Diabetes mellitus: dangerous consequences, good prevention options

Interview with Prof. Dirk Müller-Wieland, German Diabetes Association (German: Deutsche Diabetes Gesellschaft)

Diabetes is a lifestyle disease that could result in dangerous consequences for the individual patient and the entire society. However, you can successfully stop this disease with targeted prevention methods.


Photo: Smiling middle-aged man with suit and glasses - Prof. Dirk Müller-Wieland

Prof. Dirk Müller-Wieland; ©German Diabetes Association

Prof. Dirk Müller-Wieland of the German Diabetes Association talks with MEDICA.de about the problem diabetes mellitus presents and how important prevention is.

Professor Müller-Wieland, in what way is diabetes a problem for society?

Dirk Müller-Wieland
: Diabetes mellitus is a problem for society, since it is a common cause for many secondary diseases and complications. Currently we assume there are about eight to eleven million patients affected by this disease in Germany. Diabetes is the leading cause of blindness and renal failure in Germany. Painful nerve changes also often occur in patients as a result. In 20 to 30 percent of patients, these diseases are already present at the time of the initial diagnosis.

Another issue is the fact that the risk of cardiovascular disease in patients with diabetes mellitus is two to three times higher than for patients without diabetes. The frequency of atrial fibrillation and thus the risk for stroke occurs about twice as often in diabetes patients.

This is why this disease is not just a risk for the individual patient, but thanks to long-term complications and associated lost work time, it is also a problem for the entire society.

How much does treatment differ, if the diagnosis is made for a child versus an adult?

: The treatment is fundamentally different, because these are also completely different diseases. Diabetes mellitus in infants is an autoimmune disease. For reasons we still don’t know yet the body identifies cell structures that produce insulin as “foreign”. Therefore, they are slowly being destroyed. The therapy consists of replacing the lack of insulin and controlling increased blood glucose levels.
Photo: Overweight people from behind

Diabetes leads to many complications that can significantly reduce through control of various risk factors such as obesity; ©panthermedia.net/ Jakub Cejpek

In contrast, in patients with type 2 diabetes, which usually occurs in adulthood, one fundamental factor is that insulin does not work adequately even though it is available. The causes for this insulin resistance are varied. Previously unknown genetic predisposition and changes in quantity as well as body fat distribution play an important role in this. This is why the focus is on so-called therapeutic lifestyle measures. This includes weight reduction and an increase in physical activity; when this is not enough, drug therapy is applied.

There is also the option to treat patients with type 2 diabetes by administering insulin. When would you resort to this method?

: This is a last resort. If a change in lifestyle and medication do not lower blood glucose levels sufficiently, you fall back on insulin injections. However, patients often gain weight instead of losing it and there is a risk for hypoglycemia.

What consequences does untreated diabetes entail in the different phases of life? When would you start suffering from secondary diseases?

: Metabolic disturbances due to too little or too much insulin are an acute threat for patients with type 1 diabetes. For patients with type 1 and type 2 diabetes, late complications in the tiny blood vessels depend on the quality of blood glucose levels. In patients with type 1 diabetes, usually these complications occur after several years of having diabetes. However, you need to remember that this type of diabetes can already occur in early infancy. In patients with type 2 diabetes, which is primarily diagnosed in adults, this can already be observed when the diagnosis is made. What’s more, with diabetes, the risk for complications in the large blood vessels and thus myocardial infarction and stroke is increased.

All secondary diseases can be significantly reduced by an early, effective and safe reduction of blood glucose levels as well as control or rather avoidance of other risk factors such as excess weight, smoking, high blood pressure and changed blood lipid levels for instance.

How important is diabetes prevention and what measures are being taken in this regard?

: Various studies – such as a large American study on diabetes prevention that we recently discussed during the American Diabetes Convention in San Francisco – show that diabetes prevention is extremely important. They show that intense lifestyle measures such as weight reduction, a healthy diet and physical activity can reduce the risk for diabetes in overweight at-risk patients by about 60 percent within three years. This is why it is very important to educate the public about this issue. Among other things, this is also concern of the German Diabetes Association and its umbrella organization diabetesDE – German Diabetes Assistance (German: Deutsche Diabetes-Hilfe), which has tried for several years to make policy makers more aware of this topic and to implement a national diabetes program.
Foto: Michalina Chrzanowska; Copyright: B. Frommann

© B. Frommann

The interview was conducted by Michalina Chrzanowska and translated by Elena O'Meara.