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Update Typ-1-Diabetes

Update on type 1 diabetes

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Zusammenfassung

Beim Typ-1a-Diabetes entwickelt sich auf dem Boden eines chronischen Autoimmunprozesses ein absoluter Insulinmangel mit Ketoseneigung. Prospektive Studien belegen, dass eine intensivierte Insulintherapie die Lebensqualität verbessert und der Vermeidung diabetesassoziierter mikro- und makrovaskulärer Folgeerkrankungen dient. Der Goldstandard der Behandlung ist daher die funktionelle Insulintherapie unter Verabreichung eines Basalinsulins und eines kurz wirksamen prandialen Insulins. Die Therapieziele sollten gemeinsam mit dem Patienten festgelegt werden. Ein HbA1c-Wert < 7,0% zeigt eine gute, ein Wert ≤ 6,5% eine sehr gute Blutzuckereinstellung an, solange keine schweren Hypoglykämien auftreten. Da auch bei Typ-1-Diabetikern die Prävalenz kardiovaskulärer Risikofaktoren mit dem Alter steigt, sollten auch die Dyslipidämie und arterielle Hypertonie zielwertorientiert behandelt werden. Durch diesen multimodalen Therapieansatz kann die Lebensqualität von Menschen mit Typ-1-Diabetes optimal erhalten werden.

Abstract

Type 1a diabetes develops from a chronic autoimmune process leading to absolute insulin deficiency and proneness to ketosis. Prospective studies have clearly shown that intensive insulin therapy (ICT) results in improved quality of life and reduced development of diabetes-associated microvascular and macrovascular complications. The gold standard of therapy in type 1 diabetes is insulin injection with a basal bolus insulin regimen, in which patient daily routine and wishes are considered. The treatment goals should be determined on an individualized basis together with the patient. An HbA1c value < 7.0% is considered to be well controlled while values ≤ 6.5% indicate an excellent blood glucose control, as long as there are no episodes of severe hypoglycemia. As many adult patients with type 1 diabetes develop additional cardiovascular risk factors dyslipidemia and hypertension should also be considered and treated according to current treatment guidelines. A multimodal treatment may be the best way to preserve quality of life in patients with type 1 diabetes.

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  1. Medizinische Klinik und Poliklinik IV, Diabeteszentrum, Klinikum der Universität München, Ziemssenstr. 1, 80336, München, Deutschland

    I. Heukamp, C. Then, A. Lechner &  J. Seissler

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  1. I. Heukamp
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  2. C. Then
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  3. A. Lechner
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  4. J. Seissler
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Correspondence to J. Seissler.

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Heukamp, I., Then, C., Lechner, A. et al. Update Typ-1-Diabetes. Internist 54, 201–216 (2013). https://doi.org/10.1007/s00108-012-3174-7

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