In recent decades, information has occurred warning about the "epidemic" of diabetes, prevention campaigns focused on the importance of thorough control of glucose levels and a whole health industry around that figure.Many doctors today denounce that this simplistic vision of the disease is becoming healthy people and does not help correctly treat truly sick people, in addition to generating huge dividends to the pharmaceutical industry.
We refer to type 2 diabetes, the elderly, linked to food or bad life habits.Do not confuse with type 1 diabetes, an autoimmune disease that occurs in young people, in which the death of pancreas cells makes external insulin need.Type 2 diabetes "is a very complex disease, which for now we do not understand, and by focusing excessively on blood glucose we are wrong," explains Juan Gérvas, a retired general doctor, doctor of medicine and visiting professor at the National Health School of HealthPublic
Since the 90s, a series of changes have made millions of people into patients.A group of experts convened by the American Diabetes Association modified in 1997 the blood sugar threshold over which type 2 diabetes was considered to be suffered from 140mg/dl to 125 .Automatically, only in the US 1.9 million people went on to have the disease and be susceptible to being medicated.The figure practically doubled in that country, and worldwide.Some researchers alerted the consequences."There is no evidence that correcting these minor elevations improves health," said researchers Steve Woolf and Stephen Rothemich, at the American Family Physician already in 1998.
In addition to this change, since 2003, a second scale for people with a level of sugar greater than 100mg/dl, which become diagnosed as 'prediabetic' .It is a label to name healthy people with slightly high blood glucose figures, but not enough to be considered diabetic, and that in the long term they can have a higher risk than the rest of the population to develop the disease.It is, therefore, an indicator and not a disease itself.In spite of this, in 2008 and 2013 new statements of medical societies established that diabetes medications could be applied to treat prediabetes, if the levels did not fall down other pathways (adequate food, exercise ...).The sales of medications shot."The logic of the treatment of prediabetes with medications is basically stupid," said James McCormack, a pharmacist and professor at British Columbia University."We treat 100% of people with prediabetes with a medicine to prevent less than 15% of these people developing diabetes, a condition for which they may need that medication." "There is no proven benefit to give an antidiabetic treatment toThese people before developing diabetes, especially since many of them will never develop diabetes, ”said John S. Yudkin, in an investigation carried out in 2014 by the University College of London and the Mayo Clinic.
Enrique Gavilán, family doctor and research responsible for the Laboratory of Innovative Practices in Polymdication and Health, Polimedlab, alert about this new reality: “The concept of prediabetes is similar to that of other pre-diseases, such as prehipertension or preosteoporosis.They make us see that they are states that will inevitably give way to diseases that are feared by all, but the reality is that in a very important percentage this is not so. ”In this line, John S. Yudkin insisted that “thePrediabetes is an artificial category with zero clinical relevance. ”Juan Gérvas ironized in this regard: "One ends up having prehipertension and being premuerto."
But who is responsible for determining these figures?According to a recent journalistic investigation published by the prestigious American newspaper Milwakee-Wisconsin Journal Sentinel, “each of the expert panels that changed disease definitions to increase the number of patients susceptible to being treated with medications had members who received money from money fromThese types of companies [...] 13 of the 19 members of the 2013 expert committee received more than 2 million dollars from the diabetes industry for making speakers or consulting work since 2009, according to an analysis of the dataof the pharmaceutical companies themselves ”.This research states that the diabetes industry has become 45% of American adults (71 million people) generating a business volume for pharmacists, only in the US, of 23 billion dollars a year a year"More than the combined income of the National Soccer League, the Baseball Mayor League and the National Basketball Association."
“I remember the change of definition of diabetes when I was studying and we all saw it as an advance, which we thought could improve patient care.In no case did we guess that behind all this there were commercial interests, scientific societies at the service of those interests, ”Licks Abel Novoa, a family doctor and president of Nogracias, platform for transparency, integrity and equity in health policies, health care and biomedical research.Novoa explains that the case of diabetes is not unique.Clinical standards of various diseases have also been modified in recent decades.Hypercholesterolemia, arterial hypertension or overweight have seen the levels that determine these diseases descend, and it has been possible to increase the number of people likely to be treated with medications in an overwhelming way.
Doubtive results
Seen the increase in spending, it is worth asking whether it has been useful, if the medication to maintain the “normal” glucose rates has managed to reduce the mortality of diabetic people.Numerous studies have pointed out that it has not been so."From 2004 to 2013, none of the thirty new medicines for diabetes that have entered the market have proven to improve the key results, such as the reduction of heart or brain attacks, blindness or other disease complications," says researchmade by Milwaukee Journal Sentinel.In fact, it has been shown that trying to make diabetics maintaining a glycemia figure close to normal increased their mortality, according to a study published in the New England Journal of Medicine.This research, carried out in 2008, detected a rate of 22% greater death due to any cause and a 35% higher death rate due to cardiovascular causes in people with type 2 diabetes whose blood sugar had been put under intensive control.
Abel Novoa warns of the damage produced by this strict control in the older population: “Hypoglycemia, many emergency visits, falls ... but of course, convincing the elderly that nothing happens because they have 250 sugar is very complicated,They are very afraid.A fear that we have introduced, doctors.And doctors influenced by scientific societies. ”In fact, over -treatment is one of the factors causing greaternumber of deaths in Europe.“EU's official data are 197,000 dead a year due to adverse effects of medicines.600 dead daily dead, when 75 people a day in the EU die, ”explains Gérvas.
Proof that these strict glucose controls are not effective is precisely the case of the Spanish State, where diabetic patients are dedicated a great diagnostic and therapeutic effort, which achieves good glucose control rates and, despite this,The indicators of amputations and other derived diseases are much worse to the European average.“We are not paying the attention that patients who have gravity deserve and need, and yet we are shooting the offer of treatments to patients who are not.We are doing it wrong above and below, ”says Gérvas.
And this not to mention the side effects of the drugs.“Antidiabetic medications have, depending on the type, more and more side effects.Recently, an antidiabetic, the Avandia, an international Super Surves, which was ten years in the market, causing heart attacks and accidents.Keep in mind that diabetes is to avoid, among other things, that there are heart attacks and stroke, ”explains Novoa.“The only thing they do is demonstrate that a medicine decreases sugar to get it approved.They are not asked to reduce cardiovascular mortality, ”he adds.“A doctor with the best intentions and studious, concerned about his patients, if strictly follow the medical practice guides it is very likely that it causes more damage than benefit.This is the most terrible.Medicine is in a very complicated situation.The science on which many decisions are based is vitiated with base, is biased.It no longer responds to the needs of patients, but to the variables that interest the medical industry to sell more medications, ”says Novoa.
In what all the data coincide is that, in the case of type 2 diabetes, the key does not seem to be in glucose, but in a much more complex variable: poverty."The idea is transmitted that diabetes have it all, when it is not," says Gérvas.“Diabetes looks more like a social problem, such as drug addiction, than to a medical problem.The purely medical approach, which is the one that exists right now, does not go anywhere.There is talk of health education, which is like blaming the individual of their customs, when what determines people's customs is where they were born: their social context, their socioeconomic level.That is why we prefer to talk more about living conditions and not life styles.Ours is an unfair society that does not give the same opportunities to all citizens and that makes the poorest, those who have less culture, those who do not live in neighborhoods that have parks next to it, and this is scientifically measured, haveconditions that make them obese, eat worse, do not exercise and finally develop diabetes.Millions of euros are dedicated to dealing with medications that have a social origin and that, surely, much less money dedicated to trying to improve these social conditions would have much more impact on the disease.This is the paradox, ”says Novoa.