Summary
Patients with type 2 diabetes often also exhibit additional features of the metabolic syndrome. These include specifically central obesity triggering development and maintenance of diabetes together with arterial hypertension, hypertriglyceridemia and low levels of high-density lipoprotein cholesterol. Chronic therapy of the metabolic syndrome in diabetics after coronary bypass surgery focuses on changes in lifestyle, i.e., cessation of smoking, changes in nutrition and increase in physical activity. Nutrition aims at fat reduction and modification to reduce saturated fatty acids, to allow mono- and polyunsaturated fatty acids instead, and moderate alcohol consumption. High fiber and complex carbohydrate diet complete the recommendations. Nutrition therapy connected to increases in physical activity are aimed at reducing weight in overweight and obese subjects, which should reduce their body weight by 5 to 10% within about 6 months. Normal weight subjects benefit from increases in physical activity by lipid and glucose regulation as well as by reduction in mortality.
Diabetes-specific therapy aims at normoglycemia including postprandial blood glucose levels, reduces blood pressure supported by ACE inhibitors and aims at weight reduction. Reduction of LDL-cholesterol is the first line therapy, also diminishing small-dense LDL particles. Decreasing triglycerides and increasing HDL-cholesterol are further lipid-regulating aims. Specifically diabetics after coronary bypass surgery need LDL-cholesterol levels below 70 mg/d (1.8 mmol/L) and triglycerides below 150 mg/dL (1.7 mmol/L). In addition, in males HDL-cholesterol should be at least above 40 mg/dl (1 mmol/L), in females above 50 mg/dL (1.3 mmol/L).
Zusammenfassung
Patienten mit Typ-2-Diabetes weisen häufig zusätzliche Facetten des metabolischen Syndroms auf, in dessen Mittelpunkt die abdominelle Adipositas steht, die schließlich den Diabetes mellitus provoziert und im Konzert mit arterieller Hypertonie, hohen Triglyzeriden und niedrigem HDL-Cholesterin unterhält. Die chronische Therapie des metabolischen Syndroms beim koronarkranken und herzoperierten Diabetiker umfasst zunächst Lebensstiländerungen wie Einstellung des Rauchens, Umstellung der Ernährung in kaloriengerechte, ballaststoffreiche, fettmodifizierte Kost mit hohem Anteil an einfach ungesättigten sowie Omega-3-Fettsäuren, sie erlaubt moderaten Alkoholgenuss. In Verbindung mit Ernährungstherapie und körperlichem Training zielt die Gewichtsreduktion auf Normgewicht ab, wobei Patienten mit deutlichem Übergewicht zwischen 5 und 10% ihres Körpergewichts in ca. 6 Monaten reduzieren sollten.
Die diabetesspezifische Therapie strebt normoglykämische Blutzuckereinstellung an, erzielt Blutdrucksenkung, hauptsächlich unterstützt durch ACE-Hemmer und Gewichtsreduktion. Die Korrektur der Blutfette umfasst Senkung von LDL-Cholesterin, Reduktion der kleinen, dichten LDL-Partikel, Senkung der Triglyzeride und Anheben von HDL-Cholesterin. Gerade der herzoperierte Diabetiker braucht als Mann HDL-Cholesterin über 40 mg/dl (1 mmol/l), als Frau über 50 mg/dl (1,3 mmol/l), sowie allgemein LDL-Cholesterinspiegel von unter 70 mg/d (1,8 mmol/l) und Triglyzeride unter 150 mg/dl (1,7 mmol/l).
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Steinmetz, A. Chronische Therapie des metabolischen Syndroms bei herzoperierten Diabetikern. Clin Res Cardiol 95 (Suppl 1), i110–i116 (2006). https://doi.org/10.1007/s00392-006-1112-1
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DOI: https://doi.org/10.1007/s00392-006-1112-1