Diabetes Mellitus: Avances Alfonso Vargas del Valle Departamento de Pediatría - División de Endocrinología Facultad de Medicina -Louisiana State University y Children’s Hospital New Orleans

El Guerrero (bronce monumental) FERNANDO BOTERO Medellín, COLOMBIA 1935- Cortesía del Profesor Silvano Bertelloni, Universidad de Pisa, Natural de Pietrasanta, Toscana, Italia

Puerta del Infierno (fresco) Puerta del Cielo (fresco)

UNITE FOR DIABETES UNIDOS POR LA DIABETES 230’000,000 individuos con diabetes 3’500.000 mueren anualmente 7’000.000 nuevos pacientes / año Cada 10” : 1 diabético muere Cada 10” : hay 2 diabéticos nuevos WWW.UNITEFORDIABETES.ORG

CADA 24 HORAS Casos Nuevos – 4,100 Muertes – 810 Amputaciones – 230 Falla Renal – 120 Ceguera - 55 The following are rough approximations to help emphasize what diabetes prevalence numbers mean to people with diabetes each and every day. Approximately, 4,100 new cases of diabetes diagnosed; 810 people die from the complications of diabetes; 230 people with diabetes will have an amputation; 120 people with diabetes will suffer from kidney failure; and 55 people with diabetes will go blind. Reference National Institute of Diabetes and Digestive and Kidney Diseases. National Diabetes Statistics fact sheet: general information and national estimates on diabetes in the United States, 2005.Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, 2005. Derived from NIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2005.

THE WEIGHT OF THE NATION EL PESO DE LA NACION - Para Ganar tenemos que PERDER! Lanzamiento nacional 14 de Mayo, 2012 Serie documental de HBO y el Instituto de Medicina (Institute of Medicine - IOM) en cooperación con el Instituto Nacional de Salud - NIH, el Centro Para el Control de Enfermedades - CDC HBO: hbo.com/theweightofthenation FACEBOOK: Facebook.com/theweightofthenation YouTube: youtube.com/hbodocs

www.ndep.nih.gov www.YourDiabetes.Info.gov Changing the Way Diabetes is Treated National Diabetes Education Program- NDEP Programa Nacional de Educación en Diabetes As you can see, NDEP has a wealth of resources. The best part is that single copies of all NDEP materials are available free of charge. Multiple copies are available at low cost. Call the toll-free number or download them from the NDEP website. Since there are no copyright restrictions, you are welcome to make and distribute as many copies as you need. You can even add your own organization’s logo to NDEP materials. Many partner organizations use NDEP materials to promote messages and educational information to their clients. And you are welcome to do so, too. NDEP asks that you give credit if you use or adapt NDEP messages. www.ndep.nih.gov www.YourDiabetes.Info.gov

Insulin Insulina Humana Primera proteína Cristalizada en forma pura Totalmente sequenciada Manufacturada sintéticamente Disponible para uso clínico en la década de los 80’s. 9

Insulina Producción de laboratorio Levaduras o Bacterias El gen de la insulina humana se inserta en el ADN por tecnología de recombinación.

Tecnología de ADN Recombinado After multiplying, the cells are broken to extract the DNA. Insulin chains are separated from the rest of the DNA. The two chains are then mixed together and joined by disulfide bonds. Other bacteria products are separated The DNA mixture is then purified so that only the insulin chains remain An overview of the recombination process. Source: Novo - Nordisk promotional brochure, pg 6. 11

Asociación de las Moléculas de Insulina Regular = hexámeros Análogos de acción rápida (dímeros o monómeros) Acción prolongada (polímeros o ligados a proteínas) 12

Bomba de Insulina

Bomba de Insulina

Bomba de Insulina sin Cable Ha Handheld PDM Personal Diabetes Manager Insulin pump/Reservoir/Infusion set

Monitoreo Casero de la Glicemia Conexión con aparatos celulares Datos e información en pantalla Información transmitida electrónicamente

Monitoreo Continúo de Glucosa - MCG MCG puede usarse intermitenmente

Monitoreo Continúo de Glucosa Monitoreo remoto en tiempo real

El futuro Detector permanente de glicemia Circuito cerrado durante el sueño Circuito cerrado completo “Páncreas Artificial” o “Célula ß Artificial”

Apps Si el médico recomienda: Fórmula? Información? Conectividad? Cubierto por el seguro de salud? Necesidad de ensayos clínicos Aprobación por la oficina Federal de Drogas y Alimentos - FDA “Coming next: Doctors prescribing Apps for patients”. New York Times Monday August 20,2012