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Diabetes mellitus type 2 is a widespread disease affecting more than eight million people in Germany. In recent decades, the number of patients has increased significantly, including in other industrialized countries. In the past, type 2 diabetes was primarily a disease of the elderly. That's why he was often referred to as "adult onset diabetes".

Meanwhile, important risk factors of the disease (such as overweight, lack of exercise) often already at a young age. As a result, young adults and even children are becoming increasingly ill with Type 2 diabetes. The term "adult onset diabetes" has thus lost its validity.

Many people with type 2 diabetes are obese (obese) and older. The diabetes itself often causes no symptoms for a long time (asymptomatic course). Sometimes it also causes nonspecific symptoms such as tiredness, lack of concentration, itching or dry skin. In addition, the abnormally high blood sugar level makes patients more susceptible to infections, such as the skin and mucous membranes (such as fungal infections) or the urinary tract.

If the type 2 diabetes has already led to secondary diseases, corresponding symptoms can also occur. These can be, for example, blurred vision or even blindness due to diabetes-related retinal damage (diabetic retinopathy). If the constantly elevated blood sugar levels have damaged the vessels and nerves, poorly healing ulcers and wounds can develop on the foot or lower leg (diabetic foot).

The diabetes type 2 treatment aims to permanently lower the elevated blood sugar levels to a healthier Nievau. This is the only way to prevent severe complications of type 2 diabetes.

To monitor the success of therapy, the HbA1c value is determined at regular intervals. In non-diabetics, it is generally less than 6.0 percent. In diabetes type 2 patients, he often goes much higher untreated. They are usually advised to aim for a HbA1c target of 6.5 to 7.5 percent during therapy. Elderly people who do not have typical diabetes symptoms may also be better off with a higher target.

In general, how much the blood sugar level should be lowered in individual cases depends on the age and the general state of health of the patient as well as on any comorbidities (high blood pressure, lipid metabolism disorders, obesity, etc.).

A successful diabetes type 2 treatment also includes the therapy of such comorbidities. This helps to positively influence the course of the disease.

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People with diabetes may need to take insulin or other diabetes medicines. Learn more about diabetes medicines and other treatment options for diabetes. 2020-03-09 Diabetes Treatment
Profiles of Doctors for Diabetes Treatment
Diabetes Treatment

Germany is one of the leading countries in diagnosis and treatment of endocrine diseases. Modern medical consultation and therapy methods not only affect the disease progress, but also help patients with diabetes mellitus to reduce the symptoms.

Here you find the information about services offered by certified Diabetes Centres in Germany.

Diabetes mellitus – urgent issue of our lifetime

According to statistical data 10 percent of Germans aged 20 to 79 have Type 1 or Type 2 diabetes. Nowadays 8 percent of the global population have diabetes. Treatment of diabetes mellitus is one of the main problems of modern medicine due to the large number of patients exposed to diabetes mellitus and numerous secondary diseases associated with it (cardiovascular disease, myocardial infarction, stroke, renal insufficiency, eye disease and limbs amputation risks).

Certified Diabetes Centres in Germany. Certification of German Diabetes Association (DDG).

The certification of Diabetes Centres in Germany is carried out in accordance with quality of standards of German Diabetes Association (DDG).

List of certified Diabetes Centres in Germany:

  • Medical centres specialized in treatment for Type 2 diabetes
  • Medical centres specialized in treatment for Type 1 diabetes
  • Centres for diabetes treatment in children and teenagers

Types of Diabetes Centres:

  • Out-patient clinics (health care facilities without ambulatory care)
  • In-patient clinics (health care facilities with ambulatory care)
  • Health care facilities as part of out-patient clinic/university hospital
  • Ambulatory care clinics with the opportunity to stay only by day or at night
  • Private clinic
  • Others

List of services offered by German Diabetes Centres

Treatment for Type 2 diabetes:

  • drug treatment
  • conventional insulinotherapy
  • intensive insulinotherapy (flexible insulin therapy)
  • adaptation to insulin therapy

Treatment for Type 1 diabetes:

  • intensive insulinotherapy (flexible insulin therapy)
  • use of insulin pump
  • adaptation to insulin therapy
  • daily measurement of blood pressure (with Guardian REAL-Time System)
  • gathering and elaborating of information with computer-assisted systems

Diabetes treatment during pregnancy:

  • Medical consultation concerning nutrition, if necessary preparing to insulin therapy
  • Treatment and care for pregnant women with Type 1 diabetes
  • Treatment and care for pregnant women with Type 2 diabetes
  • Close cooperation with specialists in gynaecology and midwifery
  • Blood sugar control after birth

Treatment of secondary diseases associated with diabetes mellitus

Diabetic foot

  • regular foot examination
  • If necessary, the staff will treat the wound and help you to find appropriate shoes
  • cooperation with skilled specialists like orthopaedists, surgeons and vascular surgeons

Affection of nerves of the lower limbs in diabetic patients

  • regular peripheral nervous system examination of the lower extremities
  • cooperation with neurologists

Renal affection in diabetic patients

  • regular urinanalysis to indicate the amount of protein
  • renal sonography (ultrasound of the kidney)
  • cooperation with nephrologists

Erectile dysfunction

  • drug treatment
  • cooperation with andrologists

Affection of the visual system in diabetic patients

  • regular examination of the eyeground by ophthalmologist

Affection of the cardiovascular system

  • screening of coronary arteries with electrocardiography (ECG) and cardiac stress test
  • echocardiography for examination of the heart function
  • duplex ultrasonography to exam cerebral blood vessels and lower extremities

Surgical Treatment for Diabetes Mellitus

Surgical Treatment for Type I Diabetes

In the presence of certain strict indications (frequent and severe acute complications of diabetes, serious late complications, the ineffectiveness of conventional treatment) in Germany clinics resort to such high-technology surgical treatments for type I diabetes as isolated pancreas transplantation and simultaneous pancreas and kidney transplantation. These technically complex surgical interventions make it possible for patients to give up insulin injections, but they require a lifelong intake of drugs that suppress the immune system so as to prevent the rejection of transplanted organs.

Recently, thanks to the improvement of immunosuppression strategies, late fates of pancreas transplantations have improved. One of the promising policies of treatment to improve glucose control in patients with type I diabetes, in many cases leading to insulin independence, is pancreatic islet cell transplantation. This innovative high-technology treatment for type I diabetes is a safer alternative to pancreas transplantation. Islet cell transplantation has no major surgical risk and creates good prospects for glycemic control. For islet cell transplantation a minimally invasive percutaneous portal embolization technique is used: islets isolated from a donor pancreas are introduced into the liver via a catheter inserted into the portal vein.

The use of new techniques aimed at preventing the rejection of transplanted tissues makes it possible for the islets transplanted into the liver to function for quite a long time.

Surgical Treatment for Type II Diabetes

The age of patients diagnosed with type II diabetes, the most common form of this disease, is steadily decreasing. The main reasons for this are obesity and hypodynamia already in their younger years. Numerous studies in recent years have identified obesity as a key cause of type II diabetes. In 80% of patients with type II diabetes, the body weight exceeds the ideal one by 15% or more. Obesity is associated with insulin resistance. Insulin resistance can be caused by a decrease in the number of insulin receptors and their defects. The adipose tissue itself, with its endocrine function, secretes substances that affect the sensitivity of tissues to insulin.

German doctors consider achieving optimal body weight through lifestyle modification (a reduced energy value of food and regular exercise) to be the primary task in the treatment of patients with type II diabetes. Dietotherapy, which is the foundation of treatment for a significant proportion of patients, in combination with physical activity leads to a natural recovery of the normoglycemic state. If the blood glucose level cannot be controlled by these measures, hypoglycemic drugs are prescribed to ensure the compensation in diabetes and maintain an active lifestyle for many years.

The treatment protocols developed by German specialists include highly effective newest antidiabetic drugs, many of which have unique properties. Under certain conditions ‒ pregnancy, intercurrent diseases, surgeries, ineffectiveness of nutritional therapy and oral medications ‒ patients with type II diabetes need to use insulin either temporarily or permanently.

The desire to reduce the level of glycemia in patients with type II diabetes mellitus by using natural means, to minimize the use of drugs or completely eliminate them has led to the rapid development of the techniques of bariatric surgery ‒ weight loss surgery. Different types of gastrointestinal surgical procedures, originally developed for the treatment of obesity, often lead to the normalization of blood glucose levels, reduce or eliminate the need for drugs. The distinct positive effect of such operations served as the basis for the emergence of a new branch of medicine ‒ interventional diabetology.

At present experts of the International Diabetes Federation consider bariatric surgery as a complete method for the treatment of type II diabetes and recommend using it at earlier stages of the disease. In Germany, along with the classic bariatric operations performed, as a rule, by using a sparing laparoscopic technique, innovative minimally invasive techniques are also used. One of them is the TANTALUS system of gastric stimulation. The principle underlying it is the implantation of special stimulants that control the muscle activity of the stomach during meals. The system is already used by several hundred European patients. German doctors believe that innovations like the TANTALUS system can be an excellent alternative to traditional surgical techniques of treating diabetes.

Another promising technique is called the EndoBarrier Gastrointestinal Liner. During gastroscopy, a thin Teflon tube is inserted into the upper intestine, which creates a mechanical obstacle to food contact with the intestinal walls throughout the duodenum and partially the jejunum. This helps to reduce the absorption of substances and caloric value of eaten foods. German doctors consider the EndoBarrier therapy to be a sparing and very effective technique. In comparison with the existing surgical techniques of treatment, the EndoBarrier is not traumatic; the risk of postoperative complications is minimal. The technique helps to significantly reduce the content of glucose in the blood and decrease or completely eliminate the need for taking antidiabetic drugs in 80% of patients. The tube is removed a few months after the operation.

Clinics in Germany successfully practise one of the newest techniques for treating diabetes ‒ extracorporeal hemocorrection, a high-technology procedure based on modern bio- and nanotechnologies. Extracorporeal hemocorrection (gravitational blood surgery, efferent therapy) is a group of modern medical techniques based on the treatment of blood components (plasma, lymphocytes, platelets, erythrocytes, etc.) outside the patient’s body. The purpose of extracorporeal hemocorrection is to change the properties of blood components or to remove harmful substances that cause or maintain the disease. The main effects of extracorporeal hemocorrection are overcoming the development of drug resistance, the intensity of side effects by reducing the dose of the drug; improvement of blood flow, microcirculation in the tissues. Indications for the procedure of extracorporal hemocorrection in diabetic patients are unstable course of the disease; resistance to exogenous insulin; a high level of antibodies against pancreatic β-cells, anti-insulin antibodies, hyperlipidemia; increasing doses of drugs used; the development of complications of the disease. As a result of the procedure, it is possible to achieve an increase in sensitivity to glucose-lowering drugs, to reduce their dosage and glycemia level; to reduce the intensity of angiopathy, neuropathy, nephropathy; to prevent further progression of vascular and neurological complications.

Latest News in Diabetes Treatment

New antigen for type 1 diabetes confirmed

04.07.2019

Scientists at the Research Center for Regenerative Therapies in Dresden, the Helmholtz Zentrum München and the German Center for Diabetes Research have identified four autoantigens that have recently been discovered to be associated with autoimmune diseases associated with the HLA genotype. For example, the HLA genotype plays a role in disease development of type 1 diabetes. Thus, HLA genes are known which increase or decrease the susceptibility to type 1 diabetes. Autoantibodies directed against these new antigens appear to be more prevalent in patients with certain genotypes shortly after the onset of type 1 diabetes.

In cooperation with the Dresden University of Technology and the Institute for Diabetes and Obesity at the Helmholtz Zentrum München, researchers from the Institute for Diabetes Research as partners in the German Center for Diabetes Research have tested new antigens for their association with type 1 diabetes. The scientists studied patients with type 1 diabetes shortly after onset of the disease for antibodies against three proteins involved in nuclear repair or transport processes - namely MLH1, NUP50 and PPIL2 - as well as antibodies to the translation initiation factor MTIF3, which is involved in the production of Proteins of mitochondria involved. The scientists wanted to gain some insight into how immunity, or, in contrast, increased susceptibility to autoimmune diseases arises.

Blood analysis revealed the following results: In patients, autoantibodies to the four new antigens were significantly more common than those in healthy controls. Patients with HLA DR3 genotype had more frequent antibodies to NUP50. If they had an HLA DR4 genotype, antibodies to MLH1 were found more frequently.

To date, the measurement of autoantibodies against four other antigens provides very reliable indications for the early detection of type 1 diabetes: they are antibodies against the endogenous hormone insulin, glutamate decarboxylase 65 (GAD65), tyrosine phosphatase (IA- 2) and the zinc transporter 8 (ZnT8). Since these antigens often initiate an autoimmune process that can later lead to type 1 diabetes, they serve as immune markers in early detection studies such as the Fr1da study or the NHS TrialNet study of the Institute for Diabetes Research at Helmholtz Zentrum München. Their detection indicates an asymptomatic early stage of type 1 diabetes.

However, autoantibodies to the newly discovered antigens will probably not be used in screening for type 1 diabetes, although they have been shown to be associated with it. "The newly discovered antigens are less important target targets for diabetes-specific autoantibodies because they only occur in subgroups of patients," said one of the first authors, Tanja Telieps.

Nonetheless, antigenicity may be of concern to affected patients, as study leader Professor Ezio Bonifacio notes: "The autoimmunity to individual proteins associated with the nucleus or mitochondria in a subgroup of patients may be indicative of systemic autoimmunity his. This would show for the first time that some patients with type 1 diabetes also show signs of systemic autoimmunity. This new finding may be important in elucidating the pathogenesis of type 1 diabetes."

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