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Kardiovaskuläre Effekte der Insulintherapie

Cardiovascular effects of insulin therapy

  • Leitthema
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Der Diabetologe Aims and scope

Zusammenfassung

Hintergrund

Die Bedeutung einer normnahen Blutzuckereinstellung und der Insulintherapie zur Prävention mikroangiopathischer Folgeerkrankungen ist unumstritten.

Typ-1-Diabetes

Die wichtige Rolle einer intensiven Insulintherapie in der Prävention kardiovaskulärer Ereignisse bei Typ-1-Diabetes wird durch die DCCT/EDIC (DCCT: „diabetes control and complications trial“, EDIC: „epidemiology of diabetes interventions and complications“) klar belegt: Auf lange Sicht reduzierte die intensive Insulintherapie das Risiko für nichttödlichen Herzinfarkt, Schlaganfall oder Tod aus kardiovaskulärer Ursache um 57 %.

Typ-2-Diabetes

Bei Patienten mit Typ-2-Diabetes wurde ein kardiovaskulärer Benefit für eine frühzeitige Insulintherapie mit normnaher Blutzuckereinstellung in der UKPDS („United Kingdom prospective diabetes study“) belegt, war aber erst in der Nachbeobachtung evident. In der Insulintherapie bei langjährigem Diabetes mellitus und/oder kardiovaskulären Vorerkrankungen ist die Vermeidung von Hypoglykämien vordringlich, um akute kardiovaskuläre Ereignisse zu vermeiden. Bei Patienten mit Herzinsuffizienz deutet sich an, dass hohe Insulindosierungen nach Möglichkeit vermieden werden sollten – der Nutzen einer normnahen Blutzuckereinstellung ist bei ihnen ebenfalls nicht nachgewiesen.

Abstract

Background

The importance of a near normal blood glucose adjustment and insulin therapy for prevention of subsequent microangiopathic diseases is undisputed.

Type 1 diabetes

The important role of intensive insulin therapy for prevention of cardiovascular events in type 1 diabetes has been clearly confirmed by the diabetes control and complications trial (DCCT) of the epidemiology of diabetes interventions and complications (EDIC) research group: in the long term, intensive insulin therapy reduces the risk of non-fatal myocardial infarction, stroke and death from cardiovascular causes by 57 %.

Type 2 diabetes

For patients with type 2 diabetes a cardiovascular benefit of early insulin therapy with near normal blood glucose adjustment was confirmed by the United Kingdom prospective diabetes study (UKPDS) but only becomes apparent in the follow-up period. In insulin therapy of long-standing diabetes mellitus and/or pre-existing cardiovascular diseases, priority is given to avoidance of hypoglycemia in order to prevent acute cardiovascular events. For patients with heart insufficiency the indications are that high insulin dosages should be avoided where possible and the benefit of a near normal blood glucose adjustment has also not been proven.

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Authors and Affiliations

  1. Medizinische Klinik I, Allgemeine Innere Medizin, Diabetologie und Endokrinologie, Evang. Krankenhaus Bethesda Duisburg Gmbh, Heerstr. 210, 47053, Duisburg, Deutschland

    M. Pfohl

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M. Pfohl gibt an, dass er Advisory-Board-Mitglied von Boehringer Ingelheim/Eli Lilly, Novo Nordisk und Sanofi ist sowie Vortragstätigkeiten für Berlin-Chemie, Boehringer Ingelheim/Eli Lilly, Novo Nordisk und Sanofi ausübte.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Pfohl, M. Kardiovaskuläre Effekte der Insulintherapie. Diabetologe 12, 171–177 (2016). https://doi.org/10.1007/s11428-016-0088-3

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