ASSIUT, Egypt—Mahmoud Hassan, a 45-year-old employee at a private clothing company, spends more than five hours a month trying to get reimbursed for medication to treat his diabetes, a disease he has been suffering from for two years.
The government pays him 150 Egyptian pounds (about $8) a month for his drugs, he said. “However, I am forced to buy vitamins and nerve-supporting drugs as prophylaxis for about 450 Egyptian pounds ($25) a month from my own pocket.”
Hassan is one of the more than eight million diabetics in Egypt. The country is one of the top ten worldwide in the number of adults living with diabetes, according to the International Diabetes Federation.
The total cost of the disease to Egypt’s economy has been calculated at more than 25 billion Egyptian pounds ($1.4 billion) a year. That figure includes direct costs of treating the disease and its complications, and indirect costs through absenteeism and early death of diabetes patients.
The cost of treating complications of the disease—which include hypertension, high cholesterol levels, cardiovascular and renal disease, and hypoglycemic retinopathy—accounts for a substantial portion ($800 million) of the direct costs, and patients like Hassan bear much of that cost out of pocket.
Although the Egyptian government helps pay the cost of treating chronic diseases among poor patients, the amounts it pays typically cover only 25 percent of the actual cost.
But hopeful new developments are on the horizon, thanks to the promising findings of a research team using nanotechnology to develop a new “nano formula” of a herbal extract called silymarin.
The new formula was shown in a study to be successful at lowering blood-sugar levels in test animals suffering from Type 2 diabetes by activating pancreatic cells that produce and secrete insulin.
The study was conducted by a joint team from the School of Pharmacy and the Urology and Nephrology Center of Mansoura University, and from Zewail City of Science and Technology, a research and education complex near Cairo. It was published in the journal Nanomedicine last year.
The researchers found that the new nano formula, compared to the extract in its natural form, significantly improved silymarin’s antioxidant properties in reducing blood-sugar levels.
“The new formula, which is administered orally, has the ability to control diabetes,” said Ibrahim el-Sherbiny, a professor of nano and materials sciences at Zewail City of Science and Technology and one of the study’s authors. “The loading of natural drugs into innovative nanotubes called nanoparticles ensures the targeted delivery of these drugs to target sites with an extended effect.”
Silymarin is considered a safe and effective herbal medicine in the treatment of many diseases, including diseases of the liver, cancer and diabetes, and is known for its antioxidant and anti-inflammatory properties. This compound is derived from a plant called milk thistle, scientifically known as Silybum marianum. However, because of its low solubility in water, silymarin is poorly absorbed in the intestine. This causes it to be rapidly excreted from the body without the patient getting benefit of it, according to el-Sherbiny.
“The challenge was to create a new nanomaterial that would increase silymarin’s water solubility, and improve its bioavailability and therapeutic effect,” said el-Sherbiny. “This would enhance patient compliance by reducing the number of doses he or she takes and reducing its side effects—something we have achieved.”
Laila Issa, head of the biochemistry department in the School of Pharmacy at Mansoura University, stressed the difficult challenges the research team faced over two years. “We have focused on the effect of silymarin as an antioxidant that can be converted to nanoparticles that make it more effective for use in the treatment of diabetes and liver disease without serious symptoms,” she said.
Today, the research team has gained new clues about how silymarin in its nano formula works to reduce blood glucose by demonstrating its role in reactivating pancreatic cells that secrete insulin. However, the next step in the research process—clinical studies to determine the formula’s safety and effectiveness in humans—remains crucial.
“This stage is very important and opens new horizons for the use of silymarin to treat diabetes and reduce its complications, including kidney failure,” said Mahmoud Gabr, a professor of cell biology at Mansoura University’s nephrology center.
Other researchers say more studies should be done to confirm the new medication’s effectiveness.
“The nanotechnology opens the door to many valuable studies and therapeutic research, but this research requires additional complement studies to know and follow up the movement of silymarin inside the body and how it counteracts pancreatic inactivity, and to compare this with other drugs,” said Kotb Abbass Metwalley, a professor of pediatrics and endocrinology at Assiut University.
El-Sherbiny wants to continue research on the new formula by comparing it with treatments already in use and other natural herbs, such as turmeric, which is also being studied for use in cancer treatment.
“We are continuing our effort to understand silymarin’s mechanism of action in controlling blood-sugar levels in order to create therapeutic compounds of natural substances,” he said.
It might take years, however, before any promising new therapies become available to patients. Until then, Hassan and other diabetics in Egypt will have to continue coping with the disease.
“I’ve heard a lot about inventions to treat diabetes,” Hassan said. “I hope they will be available soon and at reasonable prices to suit our bodies and pockets.”