When he talks about diabetes, it gets quiet in the auditorium. Prof. Fritsch works at (the) University Hostpital Tübingen. ©privat

Is diabetes our own fault or does it occur due to our living conditions? An interview with the diabetologist Prof. Dr. Fritsche from Tübingen University Hospital.

Not only Prof. Fritsche has been distinguished by the German magazine FOCUS as diebetologst, but the University Hospital in Tübingen also has an excellent reputation for the treatment of diabetes. We talked to Prof. Fritsche about the stay in his clinic and the therapeutic chances of success for diabetes.

Clinic Compass: Prof. Fritsche, why did you choose to work in the field of diabetology?  

Prof. Fritsche: I have always been interested in diabetology because diabetes is such a widespread disease. Six to eight million Germans are affected by it, which is almost every tenth person. In a clinic like the University Hospital Tübingen, where there is a maximum of medical care, about one third of all patients has been diagnosed with diabetes. The fact that the disease affects many organ systems is interesting for us and at the same time devastating for the patient. The pathophysiology is complicated and parts of it remain unexplained. Also, the therapy is also very complex and interdisciplinary. That is what makes diabetology so interesting for me.

Clinic Compass: Especially in the Arab region, many people suffer from diabetes. Did the number of people diagnosed with diabetes increase over the last years?

Prof. Fritsche: Yes, the number of diagnosed people rises. This is the case in Germany, but more particularly in second and third world countries such as India, China, Mexico and also countries of the Arab region. Nutrition is always considered to be the main cause. But this is too simple. The most important factor for the growing number of diabetics is that our population is ageing. The major risk factor for type 2 diabetes is age. Factors like exercise and nutrition are just as important for heart diseases and cardiovascular diseases as for diabetes. Strangely enough, a poor diet is always primarily associated with diabetes. Diabetes is actually much more complex than the ordinary nutritional disease that it is often seen as. Diseases such as dementia can also be related with diabetes. During pregnancy, there are problems with pre-existing diabetes, there is a new form of gestational diabetes which occurs during pregnancy. Diabetes can cause eye, kidney, nerve and vascular problems. There are a lot of factors that you have to consider when taking care of diabetes patients. You cannot reduce the disease to counting calories.

Clinic Compass: Are there any developments in the field of the therapy of the disease? Has the treatment changed in the past decades?

Prof. Fritsche: When you look at the drug therapy: twenty, thirty years ago, insulin and one or two active substances as tablets existed. Today there are not only at least five different oral treatment possibilities but also different kinds of insulin and insulin therapies available. Thus, the therapy of type 1 and 2 diabetes improved significantly.

Clinic Compass: Can you tell us something about the everyday life in the clinic? How is it organized, how does the exchange with the patients take place?

Prof. Fritsche: Diabetes manifests itself in the form of many different symptoms, that is why the attending physician has to think in interdiscipinar terms. Medical care in our clinic is organized in a way that we have a special ward for diabetes where patients are received on Mondays and discharged on Fridays. We pursue a special concept: patients sit together with doctors and we partially treat the patients in a group. That way, the biggest possible learning effect can be reached and it results in the biggest motivation possible not only for the patient but also for the assistant doctor. Another advantage is that after the discharge, the patient gets an outpatient aftercare, even if it is only limited. Thus, the assistant doctor sees the chronic patient not only on the ward but also later in the special outpatient clinic. As a result, he can find out whether the therapy that he used works or there are any adjustments necessary.

Clinic Compass: What about the sense of achievement in the therapeutic practice of diabetology? What motivates young doctors on your ward? What motivates you?

Prof. Fritsche: There is an immediate performance review once you see the patients again on an outpatient basis. Most of the time, they feel better thanks to our therapy. In addition, we have a consultation before and after treatment during which the doctor and the assistant doctor discuss and determine the therapy with the patient. The “discharge ceremony”, as I like to call the discharge interview, is a great achievement for young doctors because most patients are very thankful. You get another kind of feedback than from emergency patients who are treated for two or three days.

Clinic Compass: You mention the age as an important cause for diabetology. The Western societies are ageing. What would have to happen so that the number of patients decreases?

Prof. Fritsche: There are two different kinds of prevention: behavioural prevention and situational prevention. Situational prevention is largely a matter of politics and society. Our living environment has to be changed in a way that it becomes healthier. This includes measures to reduce highly sugared food, but also to provide a healthy environment, create opportunities to get exercise and obtain better air quality in cities. Behavioural prevention deals with the individual person. The same applies to every medical activity: I have to find the people with the greatest risk of disease. It is part of our research to identify the groups with the highest risk of diabetes. Then, we have to help these people at risk of disease by applying specifically adapted and individual prevention and treatment programs.

Prof. Fritsche, thank you for the interview.

Prof. Dr. Andreas Fritsche holds the Chair of Nutritional Medicine and Prevention in the field of diabetology of the University Hospital Tübingen. He also heads the department “Prevention and therapy of type 2 diabetes” at Paul Langerhans Institute Tübingen.