World Diabetes Day: Diagnosing Complications with Nuclear Medicine

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.