Team:BGU Israel/Human Practice/Target

The term "Pre-Diabetes" might be new to some people; however it is important to learn about it. We also have learned more deeply, through our work on the project, of the pre-diabetes scope and meanings, and we would like to share our thoughts and knowledge with everyone.

Pre-diabetes is the stage before developing type 2 diabetes. It is reflected by having a higher blood glucose levels than normal, but not high enough to be diagnosed as a diabetic. In Israel of 2013 for example, there were half million diabetes and half million pre-diabetes of 8,000,000 in total, resulting diabetes to be the third highest cause of death..

One of the major obstacles in pre-diabetes is that there are no clear symptoms, so people who are in pre-diabetes status may not actually feel anything wrong. Most of the pre-diabetics usually discover it when being tested for diabetes.

Pre-diabetes is like a warning sign. In order to prevent type 2 diabetes, and even bring your blood glucose levels to normal, you should change your way of life drastically; starting immediately with a healthier diet and frequent exercises.

Researches show that it is possible to lower the risk for type 2 diabetes up to 58% by Losing 7% of your body weight and exercising moderately 30 minutes a day, five day a week. Unfortunately, most of the pre-diabetics are incapable in changing their habits so rapidly and in short period, and as a result, been pushed to the next stage and became diabetics. Unlike the pre-diabetes stage, once fully developed diabetes, there is no way back.

We have met with a leading consulting firm – "Trigger Foresight" (Deloitte), and with a client who works at the diabetes field and looking for new solutions and researches regard to this subject. Together, we have discussed the importance of our Inner Doctor treatment for the pre-diabetic population in particular, and for the health system in general.

Here are some of our thoughts:

Our Inner Doctor treatment will be able to help pre-diabetics who are not capable of changing their life-style, whatever the reason may be. Our Inner Doctor treatment will balance blood glucose levels by treating insulin resistance and by implementing advance fat burning strategies. Needless to say, we do not intend that pre-diabetes will neglect a healthy life-style only due to a new medical solution for their situation. We aim for a combined solution - right nutrition and exercise together with our Inner Doctor treatment – which will help pre-diabetics improve their health and quality of life significantly.  

Reduce presser on the health system:
Today in Israel, due to an extremely busy public health system, most doctors have no more than 15 minutes for patient. It is almost impossible to share all the necessary knowledge with the patient and be able to answer his questions and thoughts. Dealing with diabetes requires great effort and knowledge, and therefore puts a lot of pressure on the system. Reality shows that most pre-diabetics fail in the attempt of preventing type 2 diabetes. We believe that our solution could really make a difference in the public health system. Having said that, we can take Israel as an example, which for about half million pre-diabetics that from now on will not join the diabetes circle, and therefore will lead to less pressure on the system and to a better quality of medical treatment and services.

References:

• http://www.diabetes.org/diabetes-basics/diagnosis/
• http//www.e-med.co.il/emed/new/usersite/presentations/
  eyal/messages.asp

After deciding to choose the Diabetes society in Israel as a study case for the Metabolic Syndrome we first sought to meet with the who's and who's in the field.  We visited CEO of the Diabetes Israeli Association Mr. Moti Perlmutter hoping to be guided and understand the problems of the people suffering from it, while directed as to where we can help the most. Mr. Perlmutter was very kind and helpful, he first listened and supported iGEM in general and our project specifically. He then, briefed us about the current stand of Diabetes 2 in Israel, astounding us with facts we didn't know and pointing to us the extreme differences between strong communities and the weaker ones where the Disease is prevalent. Mr. Prelmutter and the Association people accompanied all our Human Practice work in the Diabetes field, connecting us with experts, giving pamphlet materials to share in our activities, coming to lead workshops, bringing their "Diabetes-Mobile" to check patients when we requested. The combination of our drive, energy and enthusiasm with their experience, knowledge, capabilities and connections was a wonderful cooperation! (See more about the Bedouin campaign here)

Diabetes is a problem with the creation or consumption of the hormone insulin. There are two Types of Diabetes we will talk specifically on type 2, where the actual problem is with the uptake of the Insulin hormone, as the body produces Insulin without a problem but the body cells are not responsive to it, also known as Insulin resistance, which leads to a build-up of glucose in the blood liver and muscles-hyperglycemia. The great danger of Type 2 Diabetes, is that it is hard to detect and is mostly un-diagnosed when developing early in patients, so by the time patient is aware to the disease, blood glucose levels are very high and have already developed diabetes complication (Cardiovascular disease, Kidney disease, Eye disease, Nerve damage and the Metabolic syndrome and more).

Type 2 Diabetes is the most common type of Diabetes and mostly occurs in adults, but in recent years, a great rise in the prevalence among children and adolescents has been observed. Due to economic developments, ageing populations, increasing urbanization, dietary changes, reduced physical activity, and changes in other lifestyle patterns the number of people with Type 2 Diabetes is growing rapidly worldwide. It is a harsh and severe the problem and the amount of researches of population based diabetes are astronomic. Non-the-less, many governments still remain unaware of the current magnitude of the situation and the potential for increases in Diabetes and its serious complications.

Type 2 Diabetes can be found in both developed and in developing countries. It consists of 85%  to 97% of all diabetes and as research shows, developing countries will be closer to the higher percentage. The prevalence shown by the International Diabetes Federation is of 8.3% in adults, which is a total of 382 million people worldwide; most live in low-middle income countries. If the rise shall continue in the current rate, then by year 2035, 592 million people will suffer from diabetes. The death burden is tremendous - About 5.1 million people between the ages of 20 and 79 years died from diabetes in 2013, accounting for 8.4% of global deaths among people in this age group.

Statistics shows how Diabetes particularly affects those who are socially and economically disadvantaged, and worldwide the indigenous are mostly the "at risk" communities because of the recent urbanization processes leading to rapid change in diet and way of life. We can follow these trends all over the world and especially now in China.

In the Israeli society, statistics show two vulnerable communities, first, the Bedouin people who used to be nomads but have transformed into a modern life-style. Second, the immigrants from Ethiopia who, which had a quick one generation change in diet and life style. Moreover, both these population majorities come from a low-income status. In Israel  6.5% of people aged 20-75 are estimated of having diabetes, the Arabic community (including the Bedouins)  according to the general  center of heath is double the percentage  about 12% and the Ethiopian community that arrived to Israel at about 0-0.4% prevalence of diabetes, after 10 years  raised to 16% of diabetes presence.

The financial burden of diabetes varies from country to country; in Israel there exists a moderate social policy and a medical subsidies plan. Research done in Israel between the years 1999-2001 by the medical insurance company "Maccacbi" found that  all the expenses on: Hospitalizing, special doctors visits, drug treatments and nurse treatments all summed up to costs being 53% higher than the average expenses on the same gender and age group individual without Diabetes. Diabetes related expenses consisted 6.9% of all: Maccabi"'s expenses in 2001. From the patient's side, the monthly treatment -  mainly medicine and drugs stands at about 100$ and due to the fact that statistically most patients come from a low income background, sadly it seems that 15.6% of all patients in Israel gave up their medicine due to financial reasons.

Understanding the background and statistics of Diabetes gave us a better understanding of how huge and international this problem is, which gave us more motivation to suggest a better healthier and more effective solution to it. Furthermore, after reading and realizing how much money is spent on dealing with this disease we realized the potential market and financial feasibility of our project which is tremendous. We were also sad to notice that all over the world Diabetes is one of the dividers between wealthy and poor, and we hope that treating the Disease will also benefit in making  a more equal just world society.

References:

• http://www.idf.org/about-diabetes
• http://www.sukeret.co.il/


• ↑ Chodick G, Heymann AD, Wood F, Kokia E. The direct medical cost of diabetes in Israel. Eur J Health Econom 2005;6:166-71

Q: Could you please share with us your personal story?For many years I worked full time as a truck driver spending most of my day on the wheel while doing no physical activity. Having my meals always on the road I got to know all the right restaurants, good diners and fast-food pita-bread serving places, I just loved eating. During that time I felt quite good with myself didn't feel a need to visit the doctors much, didn't know much about Diabetes, and has no awareness to the risk my health was at.

Q: How did it all start then?One casual day I decided to purchase a life insurance-pension policy, and for it I needed to do some normal health tests including a urine check. The doctor, read the results, looked surprised and anxiously told me: "Sir, you have Diabetes!", I said: "It can't be!". However after seeing another doctor it became a fact.

Q: What about your family?You can probably say Diabetes hit my family very hard. Besides everything I went through, before my mother passed away she was ill and struggled with the disease. My sister was also Diabetic and tragically died from complications that came from the damage Diabetes had done to her body.

Q: What happened to you after being diagnosed?I was prescribed with medications, told to come for regular health tests monthly, eat healthy food, workout, and watch myself very closely. Sadly, I did none of those things and just kept on with my life, not taking my drugs properly and neglecting my health. It became so bad that me taking pills wasn't enough and I had to receive daily Insulin injections. By then my situation became even worse, the sugar levels in my blood reached extreme heights, I weighed 140 Kilos (~310 lb.) and I didn't go at all to monthly health tests.

Q: What happened next?It was after 9 years from firstly being diagnosed with Diabetes, and 2 years after beginning Insulin shots, that during one of my rare visits to the doctor, he told me bluntly: "Listen, if you won't pass Bariatric Surgery you simply will not survive."Only then something in me changed.

Q: How did you get out of it?From that moment I decided to take control over my life, I started with going through the Bariatric surgery. It wasn't pleasant at all, and recovery was slow, but it saved my life, ridding me of much of my excessive weight. I was back at 90 Kilos (~200 lb.), and after a month didn't even need Insulin anymore. I decided to completely change my life and lifestyle: I started exercising and checking the ingredients of everything I eat. I joined a special Diabetic Support Group which was very important for assisting my recovery and helping me stay "balanced"; we still meet every week for two hours of sharing everyday challenges and experiences. I also joined the Israeli Diabetes Association where I volunteer to this day; driving everywhere I can go to do glucose tests to help people get diagnosed in an early stage when they can still stop from becoming Diabetic. I am glad to say that recently I just finished my 2nd Degree as a qualified chef, which comes in handy during the healthy cooking workshops I lead, to raise awareness for Diabetes.

Despite my amazing improvement, to this day I continue to suffer from semi-blindness in one eye, a mal-functioning kidney and high blood pressure. Gladly, there is no further deterioration in my condition ¬- I do my best to keep it that way and to live a healthy life as much as I can.

We thank Aaron for sharing his amazing story with us, below are more general questions he kindly answered too.

Q: From your volunteer work at the Israeli Diabetes Association, how do people react when being diagnosed as Pre-Diabetes? People are shocked; they can't believe it that their sugar level is so high. They ask for another test to be done, so we clean their finger thoroughly and do the glucose-levels check again. The result is the same but they don't know how to accept it, so we send them to a Diabetes Doctor for further treatment.

Q: How does a "Day in a Life" of a Diabetic look like? You wake up in the morning, before anything else, you must check your sugar level. Every Diabetic person has a measuring device to know his blood glucose levels. Those who need to inject Insulin, must do so. The number of Insulin shots varies between once to three times a day, and you better plan ahead of time when you'll do so. It is a simple procedure – just sticking a pen-like syringe in the belly and clicking a button. Some people use pumps, if you have an insulin pump, you get a dose approximately every hour, you'll notice that the buzzer goes off. The pump also gives a "bonus" amount, which varies mainly depending on what food exactly you've eaten. One must watch his appetite rigorously, as 6 meals are advised to be eaten a day: 3 big and 3 small, making sure every meal consists vegetables and preferably in the form of a salad. Additional monitoring required: Every three months one must pass blood tests, and meet a Diabetes specializing doctor for supervision. One must go through eye and vision examinations every six months, and every year do urine proteins test.

Q: Is becoming Diabetes a financial burden? I had health-insurance so the Bariatric Surgery I did was scheduled very quickly and cost only a 250$ fee. Public healthcare is a different story and for a subsidized surgery one can wait for months, or take the other option which is a private surgery and costs a fortune. Insulin; drugs; pump batteries, tubes and accessories costs a lot too, my health insurance covered for monthly expenses over 250$, but without it would cost me a lot of money. Surprisingly, living a healthy lifestyle does not cost extra money, I know many recipes of making Diabetes-friendly healthy meals with cheap food products.

Q: Is the government doing enough to deal with Diabetes? I think the government should finance more "Diabetes Vehicles" like ours (Israeli Diabetes Association's) that will go around the country, test people's sugar levels, and early diagnose people. Condition can be stopped from becoming chronic if diagnosed early enough. Because I know how much money is spent on patients once they're ill, and handicapped, I'm sure this offer will turn out not only to serve the public health but also to be economically profitable.

Q: Would you try a Synthetically Engineered new treatment? I have participated in countless breakthrough medical researches; I even was the second patient in the country to use an Insulin pump for adults. As long as the treatment or medicine has passed Helsinki committee, is safe and will not harm me, I have no problem trying it. I don't mind "nature being altered" because it is much more important to me that there will be found a solution for Diabetes, as it would make so many lives so much better. If a "magic treatment" like you are developing in your project (The Inner Doctor) would exist, I believe it would be priceless.

A short video with Aaron
http://www.youtube.com/watch?v=6XPp7Rw-Y7g