Diseases are central to medical lifestyle. Basic research and clinical studies are the basis for targeted prevention.
Research meets medicine. ”The main theme of this year's internists' congress in Wiesbaden could hardly have been better chosen with regard to the widespread disease diabetes: Knowledge of the pathophysiology of Diabetes, the influence of genes, lifestyle and environmental factors on the development and course of the disease has grown enormously due to basic research in recent years (). In Germany, large, state-funded translational research networks play an important role, for example the competence networks and national health research centers such as the German Center for Diabetes Research with its five network partners.
Translational Research
“One of the goals of the Congress of Internists is to show how in translational symposia, for which representatives of the national research associations have sponsored the findings from basic research can be used for clinical application, ”explains the Congress President and Chair of the German Society for Internal Medicine, Prof. Dr. med. Michael Manns from the Hannover Medical School, the concept.
Metabolic syndrome, obesity and nutritional medicine form one of the main topics. The epidemic spread of overweight and obesity, the main risk factors for the metabolic syndrome, for type 2 diabetes, cardiovascular diseases and degenerations of the joint apparatus, have enormous, ultimately "hardly foreseeable consequences for health policy," says Manns. This is an important medical area of responsibility, especially for internal medicine.
The burden on patients, but also on economic and health systems, from non-communicable diseases is an internationally prominent topic in medicine, science and politics . The number of adults with diabetes has more than doubled globally since 1980 (). In Germany alone, within decade from the end of the 1990s, the prevalence of diagnosed diabetes in the 18- to 79-year-old population has risen by 38 percent: from 5.2 to 7.2 percent ().
Diseases are central to medical lifestyle. Basic research and clinical studies are the basis for targeted prevention.
Research meets medicine. ”The main theme of this year's internists' congress in Wiesbaden could hardly have been better chosen with regard to the widespread disease diabetes: Knowledge of the pathophysiology of Diabetes, the influence of genes, lifestyle and environmental factors on the development and course of the disease has grown enormously due to basic research in recent years (). In Germany, large, state-funded translational research networks play an important role, for example the competence networks and national health research centers such as the German Center for Diabetes Research with its five network partners.
Translational Research
“One of the goals of the Congress of Internists is to show how in translational symposia, for which representatives of the national research associations have sponsored the findings from basic research can be used for clinical application, ”explains the Congress President and Chair of the German Society for Internal Medicine, Prof. Dr. med. Michael Manns from the Hannover Medical School, the concept.
Metabolic syndrome, obesity and nutritional medicine form one of the main topics. The epidemic spread of overweight and obesity, the main risk factors for the metabolic syndrome, for type 2 diabetes, cardiovascular diseases and degenerations of the joint apparatus, have enormous, ultimately "hardly foreseeable consequences for health policy," says Manns. This is an important medical area of responsibility, especially for internal medicine.
The burden on patients, but also on economic and health systems, from non-communicable diseases is an internationally prominent topic in medicine, science and politics . The number of adults with diabetes has more than doubled globally since 1980 (). In Germany alone, within decade from the end of the 1990s, the prevalence of diagnosed diabetes in the 18- to 79-year-old population has risen by 38 percent: from 5.2 to 7.2 percent ().
One third of this increase is due to demographic aging, according to the epidemiologists, the remaining proportion is probably due to changes in living conditions and behavior such as reduced physical activity and dietary changes: the prevalence of obesity, the main risk factor for type 2 diabetes , had risen in the same age group by almost 20 percent to 23.6 percent in the same period (). 67.1 percent of men and 53 percent of women are overweight.
In the German population-based KORA study (KORA-S4 and -F4), based on the results of oral glucose tolerance tests, the prevalence of undetected diabetics is 50 percent estimated the prevalence of known diabetes, also for the younger population of 35 to 59 year olds (). This means: for every two patients diagnosed with diabetes, there is statistically one diabetic with an undetected disease. In the current health report of Deutsche Diabeteshilfe, the number of diagnosed diabetics is currently around six million, of which 95 percent are type 2 diabetics (). The life expectancy of 60-year-old diabetics is said to be reduced by an average of 4.5 years compared to non-diabetics of the same age.
Heterogeneous disease
Diabetes has many faces. In recent years, the disease has proven to be significantly more heterogeneous than long suspected, especially in younger patients (). In the development of insulin resistance in type 2 diabetics, genetic factors that are associated with an increased risk of obesity or dysfunction of the beta cells of the pancreas interact with environmental influences and lifestyle in variety of ways that are still poorly understood.
Autoantibodies against the insulin-producing ß-cells of the pancreas are characteristic feature of type 1 diabetes. Recently, however, ß-cell autoantibodies were detected in just under ten percent of 1,206 type 2 diabetics between the ages of ten and 17 in US study and in 36 percent in similar age group in smaller German study (,). So-called prediabetics are also heterogeneous group with regard to diabetes-relevant metabolic characteristics, because the development of diabetes is step-by-step process: dysfunction of the beta cells and insulin resistance can already exist long before increased blood glucose concentrations are measured ().
The storage of ectopic fat in insulin-sensitive organs such as the skeletal muscle, in particular but in the liver, is considered to be the key link between overeating and the development of type 2 diabetes.
One third of this increase is due to demographic aging, according to the epidemiologists, the remaining proportion is probably due to changes in living conditions and behavior such as reduced physical activity and dietary changes: the prevalence of obesity, the main risk factor for type 2 diabetes , had risen in the same age group by almost 20 percent to 23.6 percent in the same period (). 67.1 percent of men and 53 percent of women are overweight.
In the German population-based KORA study (KORA-S4 and -F4), based on the results of oral glucose tolerance tests, the prevalence of undetected diabetics is 50 percent estimated the prevalence of known diabetes, also for the younger population of 35 to 59 year olds (). This means: for every two patients diagnosed with diabetes, there is statistically one diabetic with an undetected disease. In the current health report of Deutsche Diabeteshilfe, the number of diagnosed diabetics is currently around six million, of which 95 percent are type 2 diabetics (). The life expectancy of 60-year-old diabetics is said to be reduced by an average of 4.5 years compared to non-diabetics of the same age.
Heterogeneous disease
Diabetes has many faces. In recent years, the disease has proven to be significantly more heterogeneous than long suspected, especially in younger patients (). In the development of insulin resistance in type 2 diabetics, genetic factors that are associated with an increased risk of obesity or dysfunction of the beta cells of the pancreas interact with environmental influences and lifestyle in variety of ways that are still poorly understood.
Autoantibodies against the insulin-producing ß-cells of the pancreas are characteristic feature of type 1 diabetes. Recently, however, ß-cell autoantibodies were detected in just under ten percent of 1,206 type 2 diabetics between the ages of ten and 17 in US study and in 36 percent in similar age group in smaller German study (,). So-called prediabetics are also heterogeneous group with regard to diabetes-relevant metabolic characteristics, because the development of diabetes is step-by-step process: dysfunction of the beta cells and insulin resistance can already exist long before increased blood glucose concentrations are measured ().
The storage of ectopic fat in insulin-sensitive organs such as the skeletal muscle, in particular but in the liver, is considered to be the key link between overeating and the development of type 2 diabetes.With increasing body weight, the properties and function of adipose tissue change: Chronic inflammatory processes develop, also triggered by the accumulation of macrophages of the M1 subtype, which is stimulated by dietary fat, and they promote insulin resistance ().
Also If you are overweight, the neurobiological regulation of eating behavior changes due to the appetite-suppressing hormones insulin and leptin, which are transported from the periphery via the blood-brain barrier to the brain. For example, when there is an increased supply of insulin, the activity of insulin-binding neurons, which normally trigger an inhibition of food intake, is reduced. It is possible that such complex neuronal and endocrine control circuits as well as “molecular biological memory” play role that the prevention of secondary diseases in obesity and diabetes is difficult in practice.
The question of which diseases, disease-related events or metabolic changes The aim of preventive programs should be what the appropriate target groups are and which preventive measures should be taken with what human and financial effort is controversial topic in Germany (,). It is also topic at the Congress of Internists.
Social risk factors
A low social status has long been known as risk for obesity, but the incidence in Germany is also increasing regardless of social status. The biological consequences of stress and lack of sleep: Neuroendocrine control circuits change, which increase sensitivity to food stimuli and appetite (). Physical activity then does not outweigh the excessive consumption of energy. The goals of prevention could also be to improve sleep and the social environment.
Structured, interdisciplinary programs that combine reduced calorie intake with nutritional advice and motivation to exercise are complex. However, they have proven to be effective and effective in the long term, according to Prof. Dr. med. Stephan C. Bischoff, speaker of plenary lecture at the Congress of Internists. Bischoff is Managing Director of the Institute for Nutritional Medicine at the University of Hohenheim and Head of the Center for Nutritional Medicine at the University Clinic Tübingen.
One of the major studies on this topic was carried out under the leadership of his institute (). 37 German centers included total of 8 296 obese patients (body mass index> 30 kg / m2). With the help of 52-week weight reduction program (Optifast®), women lost an average of 15.2 kilograms of body weight (intention-to-treat analysis) and men 19.4 kilograms; the waist circumference decreased by an average of eleven centimeters.With increasing body weight, the properties and function of adipose tissue change: Chronic inflammatory processes develop, also triggered by the accumulation of macrophages of the M1 subtype, which is stimulated by dietary fat, and they promote insulin resistance ().
Also If you are overweight, the neurobiological regulation of eating behavior changes due to the appetite-suppressing hormones insulin and leptin, which are transported from the periphery via the blood-brain barrier to the brain. For example, when there is an increased supply of insulin, the activity of insulin-binding neurons, which normally trigger an inhibition of food intake, is reduced. It is possible that such complex neuronal and endocrine control circuits as well as “molecular biological memory” play role that the prevention of secondary diseases in obesity and diabetes is difficult in practice.
The question of which diseases, disease-related events or metabolic changes The aim of preventive programs should be what the appropriate target groups are and which preventive measures should be taken with what human and financial effort is controversial topic in Germany (,). It is also topic at the Congress of Internists.
Social risk factors
A low social status has long been known as risk for obesity, but the incidence in Germany is also increasing regardless of social status. The biological consequences of stress and lack of sleep: Neuroendocrine control circuits change, which increase sensitivity to food stimuli and appetite (). Physical activity then does not outweigh the excessive consumption of energy. The goals of prevention could also be to improve sleep and the social environment.
Structured, interdisciplinary programs that combine reduced calorie intake with nutritional advice and motivation to exercise are complex. However, they have proven to be effective and effective in the long term, according to Prof. Dr. med. Stephan C. Bischoff, speaker of plenary lecture at the Congress of Internists. Bischoff is Managing Director of the Institute for Nutritional Medicine at the University of Hohenheim and Head of the Center for Nutritional Medicine at the University Clinic Tübingen.
One of the major studies on this topic was carried out under the leadership of his institute (). 37 German centers included total of 8 296 obese patients (body mass index> 30 kg / m2). With the help of 52-week weight reduction program (Optifast®), women lost an average of 15.2 kilograms of body weight (intention-to-treat analysis) and men 19.4 kilograms; the waist circumference decreased by an average of eleven centimeters.
The prevalence of metabolic syndrome decreased by 50 percent and the incidence of high blood pressure from 47 to 29 percent, both changes were highly significant. The benefits of weight loss have been proven over three years and have been associated with significant improvement in quality of life.
Changes in vitamin requirements
The working group around Bischoff also found that obesity has need for Micronutrients such as vitamins A, C and D, selenium and iron is increased and the increased requirement is not always balanced even by protein-rich formula diet products (). “Conservative obesity therapy, which has been declared dead, is gaining attention again through such data. Without successful conservative therapy - despite bariatric surgery - we have no chance of treating the millions of people affected in Germany alone, "says Bischoff. The cluster-randomized DaQing Diabetes Prevention Study from China () shows that the positive effects of lifestyle interventions (diet and sport) have long-lasting effect. It started in 1986 with 577 patients with reduced glucose tolerance (plasma glucose ≥ 6.67 mmol / L; 2h value after 75 g glucose). The subjects were randomized into three lifestyle intervention groups and one control group and were cared for for six years: Even 23 years after the start of the study, all-cause mortality and the incidence of diabetes were significantly reduced.
Dr. rer. nat. Nicola Siegmund-Schultze
@Literature on the Internet: www./lit1714
The prevalence of metabolic syndrome decreased by 50 percent and the incidence of high blood pressure from 47 to 29 percent, both changes were highly significant. The benefits of weight loss have been proven over three years and have been associated with significant improvement in quality of life.
Changes in vitamin requirements
The working group around Bischoff also found that obesity has need for Micronutrients such as vitamins A, C and D, selenium and iron is increased and the increased requirement is not always balanced even by protein-rich formula diet products (). “Conservative obesity therapy, which has been declared dead, is gaining attention again through such data. Without successful conservative therapy - despite bariatric surgery - we have no chance of treating the millions of people affected in Germany alone, "says Bischoff. The cluster-randomized DaQing Diabetes Prevention Study from China () shows that the positive effects of lifestyle interventions (diet and sport) have long-lasting effect. It started in 1986 with 577 patients with reduced glucose tolerance (plasma glucose ≥ 6.67 mmol / L; 2h value after 75 g glucose). The subjects were randomized into three lifestyle intervention groups and one control group and were cared for for six years: Even 23 years after the start of the study, all-cause mortality and the incidence of diabetes were significantly reduced.
Dr. rer. nat. Nicola Siegmund-Schultze
@Literature on the Internet: www./lit1714
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