. And what you can do is you can connect those just using bluetooth just like your cell phone
14:18to an insulin pump. And the insulin pump will sit somewhere in your body and it will inject a very
14:24small amount of insulin typically into the fat around your belly or around your arms or around your thighs.
14:30And by looking at what the blood sugar is and the direction that the blood sugar is changing
14:36and if somebody who's just eaten the artificial intelligence slowly but surely learns
14:44what happens to somebody's blood sugar when they do something.
14:48And so it will know first thing in the morning the blood sugar is higher so I need to give more insulin.
14:54In the afternoon this person often goes for a run their blood sugar goes down so I give less insulin.
15:00And so what you see both in the hospital and in people living at home is that these so-called closed
15:07loop systems using artificial intelligence where the machine slowly but surely learns how your blood
15:14sugar is getting regulated can control your diabetes extremely well. So just by hooking up these devices
15:22and by allowing the devices to learn what your body is doing, artificial intelligence is really
15:29changing how we manage type 2 diabetes. We try to avoid using insulin in people with type 2 diabetes when
15:36we can because the insulin will often make people gain weight. But when you get to the point where you
15:41need to give insulin or if you have somebody with type 1 diabetes where they don't make any insulin and so
15:46they have to have it given to them. The artificial intelligence now that's built into these closed loop systems
15:53and it's a closed loop because the pump talks to a sensor and the person really doesn't have to do much of
15:58anything. They are very very effective at controlling people's blood sugars and preventing low blood sugars.
16:04Dr. Ritz, you are a researcher so I would like to know what challenges do researchers face when conducting
16:13clinical studies on new therapies or new interventions for patients with type 2 diabetes?
16:21Dr. Sure, so type 2 diabetes is a disease which in my opinion has been revolutionized by clinical research
16:29and these consist of complete teams of researchers with research nurses who are good at getting IVs in people,
16:37who are good at taking samples, who know when to record things, pharmacists who can adjust the dosing of the drugs when we're treating people in the hospital or when we're treating them
16:47Dr. In a clinical research unit and both physicians and PhD researchers who can perform very complex studies looking at why people are getting type 2 diabetes and so one of the
17:02big advances that we've been working on with our group in St. Louis is trying to determine why some people who are overweight or obese
17:10never develop type 2 diabetes, they don't get high blood pressure, they don't get high cholesterol, they don't get anything at all
17:18and why some people who if they gain even a few pounds will become very very diabetic
17:25and one of the interesting clinical signs we found is that if you build up fat in your liver
17:33from the type 2 diabetes then you are much more likely to develop to have type 2 diabetes whereas if you are overweight
17:43and you don't have fat in your liver you are much less likely to have type 2 diabetes so there seems to be something really unique
17:50about building up fat in the liver that tells us this person is going to have diabetes or not
17:56number one and number two most interventions that reduce fat in the liver will also improve the body's
18:04ability to respond to insulin and so people become less diabetic so what the clinical research in diabetes
18:12has done is it's given us very good understandings of some of the causes of type 2 diabetes in different
18:19populations and i'll be talking today about why type 2 diabetes in puerto rico and in the united states is
18:28different from type 2 diabetes in africa and it's different from type 2 diabetes in india and how
18:35clinical research has really allowed us to find out what these differences are which has big implications for
18:42treatment the other advances that we've had are basic science advances so we do these studies in humans
18:50and we can look at the genetics we can look at the signaling pathways and that gives our colleagues
18:55who are working with animals or working with cell studies ideas of generating new drugs to treat type 2
19:02diabetes so one of the drugs for example that is now not used very often a drug called exanatide
19:09actually comes from the mouth of the healer monster so a naturally occurring compound and somebody took a look
19:15at it and went wow this looks like one of the hormones in the bloodstream let's see if we give this if
19:21it improves type 2 diabetes and it did and so this was from very basic research on the other end of things
19:28we know that weight loss and exercise and changes in diet in many cases can improve type 2 diabetes
19:37but getting people to do that is very very difficult and it doesn't mean that people are bad people or that
19:44they're lazy it's just it's very hard to change the habits of a lifetime and so if somebody said you
19:50have to change what you're eating and how you're getting to work and how often you exercise and you
19:56have all of these other things in your life that's very difficult to do so we have entire teams of
20:01researchers who are working with populations the world over there are people working here in puerto rico
20:07people working in native american reservations people working in inner cities people working in rural
20:13areas people working globally trying to determine what are some of the things that we can do to help
20:20patients with their type 2 diabetes and this can involve direct messaging using the cell phone people
20:28talking to them discounts with uh food so we have some research who are actually working with some of
20:35the area food banks providing meals that are specifically designed to help with type 2 diabetes
20:42they have a little bit less carbohydrate in them and this is working really well and so across the whole
20:48spectrum of diabetes research from very basic science where you're working in genetics to very advanced
20:56translational research where you're working with pregnant women in large populations clinical research and
21:02translational research is the key to both preventing treating and managing type 2 diabetes this is so
21:10important because this research is trying to understand type 2 diabetes outcomes across different
21:19populations and populations and countries and it's too important the dietary habits like lifestyle changes
21:27and yes those kind of things so i would like to know finally doctor i would like to ask you some
21:35recommendations for the people who have type 2 diabetes or how can we prevent the disease it depends a
21:43little bit when we're talking about dietary recommendations with type 2 diabetes what we should recommend
21:48so many people with type 2 diabetes are overweight or obese and even losing a very small amount of
21:56weight as little as six or eight pounds in many people will markedly improve the type 2 diabetes
22:04taking some of these medications and losing 40 50 pounds can actually make the diabetes go into remission
22:12so the diabetes completely goes away when we're looking at diet there is a lot of argument
22:17as usual as to what diet should be followed whether this should be a diet that's very high in fat like
22:24a ketogenic diet whether people should be using intermittent fasting where they're trying to avoid
22:30eating between eating a couple of days a week or time restricted eating where they only eat between
22:37let's say 7 a.m and 7 p.m so some of these behavioral techniques to try and reduce the actual amount of food that's
22:44being eaten so when people who are overweight and obese that's probably the most important thing to do
22:50one of the other things that can be done is shifting a little bit the types of food that you have in your
22:56diet so reducing the amount of carbohydrate the amount of starchy foods and added sugar things like soda
23:05that can actually have a very big impact on how well controlled your diabetes is and in some people who are
23:11very borderline these dietary changes alone can make the type 2 diabetes disappear and drop them back
23:18into um this pre-diabetic phase and so what we generally recommend for people with type 2 diabetes
23:26is to continue eating the same amount of protein to try and reduce the amount of carbohydrate that
23:31they're eating a little bit with respect to fat fat is not necessarily bad for you it depends on the type of
23:38fat that you're eating one foods that i know is um very popular within latino populations guacamole
23:45is or avocados is tremendously good for type 2 diabetes it is high in fats that are heart healthy and
23:54seem to reduce your risk of heart disease it's very high in potassium which is good for the pancreas
24:00function and seems as if it may actually help with type 2 diabetes so a lot of this is focusing on
24:06how much you're eating so even if you're just eating a little bit less every day that will be very
24:12effective in improving to type 2 diabetes and if you can incorporate exercise into that that's
24:18tremendously helpful another thing that can be done from a sort of behavioral standpoint is weighing
24:23yourself regularly people who weigh themselves regularly tend not to gain as much weight over a longer
24:31period of time and it may just be that they're being more weight conscious there's nothing magic about
24:36weighing yourself but it just means that you're continuing to remind yourself whether your body
24:41weight is going up or down or staying the same so you can kind of adjust your diet based on that
24:46so i hope that answers your question yes thank you and try to work you know the last 30 minutes per day
24:54right yes exercise is incredibly important for reducing blood sugar because when you're exercising
25:01your muscles burn through sugar it improves your mood so it tends to make you eat less and when we look at
25:11studies where people have lost weight so getting people to lose weight is actually pretty easy we all go
25:16on diets and we lose a few pounds and then because we're not able to keep these changes in place we slowly
25:22but surely get back to where we started so the biggest factors which have been shown to reduce likelihood of
25:29gaining weight again are weighing yourselves regularly and exercising ideally 45 minutes a day five days a
25:38week that's very important for weight prevention but even exercising as little as 20 minutes three times a
25:45day or three times a week rather not three times a day that would be a lot um seems as if that can
25:52prevent this progression the american heart association and other groups will recommend
25:56about two hours of total exercise per week i think this is a very reasonable and achievable
26:04recommendation my thought with exercise i think for the most part is try to find something that you enjoy
26:10because if you don't enjoy doing it you're not going to stick with it and what's the point in spending two hours a week
26:16doing something that you hate just for a medical reason you should be doing this and finding something
26:21that you enjoy whether it's water aerobics or swimming or running or sitting on the exercise bike or
26:28salsa dancing whatever it is that makes you feel good i think is very important thank you so much
26:35dr reeds for sharing your time your knowledge and insights with us today i hope you have a good
26:42conference mucho gracias thank you okay to our audience thank you for watching if you are interested
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