Der Diabetologe

, Volume 9, Issue 1, pp 19–24

Kardiovaskuläres Risiko bei Hypoglykämie

Viele Indizien, keine Beweise
Leitthema

Zusammenfassung

Das erhöhte kardiovaskuläre Risiko von Patienten mit Typ-2-Diabetes mellitus lässt sich nur sehr begrenzt über eine intensivierte Blutzuckertherapie senken. Paradoxerweise führte eine intensivierte Blutzuckertherapie in der Studie Action to Control Cardiovascular Risk in Diabetes (ACCORD) sogar zu einer erhöhten Mortalität. Als möglicher Verursacher wird eine erhöhte Hypoglykämierate in der Gruppe mit intensivierter Therapie verdächtigt, ohne dass die unmittelbare Kausalität bewiesen werden konnte. Die Bedeutung von Hypoglykämien als Induktor kardiovaskulärer Ereignisse bei Patienten mit Typ-2-Diabetes ist seitdem ins Rampenlicht gerückt. Die Beweislast geht über einen Indizienprozess bisher jedoch noch nicht hinaus.

Schlüsselwörter

Diabetes mellitus Typ 2 Blutglukose Hypoglykämisch wirkende Agenzien Mortalität Follow-up-Studien 

Cardiovascular risk in hypoglycemia

Numerous indications, no evidence

Abstract

Diabetes mellitus is a major cardiovascular risk factor. Intensified glucose lowering therapy provides only scant cardiovascular benefit in diabetes mellitus type 2 patients in comparison to standard glucose lowering therapy, and it might even hold risks in some patient subgroups. This was demonstrated in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trail, in which intensified glucose lowering therapy increased mortality. The cause of this paradoxical effect currently remains unknown; however, it might be linked to the increased rates of hypoglycemia in the intensified treatment group. Hypoglycemia has since become a focus of attention as a potential factor in mortality. Although hard evidence is currently unavailable, a variety of associative and mechanistic studies support relevant interaction, which will be discussed in the following.

Keywords

Diabetes mellitus type 2 Blood glucose Hypoglycemic agents Mortality Follow-up studies 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Medizinische Klinik I – Kardiologie, Pneumologie, Angiologie, Internistische IntensivmedizinUniversitätsklinikum AachenAachenDeutschland

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