Summary
Patients with diabetes nowadays are not directly endangered by dysglycemia, but they suffer vascular complications. The diabetic patient with existing cardiovascular (CV) disease has a particularly high risk for further CV complications and, therefore, requires specific attention. These patients need an intense and multimodal therapeutic approach which includes a strong interdisciplinary cooperation between the cardiologist and the diabetologist. Cardiac rehabilitation can effectively improve prognosis of CV patients with numbers needed to treat (NNT) comparable to standard pharmacological treatment. In diabetics, after coronary surgery, metabolism frequently and markedly deteriorates, and this requires strict metabolic monitoring and close cooperation between the diabetes team and the other professionals (cardiologist, nurses, physiotherapists, psychologists . . .) to reduce complications arising from hyperglycemia and also hypoglycemia and to improve the CV risk factors by lifestyle changes. Frequently, diabetes is only diagnosed during the hospital stay for CV complication; therefore, in these patients, specific attention is required for teaching and inauguration of therapy.
Due to the high risk of these patients and the need of qualified metabolic co-treatment, following CV surgery, diabetic patients should be treated preferentially in rehabilitation centres specialised in both cardiac and metabolic care. Recent studies indicate that a multimodal and aggressive approach in CV diabetic patients can markedly improve their prognosis.
Zusammenfassung
Der herzkranke Diabetiker nach koronarchirurgischen Eingriffen stellt aufgrund seiner hohen vaskulären Gefährdung und der vielfältigen Probleme im Bereich des Stoffwechsels eine besondere Herausforderung für die kardio-metabolische Rehabilitation dar. Eine optimierte Versorgung dieser Patienten erfordert eine engmaschige Kooperation zwischen Patient, Arzt und Diabetesberater bzw. Diabetesassistent, letztendlich unter der Supervision durch einen erfahrenen Diabetologen. Rehabilitationskliniken weisen ein multiprofessionelles Team an Schwestern, Psychologen, Sport- und Bewegungstherapeuten, Sozialarbeitern sowie Ernährungsberatern auf, die im Umgang mit chronisch Kranken besondere Erfahrung besitzen und damit die beste Voraussetzungen für eine umfassende Betreuung dieser kardiovaskulären Patienten haben.
Aufgrund der Komplexität der postoperativen Stoffwechselführung und -neueinstellung sowie der hohen kardiovaskulären Gefährdung der diabetischen Patienten sollten diese besonders nach herzchirurgischen Eingriffen bevorzugt in Rehabilitationskliniken verlegt werden, in denen die Strukturqualität und Stoffwechselexpertise für eine engmaschige qualifizierte Versorgung der Patienten gegeben ist.
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Jacob, S. Die Bedeutung der Rehabilitation beim herzkranken Diabetiker nach chirurgischen Eingriffen. Clin Res Cardiol 95 (Suppl 1), i103–i109 (2006). https://doi.org/10.1007/s00392-006-1108-x
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DOI: https://doi.org/10.1007/s00392-006-1108-x