Symposium Focuses on Diabetes and the Heart

The heart and type 1 diabetes were the main topics in 2014 in the advanced training symposium for physicians organized by the Institute of Diabetes Research at Helmholtz Zentrum München, a partner in the DZD, in the Klinikum rechts der Isar. The event was well attended with nearly 100 attendees.

In his presentation at the symposium, Professor Heiko Lickert of the Institute of Diabetes and Regeneration Research, Helmholtz Zentrum München, explained that even in patients who had had type 1 diabetes for more than 50 years, beta cells could be detected that were still functioning (and thus still producing insulin). On the basis of a biomarker identified by his research group, two kinds of beta cells could be identified which are presumably different in their regenerative capability. This knowledge will be used in the future for therapeutic approaches for the regeneration of beta cells in people with diabetes. 
Privatdozent Peter Achenbach of the Institute of Diabetes Research, Helmholtz Zentrum München, raised the question in his presentation whether the beta cells in type 1 diabetes were destroyed episodically or continuously. Study results have shown that after the appearance of autoantibodies, the development of type 1 diabetes proceeds at different speeds, since the immune response is not always equally strong. 
Diabetes and MS
In her presentation, Privatdozent Susanne Bechtold of the Dr. von Hauner Children’s Hospital (LMU) in Munich outlined the extent to which the two autoimmune diseases type 1 diabetes and multiple sclerosis (MS) are related. Both diseases are characterized by a reduced supply of vitamin D. It is unclear, however, to what extent this lack can be made responsible for the development of these diseases. According to Bechtold, epidemiological data suggest that the risk of developing MS in people with type 1 diabetes is three to five times higher than in people without diabetes.

Subcutaneous and intraperitoneal insulin therapy
Privatdozent Michael Hummel of the Forschergruppe e.V. gave an overview of new and future types of insulin. Although oral and inhalation insulin were still a long way off, researchers were still interested in their development. While long-acting types of insulin with higher concentrations and a longer half-life are already currently used in therapy, a so-called “smart” insulin is still under development. This type of insulin is only supposed to have an effect when blood glucose levels are high, so that hypoglycemia episodes can be prevented.
Dr. Andreas Liebl of the specialist clinic Bad Heilbrunn presented the intraperitoneal insulin therapy. Here the insulin is released by means of an insulin pump via a port implanted into the abdominal cavity. In this way, in patients with subcutaneous insulin resistance, blood glucose levels can be better adjusted and complications reduced. This therapy is currently being used in approximately 30 patients in Germany. 

Heart disorders associated with diabetes
Heart attack or heart failure are among the complications associated with type 2 diabetes. According to Privatdozent Martin Füchtenbusch of the Forschergruppe Diabetes e.V., patients with diabetes have a two-fold higher risk for these events than patients without diabetes. With poorly controlled blood glucose levels and following severe episodes of hypoglecemia, mortality rates rise.
Professor Christian Hengstenberg of the German Heart Center Munich (TUM) pointed out that in patients with heart failure, the occurrence of diabetes and mortality rates are significantly increased. Heart failure leads to death in 31 per cent of those affected with diabetes in contrast to 24 percent of the normal population. He therefore called for “aggressive drug therapy for heart failure in diabetes patients”.
The risk of a cardiovascular event is influenced by cholesterol levels, among other factors. According to Professor Klaus Parhofer of the University Hospital Munich (LMU), a reduction of LDL cholesterol by 1 mmol per liter (approx. 39 mg/dl) leads to a reduction of cardiovascular events by 22 percent. Until now it has been unclear whether this also applies to patients with very low LDL base levels or whether this only applies to statin-induced LDL reduction. Recent data show that even a reduction of levels under 70 mg/dl provides a benefit and that it does not matter so much how LDL levels are lowered but that they are lowered at all. Therefore, in Parhofer’s view, LDL levels should be optimally adjusted in patients with diabetes and cardiovascular disease at the earliest possible stage.
Statins are used to lower LDL cholesterol. Professor Carsten Otto discussed problems with statin intolerance in his presentation. In more than 50 percent of the cases, measures such as adjusting the dose, reducing dosing frequency or switching to another statin enabled the statin therapy to be continued.

Genetic component in type 2 diabetes
In the final presentation, Professor Hans Hauner of the Else Kröner Fresenius Center for Nutritional Medicine (TUM) pointed out that type 2 diabetes has a strong genetic component. In his view, type 2 diabetes is a heterogeneous disease with different clinical pictures. The objective for the future is targeted personalized therapy, taking into account the genetic material of the patient. He presented a bioinformatic method developed by his group for predicting disease-related gene variants.