Diabetes therapy tailored to the patient

Diabetes therapy tailored to the patient

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

At the 48th annual conference of the European Association for the Study of Diabetes (EADS), which opened in Berlin today, Professor Andreas Pfeiffer, chief physician of endocrinology at the Berlin University Hospital Charité, discussed the new therapy guidelines for the treatment of diabetes. The new treatment guidelines are intended to significantly improve patient care in the future.

In the future, advice and care for diabetes patients would be more time-consuming for doctors, but for patients there is "the chance that they will no longer be over-treated and that there will be no dangerous side effects," said diabetologist Professor Andreas Pfeiffer, President of the European Diabetes Congress. The changes in patient care due to the new therapy guidelines of the European and American professional associations (American Diabetes Association, ADA) form a focal point 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 The diabetes guidelines for the treatment of diabetes, which were adopted in April, require, for example, that all diabetics are informed by a doctor about the possibilities of dietary interventions, the importance of physical activity and appropriate weight management. Doctors are also encouraged to create individualized treatment plans for the patients, taking into account symptoms and comorbidities. Prof. Pfeiffer emphasized that from now on the patients should be considered even more individually. So far, the treatment has sometimes failed to meet the individual needs of the patient, the expert reported, citing the results of a three-year study with around 30,000 diabetes patients. Based on the new therapy guidelines, there is now an opportunity to significantly improve the overall treatment of the metabolic disease and to avoid possible impairments due to faulty therapies.

Overdosage of medication Professor Pfeiffer cited over-therapy or overdosage of medication as an example of typical treatment errors in diabetes. According to the diabetologist, "older patients often cannot handle insulin safely and therefore risk a dangerous hypoglycaemia if the insulin dose is too high." This has significantly more serious effects for the organism than short-term hypoglycaemia. Because high blood sugar is a long-term problem for the body, but acute symptoms are not expected here for the time being. Hypoglycemia (hypoglycaemia), on the other hand, may lead to acute symptoms such as high blood pressure, rapid heartbeat, cognitive loss, loss of consciousness, including fainting, paralysis and seizures. In the worst case, hypoglycaemia can also result in the death of the patient.

Therefore, the risk of hypoglycaemia or an overdose of insulin should be avoided urgently. According to the new therapy guidelines of the EADS and ADA, for example, the insulin dose can be reduced in patients who are already over 70 years old and who have so far not shown any serious complications from diabetes in order to minimize the risk of hypoglycaemia. According to Prof. Pfeiffer, it is unlikely that possible phases with high blood sugar levels will cause damage here. Not every patient had to be perfectly attuned at the age of 75. Possible advantages and disadvantages of the treatment should be carefully considered, the expert explained.

Only ten percent of the risk of diabetes can be explained In addition to the new therapy guidelines for the treatment of diabetes, the genetic basis of the disease will also be discussed intensively at this year's diabetes congress in Berlin. Some new findings will be presented here at the 48th EADS annual conference, but at the same time there are still numerous open questions, explained Prof. Pfeiffer. For example, "around 60 genes have been shown to influence the tendency to diabetes - yet they can only actually explain about ten percent of the risk of diabetes," the expert explained. At this point, other factors must play an important role, with Pfeiffer assuming that so-called "epigenetic factors are decisive." 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 genes are modified in the course of life.

According to the experts, the epigenetic processes could be of particular importance in the development of diabetes, but it is still largely unclear when they will have an effect. The professor explained that this could happen later in life, but possibly even in the infant and even in the fetus in the womb, which is why the behavior of pregnant women and mothers is so crucial here, emphasized the Berlin diabetologist. "If the mother-to-be is a smoker, diabetic or overweight, this affects the child's health negatively," said Pfeiffer. In addition, nutrition and prosperity play an important role in the first year of life. The President of the EADS Congress said: "If the child is overfeeded and is too fat, his later risk of diabetes increases significantly." This also applies "in the event that the baby - as is often the case with smokers - is born smaller than normal and then gaining weight too quickly, ”continues Pfeiffer. However, it has so far remained unclear exactly how the epigenetic factors work and what possibilities there are to compensate for unfavorable factors such as gestational diabetes.

Shift work increases the risk of diabetes Shift work has long been 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 projects have shown that constantly changing working hours and night work increase the risk of obesity and metabolic diseases such as diabetes. However, genetic factors also play a role here, as Professor Pfeiffer told 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 things metabolic processes. Anyone who works shift shifts permanently influences the function of these genes and thus increases their risk of diabetes. ”

According to Pfeiffer, shift work is a health problem and therefore also a social one. It must be discussed which health risks people are exposed to in such activities and how these could possibly be mitigated. The expert names two ways to counteract the risk of illness. If you take care to eat a healthy diet and maintain a normal weight and exercise regularly, you can significantly reduce the risk of diabetes. This tip applies not only to shift workers but to everyone. The European Diabetes Congress will take place in Berlin until Friday. A total of 18,000 scientists, experts and doctors discuss new findings and possible treatment methods. (sb, fp)

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Image: Thomas Siepmann, Pixelio

Author and source information

Video: Using Data u0026 Technology to Tailor Personalized Medicine. Kaiser Permanente (September 2020).