Moderne Laborparameter in der Differentialdiagnostik des Diabetes mellitus Typ 2

Zusammenfassung

In den vergangenen Jahren konnten die pathophysiologischen Zusammenhänge zwischen Diabetes mellitus und dem Auftreten kardiovaskulärer Ereignisse weiter aufgeklärt werden. Die Insulinresistenz und das Auftreten einer β-Zell-Funktionsstörung können unabhängig von ihren Auswirkungen auf den Blutzucker einen direkten Effekt auf die Progression der Arteriosklerose ausüben. Der Einsatz zusätzlicher Laborparameter zur individuellen pathophysiologischen Charakterisierung von Patienten mit einem Diabetes mellitus Typ 2 könnte hierbei zu einer Verbesserung der Therapie und zu einer Reduktion des kardiovaskulären Risikos beitragen. Intaktes Proinsulin wird von der β-Zelle sezerniert, und der Anstieg dieses Biomarkers im Blut kann als Parameter der β-Zell-Dysfunktion gewertet werden. Erhöhte Spiegel an intaktem Proinsulin können ferner zur Diagnose einer Insulinresistenz mit einer Spezifität von 100 % bei einer Sensitivität von 50 % herangezogen werden. Ein weiterer biologischer Parameter zur Beurteilung der Insulinresistenz ist das vom viszeralen Fettgewebe sezernierte Adiponektin. Aufgrund seiner hohen Sensitivität eignet es sich insbesondere zur Verlaufsbeobachtung einer Insulinresistenz unter einer therapeutischen Intervention. Beide Biomarker haben einen hohen prädiktiven Wert zur Beurteilung des kardiovaskulären Risikos bei Typ-2-Diabetikern. Zur Beurteilung der vaskulären Inflammation kann eine Bestimmung des hoch sensitiven CRP zusätzliche Informationen zum kardiovaskulären Risiko liefern.

Summary

During the recent years increasing knowledge has been obtained in the understanding of the coincidence of type 2 diabetes and cardiovascular disease. Insulin resistance and beta cell failure were shown to have a direct impact in the pathogenesis of arteriosclerosis which goes far beyond the effects of elevated glucose levels. The use of additional laboratory parameters for the characterisation of patients with type 2 diabetes on a pathophysiological basis might improve treatment strategies and might help to reduce the cardiovascular risk in patients with type 2 diabetes. Intact proinsulin is secreted from the beta cell and increasing levels of intact proinsulin serve as an indicator of beta cell failure. In addition, increased levels of intact proinsulin were shown to predict insulin resistance with a specificity of 100 % and a sensitivity of about 50 %. On the other side, adiponectin, derived from the visceral adipose tissue, serves as a marker closely correlated to insulin sensitivity. Plasma adiponectin is a very sensitive marker of insulin resistance and might be used for the judgement of therapeutical interventions aimed to improve insulin sensitivity. In addition, both markers are predictive for the estimation of cardiovascular risk in patients with type 2 diabetes. Measurement of inflammation, by high sensitive CRP might add further information about the cardiovascular risk of a patient with type 2 diabetes.

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