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Primär- und Sekundärprävention des Schlaganfalls bei Diabetes

Primary and secondary prevention of ischemic stroke in diabetes

  • Leitthema
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Zusammenfassung

Schlaganfälle sind weltweit eine der wichtigsten Ursachen für dauerhafte Behinderung und Tod im Erwachsenenalter. Neben der arteriellen Hypertonie, Rauchen, Bewegungsmangel und kardialen Erkrankungen ist Diabetes mellitus ein unabhängiger und beeinflussbarer Risikofaktor für ischämische Schlaganfälle. Es gibt bisher keine eindeutige Evidenz für eine Reduktion der Inzidenz von Schlaganfällen durch medikamentöse oder nichtmedikamentöse Normalisierung und Senkung des langfristigen Glukosespiegels. In der täglichen Praxis wird dennoch zumeist die Normalisierung der Blutzuckerkonzentration angestrebt. Dies gilt auch für die Akutphase nach einem Schlaganfall. Eine zu starke Reduzierung des kurz- und langfristigen Glukosespiegels kann aber nicht empfohlen werden, da hier das Risiko für unerwünschte Nebenwirkungen (Hypoglykämien) mögliche Vorteile überwiegt. Der besondere Fokus der Prävention von Schlaganfällen bei Diabetespatienten liegt auf der leitliniengerechten Behandlung beeinflussbarer vaskulärer Risikofaktoren wie arterieller Hypertonie, Hypercholesterinämie, Übergewicht oder Rauchen.

Abstract

Stroke is one of the most important causes of permanent disability and death in adults worldwide. In addition to hypertension, smoking, lack of physical activity and cardiac diseases, diabetes mellitus is an independent and modifiable risk factor for ischemic stroke. To date no unambiguous evidence exists for a reduction of the incidence of stroke by normalizing and lowering of long-term glucose levels with or without drugs. Nevertheless, normalization of blood glucose is an important goal in daily clinical practice. This also applies to the acute phase after stroke. Excessive lowering of short-term and long-term glucose levels is not recommended due to the increased risk of adverse events (hypoglycemia) which outweighs possible benefits. The focus in the prevention of stroke in patients with diabetes consists of guideline-conform treatment of modifiable vascular risk factors, such as hypertension, hyperlipoproteinemia, obesity and smoking.

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Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: F. Geisler hält Aktien der Fa. Sanofi. M. Endres erhält Forschungsförderung von der DFG (Exzellenzcluster NeuroCure; SFB TR 43, KFO 247, KFO 213), BMBF (Centrum für Schlaganfallforschung Berlin), EU (Eustroke, ARISE, WakeUp), Volkswagen Stiftung (Lichtenberg Programm) und Corona Stiftung. Er erhält oder erhielt Forschungsförderung von den Firmen AstraZeneca, Sanofi und Roche sowie Honorare durch Beratungstätigkeit von Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, MSD, Pfizer, Sanofi, durch Vortragshonorare von Astra Zeneca, Bayer, Berlin Chemie, Bristol-Myers Squibb, Boehringer Ingelheim, Desitin, Eisai, Ever, Glaxo Smith Kline, MSD, Novartis, Pfizer, Sanofi, Takeda, Trommsdorf. G.J. Jungehülsing erhält Drittmittelförderung durch das Bundesministerium für Bildung und Forschung (BMBF) über die Förderung „Center for Stroke Research Berlin“ (01 EO 0801). Er erhielt Vortragshonorare von Bayer Health Care, Genzyme, Novartis und Pfizer.

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Authors and Affiliations

  1. Klinik und Poliklinik für Neurologie, Charité – Universitätsmedizin Berlin, Hindenburgdamm 30, 12203, Berlin, Deutschland

    F. Geisler, M. Endres & G.J. Jungehülsing

  2. Center for Stroke Research Berlin (CSB), Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    F. Geisler, M. Endres & G.J. Jungehülsing

  3. Exzellenzcluster Neurocure, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    M. Endres

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  1. F. Geisler
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Correspondence to F. Geisler.

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Geisler, F., Endres, M. & Jungehülsing, G. Primär- und Sekundärprävention des Schlaganfalls bei Diabetes. Diabetologe 9, 204–209 (2013). https://doi.org/10.1007/s11428-012-0949-3

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