The landscape of metabolic health and obesity management has actually been transformed by the introduction of Glucagon-like peptide-1 (GLP-1) receptor agonists. In Germany, medications such as Ozempic ®, Wegovy ®, and Mounjaro ® have become household names, not just for their medical efficacy however also for the conversations surrounding their availability and expense. For clients navigating the German health care system, understanding the monetary ramifications of these “development” treatments is essential.

This article offers an extensive analysis of the costs connected with GLP-1 therapy in Germany, the role of health insurance coverage, and the regulative structure that determines prices.

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What is GLP-1 Therapy?

GLP-1 receptor agonists are a class of medications that simulate a natural hormone produced in the gut. They work by stimulating insulin secretion, slowing stomach emptying, and signifying the brain to increase satiety (the sensation of fullness). At first developed to treat Type 2 Diabetes, their profound effect on weight loss has actually caused their approval for chronic weight management.

In Germany, the most typically recommended GLP-1 and related dual-agonist medications consist of:

• Semaglutide: Marketed as Ozempic ® (for diabetes) and Wegovy ® (for weight reduction).
• Liraglutide: Marketed as Victoza ® (for diabetes) and Saxenda ® (for weight loss).

• Tirzepatide: Marketed as Mounjaro ® (a double GLP-1/ GIP agonist for both diabetes and weight-loss).

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The Cost Structure in Germany: Public vs. Private

The rate a client pays for GLP-1 therapy in Germany depends greatly on the medical indication (diagnosis) and their type of health insurance. Germany runs on a double system: Statutory Health Insurance (Gesetzliche Krankenversicherung – GKV) and Private Health Insurance (Private Krankenversicherung – PKV).

1. Statutory Health Insurance (GKV)

For the roughly 90% of the population covered by GKV, the cost is mostly figured out by the Standard Care (Regelversorgung) standards.

• For Type 2 Diabetes: If a doctor deems the medication clinically needed, the GKV covers the expense. The client just pays a statutory co-payment (Zuzahlung), which is typically 10% of the medication cost, with a minimum of EUR5 and an optimum of EUR10 per plan.
• For Obesity/Weight Loss: Currently, German law ( § 34 SGB V) categorizes weight reduction medications as “way of life drugs.” This implies that even if a medical professional prescribes Wegovy ® or Saxenda ® for obesity, the GKV is legally forbidden from reimbursing the expense. The client needs to pay the full drug store price out of pocket.

2. Private Health Insurance (PKV)

Private insurers have more versatility. While they often follow the lead of the GKV, numerous PKV providers will compensate the cost of GLP-1 therapy for weight reduction if a medical necessity is shown (e.g., a BMI over 30 with comorbidities like hypertension or sleep apnea). Nevertheless, this depends upon the particular regards to the individual's insurance contract.

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Estimated Monthly Costs for GLP-1 Therapy

When paying of pocket (as a “Selbstzahler”), clients undergo the regulated pharmacy list prices (Apothekenabgabepreis). Unlike in the United States, drug rates in Germany are strictly regulated, preventing the extreme cost volatility seen somewhere else, though the costs remain considerable for lots of.

Table 1: Estimated Monthly Costs for Self-Payers (Standard Dosages)

Medication

Main Indication

Approximated Cost (per 4 weeks)

Ozempic ® (Semaglutide)

Type 2 Diabetes

EUR80— EUR90 *

Wegovy ® (Semaglutide)

Weight Management

EUR170— EUR300 (Dose dependant)

Mounjaro ® (Tirzepatide)

Diabetes/ Obesity

EUR260— EUR330

Saxenda ® (Liraglutide)

Weight Management

EUR290— EUR310

Victoza ® (Liraglutide)

Type 2 Diabetes

EUR120— EUR140

* Note: Ozempic is hardly ever offered to self-paying weight loss clients due to strict supply policies and its classification for diabetes.

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Elements Influencing the Price

Numerous factors add to the last expense a client gets at a German drug store:

1. The Titration Schedule: GLP-1 medications require a progressive increase in dosage to reduce gastrointestinal side effects. For medications like Wegovy ®, the price increases as the dose increases. A “starter dose” (0.25 mg) is more economical than the “maintenance dosage” (2.4 mg).
2. Pharmacy Fees: German drug stores include a standardized markup and a fixed charge per prescription, which is consisted of in the rates noted in Table 1.
3. Import vs. Local Supply: Due to worldwide scarcities, some drug stores might source global variations of the drugs, which can periodically result in rate variations, though this is unusual in the routine German market.

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Why is Wegovy More Expensive than Ozempic?

A typical point of confusion for clients is the cost distinction in between Ozempic ® and Wegovy ®, considered that both include the exact same active component: Semaglutide.

The reasons are mainly regulative and industrial:

• Branding and Approval: Wegovy ® is authorized at greater dosages specifically for weight reduction and underwent various scientific trial pathways.

• Health care Laws: Because Ozempic ® is a diabetes drug, its price is heavily negotiated in between the maker and the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband). Wegovy ®, being a “way of life” drug, is exempt to the exact same price-capping negotiations meant for essential chronic illness medications.

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Comparing Coverage: A Summary

The following table sums up the protection landscape based upon insurance coverage and medical diagnosis.

Table 2: Coverage Matrix for GLP-1 Therapy in Germany

Diagnosis

GKV (Public) Coverage

PKV (Private) Coverage

Type 2 Diabetes

Covered (minus EUR10 co-pay)

Usually 100% Covered

Obesity (BMI >>

30) Not Covered (Self-pay)

Often covered with medical evidence

Overweight (BMI >> 27) + Comorbidity

Not Covered (Self-pay)

Case-by-case examination

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Long-term Financial Considerations

GLP-1 treatment is normally planned as a long-term treatment. Scientific information suggests that when clients stop taking the medication, a significant portion of the lost weight might be restored. Therefore, clients considering self-paying for these medications need to factor in the multi-year cost.

• Yearly Expense: An upkeep dose of Wegovy ® can cost approximately EUR3,600 per year.

• Ancillary Costs: Patients also need to spending plan for regular physician visits, blood work to monitor kidney and thyroid function, and potentially dietary therapy, which might or may not be covered by insurance.

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Useful Tips for Navigating Costs in Germany

• Consult Your Insurer: If you have private insurance coverage, always request a “expense übernimmt” (cost assumption) statement before starting therapy.
• Green Prescriptions (Grünes Rezept): For self-payers, doctors release a green prescription. While this doesn't use a discount, the costs can often be claimed as an “amazing concern” (außergewöhnliche Belastung) on German earnings tax returns if they surpass a specific percentage of income.

• Prevent Illegal Sources: Due to the high expense and lacks, counterfeit pens have actually gotten in the marketplace. Constantly purchase through a certified German “Apotheke.”

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Frequently Asked Questions (FAQ)

1. Can a GP (Hausarzt) prescribe GLP-1 drugs for weight loss?

Yes, any licensed doctor in Germany can recommend these medications. Nevertheless, if it is for weight reduction, they will likely issue a “Privatrezept” (Private Prescription) regardless of your insurance status, suggesting you must pay at the pharmacy.

2. Exists Mehr erfahren of Ozempic or Wegovy readily available in Germany?

No. The active ingredient, Semaglutide, is under patent security by Novo Nordisk for several more years. Generic versions are not expected in the German market in the instant future.

3. Will the GKV ever cover Wegovy?

There is ongoing political debate in Germany regarding this. While the Federal Joint Committee (G-BA) presently keeps the exemption of weight-loss drugs, medical associations are lobbying to recognize obesity as a chronic illness, which could ultimately alter compensation laws.

4. Are these medications cheaper in other EU countries?

While costs vary across Europe due to various nationwide policies, the rate in Germany is reasonably mid-range. It is often more affordable than in Switzerland or the USA, however might be slightly more expensive than in France or Italy. Keep in mind that a German prescription is normally needed to buy them in a German drug store.

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GLP-1 therapy provides a promising course for managing Type 2 Diabetes and weight problems, but the financial barrier in Germany stays substantial for those seeking weight reduction treatment. While diabetes clients enjoy thorough protection under the GKV, weight problems patients are currently delegated bear the costs alone. As medical understanding of obesity progresses, the German health care system might ultimately adjust its compensation policies. Until then, patients must thoroughly weigh the medical advantages versus a month-to-month out-of-pocket expenditure that can vary from EUR170 to over EUR300.

In current years, the landscape of metabolic health treatment has actually gone through a substantial transformation. At the leading edge of this shift are GLP-1 (Glucagon-like Peptide-1) receptor agonists. Initially established to treat Type 2 diabetes, these medications have actually acquired global attention for their secondary, potent application in persistent weight management. In Germany, a country with an extensive regulative framework and an extremely structured healthcare system, the introduction and adoption of GLP-1 injections have stimulated comprehensive conversation amongst medical experts, policymakers, and the public alike.

This guide provides an extensive look at GLP-1 injections within the German context, covering their mechanism of action, accessibility, legal policies, expenses, and the present state of insurance protection.

What Are GLP-1 Receptor Agonists?

GLP-1 is a hormone naturally produced in the intestinal tracts. It plays an important function in managing blood sugar level levels and cravings. GLP-1 receptor agonists are synthetic variations of this hormonal agent that remain in the body considerably longer than the natural version.

These medications operate through 3 main mechanisms:

1. Insulin Secretion: They stimulate the pancreas to launch insulin when blood sugar level levels are high.
2. Glucagon Suppression: They prevent the liver from launching excessive sugar.
3. Stomach Emptying: They slow down the rate at which food leaves the stomach, leading to a prolonged sensation of fullness.
4. Appetite Regulation: They act upon the brain's “appetite center” to lower food cravings and increase satiety.

Available GLP-1 Medications in Germany

The German pharmaceutical market, governed by the Federal Institute for Drugs and Medical Devices (BfArM), uses several GLP-1 and dual-agonist medications. While some are strictly for diabetes, others have gotten specific approval for obesity treatment.

Table 1: Common GLP-1 and Related Medications in the German Market

Brand Name

Active Ingredient

Frequency

Main Indication (Germany)

Ozempic

Semaglutide

Weekly Injection

Type 2 Diabetes

Wegovy

Semaglutide

Weekly Injection

Obesity/ Weight Management

Mounjaro

Tirzepatide *

Weekly Injection

Type 2 Diabetes & & Obesity

Victoza

Liraglutide

Daily Injection

Type 2 Diabetes

Saxenda

Liraglutide

Daily Injection

Weight Problems/ Weight Management

Rybelsus

Semaglutide

Daily Oral Pill

Type 2 Diabetes

Trulicity

Dulaglutide

Weekly Injection

Type 2 Diabetes

* Tirzepatide is a dual GIP and GLP-1 receptor agonist, typically classified with GLP-1s due to similar effects.

The Regulatory Framework in Germany

The circulation of GLP-1 injections in Germany is strictly regulated. Unlike some other jurisdictions where “medical health spas” might use these treatments with very little oversight, Germany requires a doctor's prescription for all GLP-1 medications.

Prescription Categories

In Germany, a difference is made between treatment for a medical condition (Type 2 Diabetes) and “way of life” or preventive treatment (Weight Loss).

• Type 2 Diabetes: Patients identified with Type 2 Diabetes are qualified for these medications under the guidance of a family doctor or endocrinologist.
• Obesity (Adipositas): For weight-loss, medications like Wegovy and Saxenda are authorized for clients with a BMI over 30, or a BMI over 27 with at least one weight-related comorbidity (e.g., hypertension).

The “Lifestyle-Arzneimittel” Challenge

Under Section 34 of the Social Code Book V (SGB V), the German government classifies specific drugs as “way of life” medications. Historically, weight loss drugs have fallen under this category, implying that statutory medical insurance companies (Gesetzliche Krankenversicherung – GKV) are typically restricted from covering them, even if a medical professional deems them clinically essential.

Insurance Coverage and Costs

The expense of GLP-1 injections in Germany depends greatly on the patient's insurance status and the particular diagnosis.

Statutory Health Insurance (GKV)

For patients with Type 2 Diabetes, GKV providers (such as TK, AOK, or Barmer) typically cover the costs of medications like Ozempic or Trulicity. The client normally just pays a small co-payment (Zuzahlung) of EUR5 to EUR10. Nevertheless, GKV presently does not cover medications recommended entirely for weight-loss (like Wegovy), despite the severity of the obesity.

Private Health Insurance (PKV)

Private insurance providers in Germany are often more flexible. Some PKV service providers cover Wegovy or Saxenda if the doctor provides a comprehensive validation demonstrating that the weight loss is clinically needed to avoid more issues like heart problem or joint failure.

Out-of-Pocket Costs (Selbstzahler)

For those paying out-of-pocket, the expenses can be considerable:

• Wegovy: Depending on the dose, month-to-month expenses can range from EUR170 to over EUR300.
• Saxenda: Approximately EUR290 monthly.
• Ozempic (if prescribed off-label): Roughly EUR80 to EUR100 for a month's supply, though off-label prescribing for weight-loss is currently prevented in Germany due to lacks.

Supply Shortages and BfArM Guidance

Germany, like the remainder of the world, has faced considerable supply scarcities of GLP-1 medications, especially Ozempic. Since Ozempic was regularly recommended “off-label” for weight loss, supply for diabetic patients ended up being stretched.

In response, the BfArM issued numerous suggestions:

1. Prioritization: Physicians are urged to prioritize diabetic clients for Ozempic.
2. Export Bans: To ensure domestic supply, Germany has actually periodically executed constraints on exporting these medications to other countries.
3. Stringent Documentation: Pharmacies are under increased analysis to ensure that prescriptions for Ozempic are for diabetes clients only.

The Process: How to Get GLP-1 Injections in Germany

The German medical system stresses security and long-lasting monitoring. The common path for a client consists of a number of actions:

1. Initial Consultation: A client consults with their GP or an endocrinologist to discuss weight or blood sugar issues.
2. Diagnostic Testing: Blood work is required to inspect HbA1c levels, kidney function, and thyroid health.
3. Prescription Issuance: If eligible, the doctor concerns a prescription. This can be a “Pink Note” (Kassenrezept) for GKV-covered diabetes treatment, a “Blue Note” (Privatrezept) for self-payers or private patients, or an E-Rezept (Electronic Prescription).
4. Pharmacy Fulfillment: The client takes the prescription to a local Apotheke. If Wo bekomme ich GLP-1 in Deutschland? is out of stock, the drug store can often order it through a wholesaler, though wait times may use.
5. Follow-up Visits: German physicians generally need check-ups every 3 to 6 months to keep track of side effects and change does.

Security and Side Effects

While extremely reliable, GLP-1 injections are not without dangers. German medical specialists stress the importance of using these drugs only under supervision.

Typical Side Effects:

• Nausea and throwing up
• Diarrhea or constipation
• Stomach pain
• Tiredness

Serious however Rare Risks:

• Pancreatitis
• Gallbladder problems
• Potential danger of thyroid C-cell tumors (kept in mind in animal studies)

Summary of the Current State

• Growing Popularity: Demand in significant cities like Berlin, Munich, and Hamburg is at an all-time high.
• Medical Focus: German guidelines stress that these injections are not a “fast repair” however a tool to be utilized alongside diet plan and exercise.

• Legal Barriers: The SGB V stays a major obstacle for extensive insurance protection for weight reduction.

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Frequently Asked Questions (FAQ)

1. Is Wegovy available in Germany?

Yes, Wegovy was officially released in Germany in mid-2023. It is offered for adult patients with a BMI of 30+ or 27+ with comorbidities.

2. Can I get Ozempic for weight loss in Germany?

While Ozempic contains semaglutide (the exact same ingredient as Wegovy), its approved sign in Germany is for Type 2 Diabetes. Due to scarcities, BfArM strongly discourages its use for weight loss to ensure diabetic clients have access. Wegovy is the proper alternative for weight management.

3. Does the Krankenkasse (GKV) pay for weight-loss injections?

Usually, no. Statutory insurance coverage thinks about these “way of life” drugs. Nevertheless, if the client has Type 2 Diabetes, the insurance coverage will cover the GLP-1 medication prescribed for that condition.

4. Can I buy GLP-1 injections online in Germany?

Legally, you can only acquire these medications from a certified pharmacy with a valid prescription. Be careful of websites using these drugs without a prescription, as they are frequently counterfeit and hazardous.

5. What happens if I stop taking the injection?

Research studies reveal that numerous patients restore weight after stopping GLP-1 therapy if lifestyle modifications (diet and workout) are not maintained. German physicians usually recommend a long-lasting plan for tapering or upkeep.

6. Are there oral alternatives to injections?

Yes, Rybelsus is an oral tablet kind of Semaglutide available in Germany, mainly indicated for Type 2 Diabetes.

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Advantages of GLP-1 Therapy (A Summary List)

• Significant Weight Loss: Clinical trials reveal an average loss of 15% to 20% of body weight with Semaglutide.
• Cardiovascular Health: Reduction in the danger of significant negative cardiovascular events (strokes, cardiac arrest).
• Blood Glucose Control: Highly efficient at lowering HbA1c levels in diabetic clients.
• Non-Invasive: Though they are injections, the needles are extremely fine and normally pain-free, administered as soon as a week in the house.
• Cravings Control: Helps remove “food sound,” making it simpler for clients to stick to a calorie-restricted diet plan.

The landscape of metabolic health and weight management has gone through a substantial improvement with the introduction of Glucagon-like peptide-1 (GLP-1) receptor agonists. In Germany, these medications— initially established for the treatment of Type 2 diabetes— have actually gotten enormous appeal for their effectiveness in treating weight problems. However, the surge in demand has actually created an intricate environment for clients, healthcare service providers, and pharmacies alike.

This article offers an in-depth take a look at GLP-1 medications within the German pharmaceutical market, exploring the legal framework, schedule, expenses, and the scientific role these drugs play in contemporary German medication.

What are GLP-1 Receptor Agonists?

GLP-1 receptor agonists are a class of medications that simulate a natural hormonal agent produced in the gut. When an individual eats, GLP-1 is launched, promoting insulin secretion, hindering glucagon (which raises blood sugar), and slowing gastric emptying. Crucially for weight management, these medications likewise signify the brain's satiety centers, decreasing hunger and food yearnings.

In Germany, these drugs are managed strictly by the Federal Institute for Drugs and Medical Devices (BfArM). They are classified as “Rezeptpflichtig” (prescription-only), implying they can not be gotten over-the-counter and require a valid medical diagnosis and supervision.

Available GLP-1 Medications in Germany

The German pharmaceutical market hosts a number of GLP-1 and dual-agonist (GLP-1/ GIP) medications. While some are particularly approved for Type 2 diabetes, others have received approval for persistent weight management.

Table 1: Overview of GLP-1 Medications in Germany

Trademark name

Active Ingredient

Primary Indication

Producer

Administration

Ozempic

Semaglutide

Type 2 Diabetes

Novo Nordisk

Weekly Injection

Wegovy

Semaglutide

Obesity/Weight Management

Novo Nordisk

Weekly Injection

Mounjaro

Tirzepatide (GLP-1/ GIP)

Diabetes & & Obesity

Eli Lilly

Weekly Injection

Victoza

Liraglutide

Type 2 Diabetes

Novo Nordisk

Daily Injection

Saxenda

Liraglutide

Obesity/Weight Management

Novo Nordisk

Daily Injection

Rybelsus

Semaglutide

Type 2 Diabetes

Novo Nordisk

Daily Oral Tablet

Trulicity

Dulaglutide

Type 2 Diabetes

Eli Lilly

Weekly Injection

The Legal and Regulatory Environment in Germany

Germany preserves high requirements for drug safety and circulation. All GLP-1 medications should be given through certified drug stores (Apotheken), whether they are standard brick-and-mortar facilities or certified online drug stores.

Prescription Requirements

Under German law, a client needs to speak with a doctor (such as a GP, Diabetologist, or Endocrinologist) to get a prescription. The doctor assesses the patient's Body Mass Index (BMI), pre-existing conditions (like cardiovascular illness or high blood pressure), and blood glucose levels.

The Role of BfArM and Supply Shortages

Due to global need, Germany has dealt with significant supply shortages (Lieferengpässe). The BfArM has provided a number of statements advising physicians to prioritize patients with Type 2 diabetes for medications like Ozempic, as these clients count on the drug for blood sugar level stability. This has actually resulted in stricter analysis of “off-label” recommending for weight-loss.

Costs and Health Insurance Coverage

The expense of GLP-1 treatment in Germany is a significant factor for numerous clients. The repayment structure varies depending upon the type of insurance and the particular diagnosis.

Statutory Health Insurance (GKV)

For patients with Type 2 diabetes, the Gesetzliche Krankenversicherung (GKV) typically covers the costs of drugs like Ozempic or Trulicity, minus a small co-payment (Zuzahlung). However, German law (particularly § 34 SGB V) presently classifies weight-loss medications as “lifestyle drugs,” suggesting that even if a client is scientifically overweight, the GKV is frequently restricted from covering drugs like Wegovy or Saxenda.

Private Health Insurance (PKV)

Private insurance companies (Private Krankenversicherung) offer more flexibility. Protection often depends on the particular terms of the individual's policy and the medical requirement argued by the recommending physician.

Table 2: Comparative Administration and Practical Use

Function

Subcutaneous Injection (Weekly)

Subcutaneous Injection (Daily)

Oral Tablet (Daily)

Convenience

High (as soon as a week)

Low (requires daily routine)

High (no needles)

Steady State

Consistent levels

Quick absorption

Requires stringent fasting

Typical Brands

Wegovy, Ozempic, Mounjaro

Saxenda, Victoza

Rybelsus

How to Obtain GLP-1 Medications in Germany

For those looking for these treatments, the procedure follows a standardized legal path:

1. Initial Consultation: A visit to a doctor to talk about metabolic health. Blood tests (HbA1c, liver enzymes, kidney function) are typically carried out.
2. Prescription Issuance: If eligible, the doctor problems a Kassenrezept (pink prescription for GKV covered cases) or a Privatrezept (blue or white prescription for personal payers).
3. Pharmacy Fulfillment: The client takes the prescription to a regional drug store or uploads it to a qualified German online drug store (e.g., Shop Apotheke, DocMorris).
4. Storage and Transport: Since a lot of GLP-1 drugs are temperature-sensitive, pharmacies must make sure the cold chain is maintained. Clients should keep their pens in the refrigerator in your home.

Adverse Effects and Safety Considerations

While highly effective, GLP-1 medications are not without risks. Medical guidance is mandatory to handle prospective adverse effects.

Common Side Effects:

• Gastrointestinal Distress: Nausea, throwing up, diarrhea, and irregularity are the most regularly reported concerns, especially during the dose-escalation phase.
• Satiety Changes: A significant decrease in cravings which, if not managed, can lead to nutrient shortages.
• Injection Site Reactions: Redness or itching at the website of the needle.

Serious Risks (Rare):

• Pancreatitis.
• Gallbladder problems.
• Prospective thyroid C-cell tumors (noted in animal studies; human threat is still being kept an eye on).

The Future of GLP-1 in Germany

The German pharmaceutical market is bracing for much more advanced models of these drugs. Scientific trials are ongoing for triple-agonist medications (targeting GLP-1, GIP, and Glucagon) which guarantee even greater weight loss outcomes. Additionally, there is ongoing political argument regarding whether the GKV must upgrade its policies to cover weight-loss treatment for patients with serious obesity-related comorbidities.

FAQ: GLP-1 Pharmacy and Availability in Germany

1. Can I buy Ozempic without a prescription in Germany?

No. It is prohibited to offer or buy Ozempic or any GLP-1 medication without a legitimate medical prescription in Germany. Doing so brings GLP-1-Rezept in Deutschland to the capacity for fake products.

2. Is Wegovy presently readily available in German drug stores?

Yes, Wegovy was formally introduced in Germany in mid-2023. However, supply stays intermittent. It is suggested to inspect with numerous pharmacies or utilize online schedule trackers.

3. Just how much does a regular monthly supply of GLP-1 cost out-of-pocket?

For those paying independently (Selbstzahler), prices range depending upon the dose. Usually, patients can expect to pay between EUR170 and EUR350 per month for medications like Wegovy or Mounjaro.

4. Exist “Bio-identical” or intensified GLP-1s in Germany?

Unlike the United States, the compounding of GLP-1 medications in drug stores is not a basic practice in Germany. Regulative authorities focus on making use of factory-sealed, branded pens to ensure sterility and dose accuracy.

5. What takes place if my local drug store is out of stock?

Patients are motivated to ask their pharmacist to examine the “Großhandel” (wholesaler) stock or to offer a digital prescription that can be examined across various drug store chains. Some pharmacies allow clients to “pre-order” the next month's supply to make sure connection of care.

GLP-1 medications represent a milestone in German health care for the treatment of diabetes and weight problems. While supply chain problems and insurance hurdles remain, the accessibility of these drugs through licensed drug stores makes sure that clients receive top quality, regulated care. As research study continues and production scales up, GLP-1 agonists are expected to remain a foundation of metabolic medicine in Germany for the foreseeable future.