The German Foundation of Internal Medicine, together with the DGIM, selected a study from the field of diabetology as the best study for the prevention of internal diseases. The Tübingen Lifestyle Intervention program “TULIP” elucidated why the risk of imminent diabetes cannot always be effectively prevented by the general recommendation to make lifestyle modifications.
Success factors for diabetes prevention
Award winner Professor Norbert Stefan, together with colleagues at Tübingen University Hospital, identified two phenotypes that can predict in which patients a lifestyle intervention can be expected to sufficiently reduce elevated blood glucose levels. According to the study, what is crucial is whether patients have an insulin secretion disturbance and/or a combination of non-alcoholic fatty liver and insulin resistance. “Subjects with these characteristics have a 4.5 times lower chance of success. Now in the nationwide Pre-Diabetes Lifestyle Intervention Study (PLIS) we are investigating together with all DZD partners whether at-risk people with pre-diabetes benefit from an especially intensive lifestyle intervention,” said Stefan.
Innovative therapy concept: Multi-hormone molecules
In the DZD-sponsored session “Highlights of Obesity and Lipid Metabolism”, DZD-scientist Dr. Timo Müller presented new active substances for the obesity treatment of the future. Until now, treatment options for obesity consisted of diet, pharmacotherapy and bariatric surgery. At Helmholtz Zentrum München research is being conducted to develop innovative approaches: Multi-hormone molecules reflect the physiological reality of natural hormone interaction better than a single active substance and can mimic the effects of bariatric surgery.
A new drug that combines the effects of three hormones (glucagon, GLP-1* and GIP**), lowers body weight by about 30 percent, about twice as much as a dual co-agonist made of GLP-1 and GIP in the same dosage. In initial investigations, very good results were also achieved with a combination of GLP-1 and estrogen. The hybrid molecule caused obese mice to have decreased appetite and lower weight. “The polytherapies combined in one molecule have the potential to become the gold standard in diabetes and obesity therapy,” said Müller.
Dr. Timo Müller presents new active substances for the treatment of obesity. Source: DZD
Sport as “panacea”
In his lecture, Professor Martin Halle, medical director of the Department of Preventive and Rehabilitative Sports Medicine at Klinikum rechts der Isar of Technische Universität München (TUM), highlighted the importance of physical activity for diabetes patients. When disease occurs, physical fitness always provides a better basis. The fitter the patient, the better cardiovascular sequelae can be prevented. For diabetes patients, 30-minute walks per day are recommended. To intensify muscular exercise, interval training should be carried out. This means repeatedly skipping for a minute during the walk.
New target: PCSK9 inhibition
New therapies to reduce LDL cholesterol were the topic of the lecture by Professor Dirk Müller-Wieland, who apart from other positions, is media spokesman of the German Diabetes Society. He presented the new drug class of PCSK9 inhibitors. The “proprotein convertase subtilisin/kexin type 9” (PCSK9) supports the degradation of the LDL receptor, with the aid of which LDL cholesterol is absorbed from the blood into the cell. By inhibiting this enzyme, the LDL level can be lowered to a significantly greater degree than with statins.
The PCSK9 inhibitor treatment can be used in patients with statin intolerance or if the LDL cholesterol levels cannot be reduced sufficiently despite a low cholesterol diet and statin intake. The drug is injected subcutaneously every two or four weeks. For this treatment, Müller-Wieland recommends large centers that already have experience with it. So far, few side effects are known. However, further safety data are required.
Research on major diseases
At the DZG stand, students and specialists in internal medicine showed interest in the training and research at the German Centers of Health Research. These national centers, funded by the German Federal Ministry of Education and Research, focus on diabetes, cardiovascular disease, cancer, lung disease, infections and neurodegenerative diseases:
German Cancer Consortium (DKTK)
German Center for Diabetes Research (DZD)
German Center for Cardiovascular Research (DZHK)
German Center for Infection Research (DZIF)
German Center for Lung Research (DZL)
German Center for Neurodegenerative Diseases (DZNE)
DZG stand: Dr. Astrid Glaser (DZD) and Christine Vollgraf (DZHK) present the German Centers of Health Research. Source: Andreas Henn
*GLP-1: Glucagon like peptide 1
**GIP: Gastric inhibitory peptide or glucose-dependent insulinotropic polypeptide