Prävalenz der Insulinresistenz in Abhängigkeit vom Körpergewicht - Bedeutung für die Primärprävention kardiovaskulärer Erkrankungen

Zusammenfassung

Zwischen der Insulinresistenz (IR) und der Entstehung von Adipositas (A), metabolischem Syndrom (MS), Diabetes mellitus Typ II (DM) bzw. kardiovaskulären Erkrankungen (CVD) besteht ein enger, sich kontinuierlich negativ entwickelnder pathophysiologischer Zusammenhang, verbunden mit einer hohen Morbidität und Mortalität und einer weltweit epidemieartigen Zunahme der Fälle. Die IR korreliert andererseits auch unabhängig von A, MS und DM direkt mit CVD. Zur Erfassung der IR wird ein in praxi leicht durchführbarer Test benötigt. In einer Studie an 115 normgewichtigen, anscheinend gesunden Probandinnen und 555 übergewichtigen bzw. adipösen Patientinnen konnte gezeigt werden, dass durch Glukose- und Insulinbestimmungen im oralen Glukosetoleranztest (o-GTT) die IR zu 27,8 % frühzeitig (bei Normgewichtigen) und zu 91,9 % rechtzeitig (bei Übergewichtigen/Adipösen) erfasst werden kann. Die Normgrenzwerte liegen für Nüchtern-Glukose bei < 102 mg/dl und für Nüchtern-Insulin bei < 13 µU/ml. Der Nachweis/Ausschluss einer IR und damit die Primärprävention aller Folgeerkrankungen muss sehr früh einsetzen, optimal mit dem 20. Lebensjahr, mit Kontrollen alle fünf bis zehn Jahre, auch bei gesunden Normgewichtigen. Die lange Latenzphase (10 - 15 Jahre) zwischen dem Nachweis einer IR und dem Auftreten klinischer Symptome wirkt sich im Hinblick auf die Effektivität von Präventionsprogrammen günstig aus.

Abstract

Insulin resistance (IR) and the development of obesity, metabolic syndrome (MS), diabetes mellitus type II (DM) and cardiovascular diseases (CVD) are closely linked to high morbidity and mortality and an epidemic increase world wide. On the other hand IR is directly correlated with CVD, independent of obesity, MS and DM. To document IR an easily performed test method is necessary. In a study on 115 female test persons of normal weight and apparently healthy and 555 overweight/obese females, the following results were obtained using an oral tolerance test for the estimation of glucose and insulin. IR could be determined early in 27.8 % of patients of normal weight, and well-aimed in 91.9 % of patients who were overweight/obese and could be treated using primary or secondary prevention. Based on our results, it may be advisable to redefine the cut-off points for glucose (102 mg/dl) and insulin (13 µU/ml) values when screening for metabolic syndrome.

Schlüsselwörter

Insulinresistenz - oraler Glukosetoleranztest - Glukose- und Insulinbestimmung - kardiovaskuläre Erkrankungen - Primärprävention

Key words

Insulin resistance - oral tolerance test of glucose - glucose and insulin determination - cardiovascular diseases - primary prevention

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