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Kommentar zur ESC/EASD-Leitlinie zu Diabetes, Prädiabetes und kardiovaskulären Erkrankungen 2013

Comments on the 2013 ESC/EASD guidelines on diabetes, prediabetes and cardiovascular diseases

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Zusammenfassung

Patienten mit Diabetes mellitus Typ 2 haben ein höheres kardiovaskuläres Risiko als Nichtdiabetiker. Die neue Leitlinie gibt Orientierung über die Störungen des Glukosestoffwechsels und das daraus resultierende Risiko für die Entstehung kardiovaskulärer Erkrankungen. Abhängig von der kardiovaskulären Begleitmorbidität wird heute der HBA1c individuell zwischen 6 und 8% eingestellt – bei jungen Diabetikern eher niedriger, bei älteren koronarkranken Diabetikern eher höher. Der Zielblutdruck liegt in den neuen Leitlinien jetzt unter 140/85 mmHg. In den neuen Leitlinien wird weiterhin die Bypass-Operation gegenüber der perkutanen koronaren Intervention (PCI) bei Diabetikern strikt bevorzugt. Dies kann nicht unwidersprochen bleiben. Diagnostik und Therapie der Herzinsuffizienz und der Herzrhythmusstörungen unterscheiden sich in den Leitlinien bei fehlenden Studien im Wesentlichen nicht von denen bei Nichtdiabetikern.

Abstract

Patients with type 2 diabetes mellitus have an increased cardiovascular risk compared with non-diabetics. The new guidelines provide physicians with orientation with respect to disorders in glucose metabolism and the risk of occurrence of cardiovascular diseases. An HBA1c level in the range of 6–8% is currently recommended, depending on cardiovascular comorbidities: in young diabetics 6% is recommended to avoid hypoglycemia and in older individuals with cardiovascular complications 8%. The target blood pressure given in the new guidelines is <140/85 mmHg. The guidelines still recommend bypass surgery instead of percutaneous coronary intervention (PCI) for diabetics; however, this recommendation is based on studies that do not reflect current practice and is disputable. Diagnostic measures and therapy of cardiac failure and arrhythmic disorders in the guidelines do not essentially differ between patients with and without diabetes, basically due to a lack of studies.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. W. Motz, W. Kerner und R. Dörr geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Herz- und Diabeteszentrum Mecklenburg-Vorpommern, Klinikum Karlsburg, Klinikgruppe Dr. Guth GmbH & Co. KG, Greifswalder Str. 11, 17495, Karlsburg, Deutschland

    W. Motz & W. Kerner

  2. Praxisklinik Herz und Gefäße, Dresden, Deutschland

    R. Dörr

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  1. W. Motz
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  2. W. Kerner
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  3. R. Dörr
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Correspondence to W. Motz.

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Motz, W., Kerner, W. & Dörr, R. Kommentar zur ESC/EASD-Leitlinie zu Diabetes, Prädiabetes und kardiovaskulären Erkrankungen 2013. Herz 39, 971–984 (2014). https://doi.org/10.1007/s00059-014-4168-0

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  • DOI: https://doi.org/10.1007/s00059-014-4168-0

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