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Hypoglycemie bij diabetes: relevant voor het cardiovasculaire risico en de cognitie?

Een actueel overzicht van reële associaties en mogelijke consequenties

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Nederlands Tijdschrift voor Diabetologie Aims and scope

Samenvatting

Hypoglycemie is een mogelijk onderschat fenomeen bij de behandeling van diabetes, bij type 2 diabetes wellicht nog meer dan bij type 1 diabetes. Recente epidemiologische en klinische studies (2005-2011) geven aanwijzingen voor belangrijke associaties tussen het optreden van hypoglycemieën en de incidentie van hart- en vaatziekten en daarmee samenhangende sterfte. Ook blijkt er een associatie met cognitief functieverlies bij de oudere, kwetsbare diabetespatiënt. Behandelstrategieën die met hypoglycemieën gepaard gaan (behandeling met SU derivaten en/of insuline), geven structureel gewichtstoename als ongewenste bijwerking. Dit komt mogelijk tot stand via een hypoglycemie maskerend, reactief eetgedrag. En gewichtstoename op zich is een cardiovasculaire risicofactor bij de patiënt met overgewicht of obesitas.

Onzekerheid is er over de causaliteit in de associaties tussen het optreden van hypoglycemieën enerzijds, en het optreden van schadelijke gebeurtenissen (hart- en vaatziekten, cognitief functieverlies, Alzheimer) anderzijds.

Metformine en nieuwe behandelstrategieën via het incretinesysteem werken glucose-afhankelijk en blijken niet geassocieerd te zijn met een verhoogde kans op hypoglycemieën en gewichtstoename. Van metformine zijn gunstige macrovasculaire eindpunten bekend, deels via preventie van gewichtstoename. Mede in dat kader zijn ook de nieuwe middelen veelbelovend, maar resultaten van hun harde eindpuntstudies zijn nog onderweg en worden vanaf 2012 verwacht.

Summary

Hypoglycaemia might be an underestimated phenomenon in the treatment of diabetes, especially type 2 diabetes. Recent epidemiological and clinical studies (2005-2011) indicate important associations between the occurrence of hypoglycaemia and the incidence of cardiovascular morbidity/mortality, as well as the loss of cognitive function. Susceptible patients of old age with type 2 diabetes are often involved. Treatment options known to induce hypoglycaemia (with sulphonylureas and insulin) support weight gain as unfavourable side effect, possibly related to defensive eating to mask hypoglycaemia. And, weight gain by itself is a cardiovascular risk factor in the overweight and obese patient.

However, it is unknown to which extent these associations are causally related: the occurrence of hypoglycaemia on the one hand and the incidence of harmful events (cardiovascular disease, loss of cognitive function) on the other hand.

Metformin and new options of treatment through the incretin system lower blood glucose levels during hyperglycaemia by acting in a glucose-dependent manner. They are not associated with an increased risk of hypoglycaemia or weight gain. Metformin is known to reduce the incidence of macrovascular disease, partly by the prevention of weight gain. Since the new classes of antihyperglycaemic agents prevent weight gain or even induce weight loss without the risk of hypoglycaemia, they might have favourable effects on the long term. However, placebo controlled trials with cardiovascular endpoints are underway – results being awaited for from 2012.

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Figuur 1.

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Authors and Affiliations

  1. Bethesda Diabetes Research Centrum, Hoogeveen, The Netherlands

    Adriaan Kooy

  2. Afdeling Interne Geneeskunde, Ziekenhuis Bethesda Bethesda Diabetes Research Centrum, Dr. G.H. Amshoffweg 1, 7909, Hoogeveen, AA, The Netherlands

    Adriaan Kooy

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  1. Adriaan Kooy
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Correspondence to Adriaan Kooy.

Additional information

1 Bethesda Diabetes Research Centrum Hoogeveen

Correspondentie:

Dr. Adriaan Kooy, internist – vasculaire geneeskundige Afdeling Interne Geneeskunde, Ziekenhuis Bethesda Bethesda Diabetes Research Centrum Dr. G.H. Amshoffweg 1 7909 AA Hoogeveen

kooy.a@bethesda.nl

Conflict of interest

Dr. Adriaan Kooy is lid van de Nederlandse en/of Europese adviesraden voor Astrazeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharp & Dohme en Novo Nordisk. Tevens is hij directeur van het Bethesda Diabetes Research Centrum te Hoogeveen, een onafhankelijk onderzoeksinstituut.

Deze publicatie is mede mogelijk gemaakt dankzij een unrestricted grant van AstraZeneca en Bristol-Myers Squibb. AstraZeneca en Bristol- Myers Squibb hebben op geen enkele wijze invloed gehad op de inhoud van deze tekst.

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Kooy, A. Hypoglycemie bij diabetes: relevant voor het cardiovasculaire risico en de cognitie?. NED. TIJDSCHR. DIABET. 9, 52–61 (2011). https://doi.org/10.1007/s12467-011-0016-5

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