Individual treatment in accordance with the latest research

How is diabetes related to stress and depression?

Comparable to diabetes mellitus, other lifestyle-related conditions like stress and stress-related diseases are on the rise. Cortisol is a major hormone produced by the adrenal gland that is essentially required to adapt the organism’s metabolism in response to stressful stimuli. This results in a rapid mobilization of energy resources that are required to cope with the challenge. However, permanent overproduction of cortisol may also result in negative consequences like loss of muscle mass and impairments of glucose metabolism ranging from increased blood glucose concentrations to diabetes mellitus. Furthermore, antidepressant therapy is frequently associated with metabolic aberrations that are mainly due to the commonly observed weight increase of patients treated with antidepressants. Taken together, the hormonal and metabolic changes associated with stress, depression and diabetes have a great deal in common and share an interesting background.

How is diabetes related to nutrition and the microbiome?

The current focus of one research project conducted at Dresden diabetes center is on the metagenome of morbid obese patients with type-2 diabetes who underwent gastric bypass surgery. Interestingly, shortly after operation a dramatic improvement of glucose metabolism can be usually observed in these patients, even before weight loss. In a pilot study, the Dresden group analysed the intestinal metagenome of patients before and 3 months after gastric bypass surgery. Interestingly, it turned out that the metagenome in all observed patients rapidly changed from a pattern associated with a high risk for diabetes into a pattern with a lower risk. This study thereby provided the first evidence for an essential role of the gut microbiome in the anti-diabetic effects of gastric bypass surgery. In the near future further exciting and important insights can be expected from this new field of research and we are now only beginning to understand the comprehensive role of the gut flora in human health and disease. The long term goal of Professor Bornstein and his team is to develop metagenome-based approaches for the development of novel strategies for the prevention and treatment of diabetes.

Has diabetes a genetic background?

Diabetes is a multifactorial disease and in particular the recent genom-wide association studies (GWAS) have revealed a more or less strong association of several genes with the risk to develop type-2-diabetes. For example, TCF7L2 has been identified as a gene with the strongest risk associated with the development of type-2-diabetes. However, things are much more complex due to the fact that a variety of other, mostly still unknown factors are essentially involved in the regulation of gene expression. These – so-called epigenetic - factors may be of environmental or microbial origin and are thought to be the true risk determinants responsible for the interplay of different genes resulting in an individual’s risk constellation.

How can we cure diabetes? – shift in paradigm

Whole organ pancreas and pancreatic islet transplantation are currently the only options available to replace the insulin-producing ß-cells in patients. Both therapeutic options can provide good control of diabetes and a prevention or stabilization of diabetic complications. The insulin producing cells are isolated from the pancreas (donor organ), purified, and then injected into the blood vessels of the liver of the diabetic patient (recipient) through a small abdominal incision. The pancreatic islet cells engraft in the liver and start to produce the recipient with insulin. In 2008, the Dresden Diabetes Center successfully launched an islet cell transplant program for the treatment of type-1-diabetes. The primary goal of this therapeutic option represents enhanced metabolic control, prevention of severe complications and significant improvement of quality of life. However, cell and organ transplantation is generally at the price of permanent immunosuppression, thereby making the patient prone to infections and other potentially severe side effects. Therefore, this therapy is restricted only to a small subset of diabetic patients that need to fulfill a number of specific criteria.

In this situation, novel therapeutic options are urgently needed. A new, visionary development could soon become reality: the Dresden scientists currently explore a small capsule harbouring insulin producing cells that was originally in Israel. This bioreactor is designed as an implantable device working as an artificial islet organ in order to supply diabetic patients with insulin. The unique advantage of this novel technique is that it effectively separates the donor cells from the recipient’s immune system, thereby making the traditional immunosuppressive therapy completely dispensable.

How can we prevent diabetes?

Type-2-diabetes is the most common metabolic disorder in the world. Currently, with more than 6 % of the world’s adult population we are experiencing an epidemic growth of the number of patients suffering from type-2-diabetes. The Dresden diabetes center introduced the first professorship for research on prevention and care of diabetes in Europe and offers specialized and customized programs aimed at an early detection and potential prevention of the disease. The Dresden diabetes competence center also developed the first European guideline for diabetes prevention and training programs to educate certified prevention managers. This concept is today used in more than 20 countries in the European Union and also introduced into practical diabetes care.