A New Beginning in Diabetes Therapy – Health

More and more children are diabetic. For them and their families, the diagnosis means a significant change, but above all there is a risk of complications – all the more so the later the diabetes is diagnosed. The diabetologist Anette-Gabriele Ziegler therefore advocates screening all children so that they can be treated as early as possible.

SZ: Why are more and more children diabetic?

Anette-Gabriele Ziegler: Childhood diabetes is an autoimmune disease, the body’s own immune system destroys the beta cells in the pancreas. As a result, it can no longer produce enough insulin. There is a genetic predisposition for this, but there are also external influences. There is growing evidence that viruses play a role in this: they infect and damage beta cells, triggering autoimmune reactions that lead to cell destruction.

When it comes to viruses, one immediately thinks of corona viruses in these times. Is the rise in childhood diabetes related to the pandemic?

The new coronavirus Sars-CoV-2 can actually infect the beta cells. And even if type 1 diabetes, which occurs in children, has been increasing for a long time: During and after the pandemic, it increased again by leaps and bounds. Health insurance data also indicate a connection between corona infections and diabetes in children. However, further studies are needed here.

The increasing obesity is not behind it?

Type 1 diabetes originally had nothing to do with obesity, unlike type 2 diabetes in adults. But consistently overeating puts ongoing stress on the pancreas. In this respect, obesity in children can certainly play a part in the increase in diabetes, especially if a child is already predisposed to this autoimmune disease.

Anette-Gabriele Ziegler heads the Institute for Diabetes Research at the Helmholtz Center in Munich, also teaches at the Klinikum Rechts der Isar of the Technical University of Munich and is Chairwoman of the Diabetes Research Group

(Photo: Matthias Tunger/Matthias Tunger Photodesign)

They demand that all children should be examined for diabetes as part of the U-examinations. For what reason?

We can detect the antibodies that destroy the beta cells before the child develops clinical diabetes, before the beta cells are completely destroyed. This can prevent dangerous derailments of the metabolism. The children do not lose weight and do not have to go to the hospital. As part of the Fr1da study in Bavaria, early detection has been offered for eight years. During this time, only two percent of the children with the diagnosis developed dangerous hyperglycaemia; without early detection, it affects 40 percent of the children.

Why is there so much time between the appearance of autoantibodies and the onset of the disease?

The pancreas is only slowly destroyed by the immune cells. It takes time for this to affect metabolism. Sometimes the beta cells stop working properly within a year or two, but sometimes it takes 15 years before a patient needs to inject insulin.

Why are the differences so big?

It depends on the patient’s immune response, and we can even roughly predict what will happen. We don’t know exactly how long it takes for a patient to become insulin dependent. But if we find a certain type of antibody in his blood at high levels, we know it’s going to be fast. These antibodies often only develop over time.

Apparently, a new drug can even delay the onset of diabetes…

The drug has already been approved in the USA and will soon be available in Europe as well. It is an antibody that affects immune cells. If you give the drug for 14 days, the destructive T-cells disappear and the good T-cells, the peacekeepers so to speak, increase proportionately. Studies have shown that it can delay the onset of diabetes for three years. And it is already being investigated whether this can be extended by giving the drug again. So far there was only insulin, nothing more. After 100 years of insulin therapy, a therapy for the immune system is now available for the first time, with very mild side effects, as far as we can see so far. This is a real fresh start.

An SZ health forum on the subject of “Children with diabetes – how to get good treatment” will take place on Monday, April 17 at 7:30 p.m. During the online event, interested parties can ask the experts questions. Participation is free, registration is required: sz-erleben.sueddeutsche.de/sz-veranstaltungen

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