Patient-matched diabetes therapy

EADS Congress: Diabetes treatment should be better adapted to the patient

02/10/2012

At the 48th Annual Meeting of the European Association for the Study of Diabetes (EADS), which opened today in Berlin, Professor Andreas Pfeiffer, head physician of endocrinology at the Berlin University Hospital Charité, has commented on the new treatment guidelines for pointed out the treatment of diabetes. The care of patients will be significantly improved with the help of the new treatment guidelines.

Although counseling and caring for diabetes patients would be more time-consuming for physicians in the future, for patients there is a "chance that they will no longer be over-treated and thus avoid dangerous side effects," explained diabetologist Professor Andreas Pfeiffer, President of the European Diabetes Federation. Congress. The changes in patient care through the new treatment guidelines of the American and American Societies (American Diabetes Association, ADA) will be a major theme at this year's EADS Congress. In addition, the latest findings from basic research in the field of diabetes are discussed.

New guidelines and individualized treatments
For example, the Diabetes Guidelines for diabetes adopted in April call for all diabetics to be informed by the doctor about the possibilities of dietary intervention, the importance of physical activity, and appropriate weight management during an educational session. Doctors are also encouraged to create personalized treatment plans for patients, taking into account the symptoms and comorbidities. Prof. Pfeiffer emphasized that patients should be considered more individually from now on. So far, the treatment has sometimes gone beyond the individual needs of patients, the expert reported, citing the results of a three-year study with about 30,000 diabetic patients. Based on the new treatment guidelines, there is now an opportunity to significantly improve the treatment of the metabolic disease as a whole and to avoid possible impairments due to incorrect therapies.

Overdose of drugs
As an example of typical treatment errors in diabetes Professor Pfeiffer called the over-treatment or overdose of the drugs. According to the diabetologist, "elderly patients often can not safely use insulin and therefore risk dangerous hypoglycaemia if they take too much insulin." This has far more serious effects on the body than short-term hypoglycaemia. Although high blood sugar is a permanent problem for the body, but acute symptoms are not expected for the time being. Hypoglycemia (hypoglycaemia), however, may cause acute conditions such as high blood pressure, palpitations, cognitive deficits, impaired consciousness, syncope, paralysis, and seizures. In the worst case, hypoglycaemia can also cause the death of the patient.

Therefore, the risk of hypoglycaemia or overdose of insulin should urgently be avoided. For example, according to the new guidelines of EADS and ADA, the insulin dose may be reduced in patients who are over 70 years of age and have not yet experienced serious diabetes sequelae to minimize the risk of hypoglycaemia. According to Prof. Pfeiffer, it is unlikely that possible phases with high blood sugar levels cause damage here. Not every patient has to be perfect at the age of 75. Possible advantages and disadvantages of the treatment should be weighed thoroughly, explained the expert.

Only ten percent of diabetes risk explainable
In addition to the new treatment guidelines for the treatment of diabetes, the genetic basis of the disease will be intensively discussed at this year's Diabetes Congress in Berlin. Some new findings will be presented at the 48th EADS Annual Meeting, but at the same time there are still many open questions, explained Prof. Pfeiffer. For example, "some 60 genes have been shown to influence the propensity for diabetes - yet they can actually explain only about ten percent of the risk of diabetes," said the expert. At this point, other factors must play an important role, whereby Pfeiffer assumes that so-called "epigenetic factors are crucial." Epigenetics describes possible changes in the activity of certain genes under the influence of external conditions, such as diet, lifestyle or other environmental factors. The original genetic material will be modified in the course of the life course.

In the emergence of diabetes, the epigenetic processes could be of particular importance in the opinion of the experts. However, when they unfold their effect is so far largely unclear. This could happen later in life, but under certain circumstances also in the baby and even in the fetus in the womb, explained Prof. Pfeiffer. Therefore, the behavior of the pregnant women and mothers at this point is so crucial, stressed the Berlin diabetologist. "If the expectant mother is a smoker, diabetic or overweight, it negatively affects the child's health," says Pfeiffer. In addition, the nutrition and thriving in the first year play an essential role. The President of the EADS Congress said: "If the child is overfed and too fat, his or her risk of diabetes increases significantly," even if the baby is born smaller than normal, as is often the case with smokers, and then gaining weight too fast, "continues Pfeiffer. However, it remains unclear how the epigenetic factors work and what options are available to compensate for unfavorable factors such as gestational diabetes.

Shiftwork increases the risk of diabetes
Shiftwork has long been in the focus of diabetes research. In addition to the increased risk of cardiovascular disease and depression, working at night and at different times could increase the risk of Type II diabetes, as research has suggested for some time. This point will also be discussed at the international congress in the coming days.

The fact is, and a number of research papers have shown that constantly changing working hours and night work increases the risk of obesity and metabolic diseases such as diabetes. However, genetic factors also play a role here, as Professor Pfeiffer explained to the "dpa": "Five central genes of the internal clock, the clock genes, and a few dozen other genes control between five and 15 percent of the entire genome, among other metabolic processes. Anyone who is constantly changing shifts influences the function of these genes and thus increases their diabetes risk. "

According to Pfeiffer, shiftwork is a health problem and a social one as well. For example, there is a need to discuss the health risks people face in such activities and how they may be mitigated. Two ways to counteract the risk of disease, the expert names. Those who take care to eat healthy and maintain a normal weight and exercise regularly can significantly reduce the risk of diabetes. This tip is not just for shift workers but for all people. The European Diabetes Congress will take place in Berlin until Friday. A total of 18,000 scientists, experts and physicians discuss new findings and possible treatment methods. (sb, fp)

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Image: Thomas Siepmann, Pixelio