Digital is the future: prevention and aftercare for diabetes – a conversation with Prof. Boris Schmitz
As part of International Diabetes Awareness Month in November, we talk to Prof. Boris Schmitz from Witten/Herdecke University about prevention, digital aftercare and the role of modern research in dealing with chronic diseases.
November ist der weltweite Diabetes Awareness Month – eine Zeit, die ganz im Zeichen der Aufklärung, Prävention und Unterstützung für Menschen mit Diabetes steht. Der Aktionsmonat erinnert an den Geburtstag von Dr. Frederick Banting, der 1921 das lebensrettende Insulin entdeckte, und ruft dazu auf, das Bewusstsein für Risikofaktoren, Früherkennung und moderne Therapieansätze zu stärken. Im Rahmen dieses besonderen Monats haben wir mit Boris Schmitz, Professor für Rehabilitationswissenschaften der Universität Witten/Herdecke gesprochen. Prof. Dr. Schmitz ist Principal Investigator des EU-geförderten Forschungsprojekts TIMELY, welches die patientenzentrierte digitale Nachsorge bei chronischen Erkrankungen wie der koronaren Herzkrankheit untersucht. Gemeinsam haben wir über die Bedeutung von Prävention, die Rolle moderner Forschung und die Chancen digitaler Monitoringlösungen im Umgang mit Diabetes diskutiert.
SEMDATEX: Given the steadily growing number of diabetes cases worldwide – and in light of Diabetes Awareness Month – how important do you think prevention is today? And how do you assess the current state of prevention research in Germany?
Prof. Dr. Schmitz: Prevention is crucial because the development of type 2 diabetes, which accounts for 95% of cases, can be influenced by lifestyle. One thing is clear: the earlier we start, the more cases can be prevented and the less likely it is that secondary diseases will develop. Research is growing in the United Kingdom, but the fundamentals of the development of secondary diseases in particular have not yet been sufficiently investigated. Another important area is early education and awareness-raising about healthy lifestyles. This should start in school. Education is an important factor in prevention, and more research is needed in the area of knowledge transfer, taking language barriers into account.
What scientifically proven measures do you recommend to people without diabetes and without heart problems in order to minimise the long-term risk of cardiovascular disease and diabetes through a healthy lifestyle – and where do you see the additional benefits of digital prevention and monitoring tools?
The good news is that measures that prevent diabetes also prevent other diseases. These include, above all, plenty of exercise, including everyday activities and endurance sports, also in combination with strength training. This also helps us prevent cardiovascular diseases and other illnesses. Your diet should be balanced. Not smoking and moderate alcohol consumption also reduce the risk. In terms of modifiable factors, the importance of body mass index (BMI) and fasting blood sugar for the risk of developing diabetes in the next 10 years has recently been reaffirmed. In the journal JAMA Network Open, the authors report, based on figures from the USA, that type 2 diabetes can be predicted quite reliably on the basis of BMI, fasting blood sugar, age and gender. People can generally influence their BMI and fasting blood sugar very well, especially through exercise and diet.
To what extent can modern concepts from rehabilitation research be transferred to the primary prevention of type 2 diabetes – especially in risk groups, such as people who are physically inactive or overweight?
Rehabilitation for patients with coronary heart disease (CHD) relies on structured lifestyle intervention programmes, target agreements and regular feedback – this also works preventively. Small, measurable steps with coaching are particularly effective, e.g. gradually increasing exercise and setting everyday nutritional goals. For people who are physically inactive or overweight, simple entry points, social support and digital guidance are particularly helpful. We believe that digital programmes such as Timely, which were developed for patients with CHD, can also be used in primary prevention.
The link between metabolism, inflammatory processes and cardiovascular disease is being highlighted more and more frequently – exercise and stress management are considered key factors in the prevention of metabolic diseases, correct?
That's right. Many people with type 2 diabetes have other risk factors such as high blood pressure, lipid metabolism disorders and obesity, which, together with diabetes, massively increase the risk of CHD. Elevated blood sugar levels over a long period of time damage the blood vessels and can thus increase the risk of secondary diseases such as heart attack and stroke. Exercise and physical activity are the best way to counteract these processes. Prevention is particularly important, and it is essential to include people at increased risk in appropriate programmes, provide them with information and support them in making lifestyle changes. This requires more programmes for children and young people, as well as for adults.
Digital monitoring solutions, such as those developed by SEMDATEX, enable continuous recording of vital parameters. What opportunities do you see in such technologies for prevention, therapy and self-management in diabetes?
You have to differentiate between the two. In prevention, solutions that have already been developed, such as Timely*, which help patients lead a healthy lifestyle and get plenty of exercise, can be implemented quickly. In the area of therapy and self-management for diabetes patients, these solutions need to be adapted, but that is possible. Data from blood sugar measurements, whether entered manually or, ideally, transmitted automatically, combined with information about medication, offer great potential here. Platforms such as Timely document long-term trends, report critical values and can inform doctors and patients. Combined with exercise data and other information, this provides a holistic picture that can effectively support therapy and self-management.
What role do structured aftercare programmes or digital health applications play, especially for people with diabetes but without known heart disease, in order to tackle potential long-term damage at an early stage and maintain heart health in a targeted manner?
Aftercare refers to the period following rehabilitation. During this phase, the aim is to consolidate the goals that have been achieved and integrate a healthy lifestyle into everyday life. Most patients can benefit from support in this regard. This can also be done effectively digitally. It can be particularly helpful when documenting the goals that have been achieved and overcoming any obstacles that are encountered. If you commit to using a suitable digital service for the duration of your aftercare and consistently implement it in combination with an aftercare assistant, then the chances of achieving lasting change are high. Achieving the defined goals reduces the risk of secondary diseases. At the Chair of Rehabilitation Research, we are working together with clinics and manufacturers such as SEMDATEX to develop and scientifically test appropriate offerings so that they can ultimately be made available to users.
*Timely is an EU-funded project under Horizon 2020 ("Preventive Cardiology in the Hands of Empowered Patients"), running from 2021 to 2025. The aim was to develop a patient-centred platform for early detection, prevention and intervention in coronary heart disease using eHealth and artificial intelligence. From January 2021, an interoperable platform with AI-supported applications, dashboards and decision aids was used to support personalised care. Based on extensive data sets, risks could be assessed, therapy deviations identified and appropriate interventions proposed.
For more information, visit: https://www.timely-project.com/