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World Diabetes Day: Diagnosing Complications with Nuclear Medicine

Insulin pen, diabetic measurement tools and pills on orange background.

Though oral medications or insulin aren’t part of the daily life of every diabetic, patients with diabetes are more likely to suffer from other diseases. (Photo: T.Barbhuiya)

537 million adults worldwide live with diabetes and the uncertainty of how it may affect them in the future. In 2021 alone, diabetes and its complications caused 6.7 million deaths, making it one of the leading causes of morbidity worldwide. The complications range from kidney failure, heart attacks, blindness, stroke to lower limb amputation. These complications can be diagnosed early, and in many cases prevented, with the use of nuclear imaging. This year, World Diabetes Day focuses on the uneven access to diabetes care around the world. The IAEA works to bridge the access gap in nuclear medicine and provide low- and middle-income countries with equipment and know-how. 

“Nuclear techniques have a vital role to play as they can help detect and therefore help prevent complications of diabetes, reduce death and increase the quality of life for diabetic patients on a global scale,” said Enrique Estrada-Lobato, a nuclear medicine physician at the IAEA.

There are two major types of diabetes. Type 1 in which there is a lack of insulin production and type 2, which is more common, in which the body’s ineffective use of insulin – a hormone which regulates the metabolism of carbohydrates, fats and protein — leading to high sugar levels. While the causes and risk factors for type 1 diabetes are unknown and prevention strategies have not yet been successful, type 2 diabetes is preventable.

Currently, there are 41 national and 8 regional IAEA projects to establish and strengthen the practice of nuclear medicine, including applications devoted to evaluating the complications of diabetic patients around the world. Through technical cooperation programmes, coordinated research activities, publications and educational activities — such as eLearning modules, recorded seminars, and training courses through the human health campus — the IAEA is supporting countries in using medical imaging effectively to early diagnose and improve care and survival rates.

Leading nuclear techniques in diagnosis

Three key nuclear techniques in medicine are used to diagnose three common complications of diabetes: diabetic foot, kidney failure and heart disease. Radiopharmaceuticals — which use small quantities of radioisotopes to highlight problematic areas in the body — and imaging techniques are used to detect these different diseases. The early diagnosis of these complications is critical to successful treatment outcomes.

Diabetic foot, a disease where patients lose sensation in their legs and are unable to feel and heal open wounds is due to high levels of sugar in the blood. It can create infections straight to the bone, leading to osteomyelitis – an inflammation or swelling in the bone. If this is diagnosed early enough, it can be treated with antibiotics. Medical imaging and nuclear medicine studies use single photon emission computed tomography (SPECT) with different radiopharmaceuticals to detect diabetic foot. More recently, positron emission tomography with fluorodeoxyglucose (FDG) such as magnetic resonance has become useful to detect the disease and evaluate the efficacy of treatment — imaging tests that help diagnose problems in the bones and define whether the infection is active or not.

Kidneys are also affected by long-term diabetes. To prevent kidney failure, it is necessary to detect the impairment of the kidney’s function at an early stage. Renal scintigraphy – a test that uses radiopharmaceuticals to assess kidney function – has shown its important role in detecting early changes. “Through the use of this technique, we’ve been able to prevent the suffering from kidney complications of 250 diabetic patients in 2020 in our hospital,” said Eleazar Ignacio from the National Institute of Medical Sciences and Nutrition in Mexico, a country greatly affected by diabetes.

Many sufferers of diabetes experience heart pain. This is due to having high sugar levels, which can damage the blood vessels. If this is not diagnosed and goes untreated, the damage can lead to heart disease. By undertaking a medical imaging technique called myocardial perfusion imaging (MPI), with related injection of radiopharmaceuticals, comparisons are made to evaluate whether the heart is functioning correctly. By giving guidance to countries on this technique, the IAEA helps to implement, harmonise and enhance the use MPI in countries which have the existing technology and those looking to develop it.

The IAEA has conducted several coordinated research projects (CRPs) aiming at evaluating the role of MPI in assessing patients with heart conditions. One was conducted and followed for 10 years to determine the role of MPI in detecting cardiac complications in asymptomatic diabetics. The participating countries were Algeria, Argentina, Bangladesh, Chile, Colombia, Cuba, Egypt, India, Israel, Italy, Lebanon, Pakistan, Slovenia, South Africa, the United States of America, Uruguay and Viet Nam.

Through the work of the IAEA, nuclear medicine facilities around the world can safely provide the necessary tests and resources needed to detect complications due to diabetes and help protect the lives of diabetic patients. This has been the case in Latin America and in Asia and the Pacific, where clinical applications of nuclear techniques have been improved and will continue to be developed through a planned new project focused on women.

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