La importancia de alcanzar el páncreas artificial
La Organización Mundial de la Salud (OMS) estima que en el mundo hay más de 220 millones de personas con diabetes, una patología en aumento. El organismo internacional calcula que dicha cifra trepará a 366 millones de personas para el año 2030.
De acuerdo con Gustavo Frechtel, presidente de la Sociedad Argentina de Diabetes (SAD), entre otros factores, esto se debe al también alarmante incremento de la prevalencia de obesidad, a la que contribuyen los malos hábitos alimentarios y el sedentarismo que sobre todo predomina en poblaciones urbanas. Del 80% al 90% de los pacientes con diabetes tipo 2 tienen sobrepeso.
En el caso de la diabetes de Tipo 1 el páncreas no produce insulina y en caso de la diabetes Tipo 2 la hormona no cumple bien su función que es la de incorporar en el interior de las células las azucares que circulan en la sangre para convertirla en energía útil para sus funciones vitales. El aumento de la glucosa en la sangre produce las diferentes complicaciones crónicas de la diabetes, indica Frechtel.
Y agrega: La diabetes tipo 1 es una enfermedad autoinmune, en la que el sistema inmune que normalmente defiende al organismo de los ataques de virus y bacterias externas, pierde la capacidad de reconocer estructuras propias y ataca la célula beta del páncreas productora de insulina. Esta forma de diabetes no cuenta actualmente con medidas de prevención aplicables, a pesar que se investiga profundamente en este tema.
En cambio, dado que la diabetes tipo 2 se relaciona con la obesidad, sí es prevenible si se mantiene un peso adecuado y se realiza actividad física, puntualiza el presidente de la SAD.
Actualmente hay nuevas drogas orales “y se ha mejorado la calidad de la insulina y su forma de aplicación, así como la calidad de los dispositivos para el control glucémico utilizado por el propio paciente. Todos estos adelantos han contribuido positivamente a mejorar la calidad de vida de las personas con diabetes.
Sin embargo el especialista reconoce que el abordaje médico de la diabetes podría mejorar aún más si tuviesen éxito varias líneas de investigación básica que están en curso.
Desde hace 30 años existe un páncreas de dimensiones similares a un tomógrafo computado, que puede controlar los niveles glucémicos del paciente conectado a él -destaca Frechtel-. Mide el nivel de azúcar en sangre y libera la cantidad de insulina necesaria para mantenerlos normales.
Y agrega: La posibilidad de contar con un páncreas artificial que tenga las dimensiones de un teléfono celular y que cumpla con esa función es un anhelo postergado para el campo de la diabetología. Estas líneas de investigación a pesar de estar avanzadas todavía no han logrado desarrollar un software que conecte ambos sistemas -el de control glucémico con el de provisión de insulina- a pesar de lo cual parece ser que en los próximos años podría estar disponible. Tener este tipo de medio terapéutico tendrá un impacto sumamente positivo en la calidad de vida del paciente diabético, sobre todo de aquel con diabetes tipo 1.
De existir un dispositivo de ese tipo, dice el especialista, se alejaría el problema de los descensos de azúcar en sangre (hipoglucemia), el tener que pincharse un dedo varias veces por día para conocer los niveles glucémicos y la preocupación de los aumentos o de la inestabilidad de los niveles glucémicos. La persona con diabetes viviría liberada de una serie de compromisos diarios que le demanda la enfermedad, por lo tanto el impacto sería sumamente favorable, enfatiza.
Otra línea de investigación, pero que aún está en un desarrollo muy preliminar es el campo de las células madre. Es una línea de investigación sumamente interesante. El hecho de poder recomponer la masa de células beta del páncreas (productoras de insulina) en el paciente diabético sería un gran logro que mejoraría significativamente las posibilidades de control, afirma Frechtel. Y continua: Otra línea interesante de investigación es la genética, que puede favorecer el conocimiento de los mecanismos moleculares íntimos que determinan la aparición de diabetes, favoreciendo la posibilidad de desarrollar nuevas drogas que ataquen específicamente esas alteraciones moleculares. De esta manera los fracasos terapéuticos se verían sustancialmente disminuidos.
Para Frechtel la prevención en la diabetes tipo 2 es muy importante ya que con cambios en el estilo de vida, vale decir descenso de peso, actividad física y una alimentación adecuada se puede prevenir la mayoría de los casos. Un adecuado control de la diabetes y otras medidas terapéuticas como el control de la hipertensión arterial, entre otros factores, pueden impedir la progresión de las complicaciones crónicas cuando la enfermedad ya está instalada.
De acuerdo con el especialista, el 40% de las personas que tienen diabetes desconocen por años que la padecen, y un 30% a 40% de ellas ya presentan complicaciones crónicas en el momento del diagnóstico.
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