In the past, it was often terrible when Dominik Ewald suspected diabetes in one of his little patients. Then excited parents came to his practice in Regensburg with a child who was not doing well at all. “The child was nauseous, it had to vomit, consciousness was often already impaired because the blood sugar level was so high,” said the board member of the Bavarian state association of the professional association of paediatricians during a SZ health forum on the “topic of children and diabetes – how a good treatment succeeds”. The blood sugar was then frantically measured, and the child was later possibly taken to the hospital, where it received urgent insulin therapy. “It was a dramatic, often traumatic experience for parents and child,” says Ewald.
In the last few years the situation has changed. Since 2015, as part of a research study, the paediatrician has been examining all his patients at primary school age during their U-examinations to see whether they are developing type 1 diabetes. In contrast to type 2, which is mainly caused by obesity, this variant of diabetes is an autoimmune disease in which the body’s own immune system gradually destroys the insulin-producing beta cells in the pancreas.
Now the panic factor is gone – thanks to the screening
If certain autoantibodies are found during such an examination, this is a sure sign of the presence of pre-diabetes, said Anette-Gabriele Ziegler, director of the Institute for Diabetes Research at the Helmholtz Center Munich and professor at the Technical University of Munich, during the SZ -Health forums. This pre-diabetes will develop into diabetes in the years that follow. Since Dominik Ewald made the diagnosis not only in the case of acute hyperglycemia, but already as part of the early detection examination, the panic factor in his treatment room has certainly disappeared. “You can clarify everything in peace, talk to the parents and prepare them,” said Ewald. The pediatrician is therefore committed to expanding screening, which has so far only been carried out in a few federal states – in Bavaria, Saxony and Lower Saxony – as part of studies.
However, critics fear that the screening could also have negative consequences – for example if false-positive results unnecessarily worry parents and children. Anette-Gabriele Ziegler emphasized that this risk was minimal. A double double bottom is used in the tests, so to speak. “Pre-diabetes is only assumed if two blood samples from the same patient show up in two different tests.”
From the point of view of the experts at the SZ Health Forum, the benefits of screening will soon increase when a new drug called teplizumab, which has already been approved in the USA, also comes onto the market in Germany. If a patient receives a 30-minute infusion with this drug every day for 14 days after the discovery of pre-diabetes through early detection, the onset of diabetes is delayed by at least three years, said diabetologist and pediatrician Olga Kordonouri, medical director of the children’s hospital “Auf der Bult” in Hanover, during the SZ Forum. This is positive because the patients get healthy years as a gift and are older and more sensible when they have to deal with their blood sugar levels, says Kordonouri. In addition, the risk of late effects and long-term complications is reduced, Ziegler added: “Early detection avoids dangerous metabolic imbalances and the body’s own insulin production is maintained for longer. In addition, therapy can be started at exactly the right time and the burden on families is lower.” All this means great advantages for the patients.
The filmmaker Bastian Niemeier reported how big the shock was when he was diagnosed at the age of 12 his Youtube channel “Diabetes without borders” informed about the disease and its treatment options. Today, when he talks to concerned parents whose child has been diagnosed with diabetes, he says: “There has never been a better time to get diabetes.”
“For me, diabetes has taken a back seat”
When Niemeier received his diagnosis nine years ago, he still had to measure his blood sugar six to eight times a day. He now wears an “Automatic Insulin Delivery System”, an AID. It consists of a sugar sensor in the upper arm and an insulin pump connected to it, which injects as much insulin into the stomach as the readings from the sensor indicate is needed. “This system does the work for me,” said Niemeier. “I get the value on my cell phone every five minutes and can eat something if hypoglycaemia occurs.” However, you also have to trust the system, he says. “I can no longer easily intervene in the insulin administration myself, so I give the system some responsibility.”
Even though Niemeier received his diagnosis without warning at the time, he has now gotten used to his diabetes. The illness hardly limits him. “Of course type 1 diabetes is a burden, I don’t want to sugarcoat that,” he said. “But today you can live very well with the disease. With the automatic system, the diabetes has moved into the background for me.” He often does not even notice when the system has to inject insulin because he has misjudged the calories he is consuming, has not slept enough or is too stressed.
The technology is a blessing, said diabetologist and pediatrician Olga Kordonouri. The first systems of this type are approved from the age of one year, tissue sensors for glucose measurement even from birth. “Kids grow into that,” she said, “and the younger a child is, the faster they learn to deal with it.”
Olga Kordonouri is convinced that technology will continue to advance in the future and become more and more reliable and sophisticated. Better and better insulins are also being developed – such as those that work faster.
In the future, diabetes may even be curable
One day, young patients today might not even need insulin at all, said Anette-Gabriele Ziegler – either because the disease can be postponed more and more with new drugs. Or because the diabetes could possibly even be reversed, even if it has already broken out. Scientists are trying to transplant fresh beta cells into patients to replace the destroyed cells and produce insulin. “So far, this has been difficult because the transplanted cells are immediately destroyed again by the patient’s immune system. But work is being done to package them so that the immune system cannot recognize them, or to tag them with signals so that the immune system is suppressed. “
In studies, Ziegler is also examining other methods of preventing the onset of diabetes. So she tries to hyposensitize children to diabetes – similar to allergies. “We give children insulin powder to eat to make the immune system tolerant to the hormone,” said Ziegler. She hopes that the destructive autoimmune processes against the beta cells will then not even begin. In another study, she gave newborns a probiotic to prevent diabetes. “We know that the intestinal bacteria in children who have diabetes are composed differently in the first years of life, which may increase the disposition.” She expects the results of her studies in the coming years. For prophylaxis, parents can only be recommended to keep an eye on their children’s vitamin D levels. “The levels of this vitamin are noticeably low in the affected children,” said Ziegler. This is also known from other autoimmune diseases.
All in all, the experts at the SZ Health Forum looked to the future with hope. Even if more and more children are getting sick, there has never been a better time to get diabetes. And it will probably only get better in the future.