We live in a world where everyone knows someone who has diabetes. The disease is characterized by the inability to produce or effectively use insulin, it is
rapidly on the rise and becoming one of the leading causes of death worldwide. According to the World Health Organization (WHO), approximately four million people die from complications due to diabetes or high blood glucose levels (WHO, http://www.who.int/news-room/fact-sheets/detail/diabetes). The fact that
80 percent of those afflicted are in middle to low-income countries, and cannot
or do not visit a medical professional regularly makes detection, diagnosis and
treatment all the more difficult. WHO also reports that the number of people with diabetes has quadrupled since 1980 to 422 million people in 2014, with India having the largest population of adult diabetics (74 million, IDF) on the planet.
Diabetes has been manageable for most patients since insulin treatments were first pioneered in the 1920s, but it still remains undiagnosed in 24 to 62 percent of the world’s population. (WHO http://apps.who.int/iris/bitstream/handle/10665/204871/9789241565257_eng.pdf;jsessionid=6C39C7451F038C0EDDCED7B9528C7FE5?sequence=1). The risk of not being diagnosed or receiving improper and insufficient treatment is catastrophic, potentially leading to blindness, kidney failure, heart attacks, stroke and lower limb amputation. Undiagnosed cases will be a core issue throughout National Diabetes Month in the United States, where over 30 million people live with the disease (Center for Disease Control https://www.cdc.gov/features/livingwithdiabetes/index.html) but many more remain undiagnosed and untreated.
Genomic medicine and next-generation sequencing has seen the fastest progress to date in being able to identify genetic markers for diabetes in patients, and particularly being able to diagnose the most accurate type of diabetes they may have. For both Type 1 and Type 2 diabetes, genomic sequencing can reveal many significant risk factors but cannot fully predict the onset of any particular condition. The specific combination of genetic markers correlated to increased risk is complicated, and a few dozen genes of many variants have been found to contribute a risk to one or both forms of the disease. Given this complex relationship, the disease cannot be accurately predicted in either form. Some rarer cases, however, can be predicted from pinpointing just one particular gene, but all of these monogenic forms of diabetes are extremely rare.
Genomic medicine is also at the heart of managing and treating the disease and can be most effective in being able to inform doctors and patients of the exact type of diabetes that is present. In both cases, physical activity is important, with the Center for Disease Control (CDC) recommending being active at least three times a week. For the undiagnosed, being checked for prediabetes (a high blood sugar condition that falls short of the definition of Type 2 diabetes) and healthy weight management are also strong ways to mitigate risk factors. For those who are diabetic patients, management is key, and balancing a healthy diet and regular blood sugar testing with treatments like insulin can mitigate the risk of the more serious symptoms associated with the disease. Still, symptoms of these risks should still be monitored closely, and a medical professional should be notified if any issue related to the patient’s diabetes arises.
The specific relationship between the human genome and all forms of diabetes is a lively field of study, one that could lead to a breakthrough on par with that of Banting and Best’s first insulin treatments. One such opportunity is in India, where Project Shivom has partnered with Genetic Technologies Limited on a pilot program meant to find a genomic answer for the nation’s unusually high rate of Type 2 diabetes. See here for more about how we’re using blockchain to combat Type 2 diabetes in India. (LINK: https://medium.com/projectshivom/blockchain-to-combat-type-2-diabetes-epidemic-in-india-1856f460bac5).