Download PDF
Diabetes aktuell 2008; 6(3): 113-118
DOI: 10.1055/s-0028-1082173
Schwerpunkt

© Georg Thieme Verlag Stuttgart · New York

Folgeerkrankungen des Diabetes mellitus – Koronare Herzerkrankung, Nephropathie und Retinopathie

Diseases subsequent to diabetes mellitus – Coronary heart disease, nephropathy and retinopathyEsther Preuß1
  • 1Diabetes Zentrum Mergentheim, Bad Mergentheim(Chefarzt: Prof. Dr. med. Thomas Haak)
Further Information

Publication History

Publication Date:
09 July 2008 (online)

Also available at
    Permissions and Reprints

See also:

Folgeerkrankungen des Diabetes mellitus – Koronare Herzerkrankung, Nephropathie und RetinopathieNotfall & Hausarztmedizin 2008; 34(04): 194-199
DOI: 10.1055/s-2008-1077126

Arteriosklerotische Gefäßveränderungen treten bereits im Stadium der gestörten Glukosetoleranz gehäuft auf und zeigen bei Diabetikern eine rasche Progredienz. Die hierbei signifikant erhöhte kardiovaskuläre Mortalität steigt mit zusätzlich vorliegender Nephropathie und Hypertonie. Ursächlich hierfür sind unter anderem akzelerierte Inflammation, endotheliale Dysfunktion und Hyperkoagulabilität. Prävention wie kausale Therapieansätze liegen, je nach Folgeerkrankung, insbesondere in einer normnahen Blutzucker– und Blutdruckeinstellung, einer Hemmung der Thrombozytenaggregation wie in einer konsequenten Lipidtherapie.

Arteriosclerotic vascular changes often occur already during the stage of disturbed glucose tolerance and progress rapidly in diabetics. Cardiovascular mortality, which is significantly increased in such cases, increases further if nephropathy and hypertonicity occur additionally. This increased mortality is inter alia due to accelerated inflammation, endothelial dysfunction and hypercoagulability. Prevention as well as on–target therapeutic approaches are – depending on the subsequent disease – especially near–normal blood sugar and blood pressure adjustment, inhibition of thrombocyte aggregation and a rigorously maintained lipid therapy.

Key words

Diabetes mellitus - coronary heart disease - nephropathy - retinopathy

Literatur

  • 1 De Vegt F, Dekker JM, Ruhe HG. et al. . Hyperglycaemia is associated with all–cause and cardiovas cular mortality in the Hoorn population: the Hoorn Study.  Diabetologia. 1999;  42 926-931
    CrossrefPubMedGoogle Scholar
  • 2 Barr EL, Zimmet PZ, Welborn TA. et al. . Risk of cardiovascular and all–cause mortality in individuals with diabetes mellitus, impaired fasting glucose, and impaired glucose tolerance: the Australian Diabetes, Obesity, and Lifestyle Study.  Circulation. 2007;  116 151-157
    CrossrefGoogle Scholar
  • 3 Haffner SM, Ronnemaa T. et al. . Mortality from coronary heart disease in subjects with type2 diabetes and in nondiabetic subjects with and without prior myocardial infarction.  N Engl J Med. 1998;  339 229
    CrossrefGoogle Scholar
  • 4 Gitt AK, Schiele R, Wienbergen H. et al. . Increased hospital and long–term mortality for myocardial infarction in patients with diabetes: results from the ACOS registry.  Eur Heart J. 2003;  24 674
    Google Scholar
  • 5 Hanley AJG, Williams K, Stern MP. et al. . Homeostasis model assessment of insulin resistance in relation to the incidence of cardiovascular disease: the San Antonio Heart Study.  Diabetes Care. 2002;  25 1177-1184
    Google Scholar
  • 6 Yusuf S, Hawken S, Ounpuu S. et al. . INTERHEART Study Investigators. Obesity and the risk of myocardial infarction in 27000 participants from 52 countries: a case–control study.  Lancet. 2005;  366 1640-1649
    CrossrefPubMedGoogle Scholar
  • 7 Evidenzbasierte Leitlinien der DDG, www.deutsche-diabetes-gesellschaft.de . 
    Google Scholar
  • 8 Leschke M, Jacob S.. Koronare Herzkrankheit und Diabetes mellitus.  Diabetologie und Stoffwechsel. 2007;  5 57-77
    Google Scholar
  • 9 Di Loreto C, Fanelli C, Lucidi P. et al. . Make your diabetic patients walk: long–term impact of different amounts of physical activity an type 2 diabetes.  Diabetes Care. 2005;  28 1295-1302
    CrossrefGoogle Scholar
  • 10 Church TS, Cheng YJ, Earnest CP. et al. . Exercise capacity and body composition as predictors of mortality among men with diabetes.  Diabetes Care. 2004;  27 83-88
    CrossrefGoogle Scholar
  • 11 Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen 0.. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes.  N Engl J Med. 2003;  348
    Google Scholar
  • 12 American Diabetes Association. . Standards of medical care in diabetes.  Diabetes Care. 2007;  30 4-41
    Google Scholar
  • 13 Guidelines for the management of arterial hypertension.  Journal of Hypertension. 2007;  25 1105-1187
    CrossrefGoogle Scholar
  • 14 HOPE Study Investigators. . Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICROHOPE substudy.  Lancet. 2000;  355 253-259
    CrossrefGoogle Scholar
  • 15 Yusuf S, Ostergren JB. et al. . Effects of candesartan on the development of a new diagnosis of diabetes mellitus in patients with heart failure. CHARM–Study.  Circulation. 2005;  112 48-53
    CrossrefGoogle Scholar
  • 16 Vermes A E; Ducharme. et al. . Enalapril reduces the incidence of diabetes in patients with chronic heart failure: insight from the Studies Of Left Ventricular Dysfunction. SOLVD–Study.  Circulation. 2003;  107 1291-1296
    CrossrefGoogle Scholar
  • 17 Leitlinien der Deutschen Hochdruckliga: www.hochdruckliga.de/-leitlinien . 
    Google Scholar
  • 18 MRC/BHF. Heart Protection Study of cholesterol lowering with simvastatin in 20.536 high–risk individuals: a randomised placebo–controlled trial.  Lancet. 2004;  360 7-22
    Google Scholar
  • 19 Shepherd J, Barter P, Carmena R. et al. . Effect of lowering LDL cholesterol substantially below currently recommended levels in patients with coronary heart disease and diabetes.  Diabetes Care. 2006;  29 1220-1226
    CrossrefGoogle Scholar
  • 20 ADA position statement: Aspirin therapy in diabetes. 
    Google Scholar
  • 21 Physician's Health Study. Aspirin and primary prevention of coronary heart disease.  N Engl J Med. 1989;  321 1825-1828
    Google Scholar
  • 22 Bakris GL.. Overview of diabetic nephropathy. UpToDate 2007 www.uptodate.com
    Google Scholar
  • 23 Ritz E, Dikow R.. The kidney in systemic disease – The patient with diabetes mellitus.  Oxford Text–book of Clinical Nephrology. 2005;  2
    Google Scholar
  • 24 Wolf G.. Pathophysiologie der diabetischen Nephropathie.  Der Nephrologe. 2007;  2 325-332
    CrossrefGoogle Scholar
  • 25 Gerstein HC.. Albuminuria and risk of cardiovascular events, death and heart failure in diabetic and non–diabetic individuals.  JAMA. 2001;  286 421
    CrossrefGoogle Scholar
  • 26 Bakris GL.. Treatment and prevention of diabetic nephropathy. UpToDate 2007
    Google Scholar
  • 27 Wang TJ.. Low–grade albuminuria and the risks of hypertension and diabetes.  Circulation. 2005;  111 1370
    CrossrefGoogle Scholar
  • 28 Sakaguchi T, Akizawa T.. K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification.  Clin Calcium. 2004;  14 9-14
    Google Scholar
  • 29 Parving HH, Lewis JB. et al. . Prevalence and risk factors for microalbuminuria in a referred cohort of type II diabetic patients: a global perspective.  Kidney Int. 2006;  69 2057
    CrossrefGoogle Scholar
  • 30 K/DOQI Clinical practice guidelines for CKD. Evaluation of laboratory measurements for clinical assessment of kidney disease. Guideline
    Google Scholar
  • 31 Stevens L.. Assessment of kidney function: Serum creatinine; BUN and GFR. UpToDate 2007
    Google Scholar
  • 32 Gross JL.. Diabetic nephropathy: diagnosis, prevention and treatment.  Diabetes Care. 2005;  28 164
    CrossrefGoogle Scholar
  • 33 Rose BD.. Management of chronic kidney disease in adults. UpToDate 2007
    Google Scholar
  • 34 Eckardt KU.. Therapie der renalen Anämie – mit welchem Ziel?.  Deutsche Medizinische Wochenschrift. 2007;  9 1837-1841
    Article in Thieme ConnectGoogle Scholar
  • 35 Hollenberg NK.. Aldosterone in the development and progression of renal injury.  Kidney Int. 2004;  66 1-9
    CrossrefGoogle Scholar
  • 36 Fiebeler A.. Neues zu Aldosteron und dem Mineralokortikoidrezeptor.  Der Nephrologe. 2007;  6 423-431
    Google Scholar
  • 37 McCulloch DK.. Treatment of diabetic retinopathy. UpToDate2007. www.uptodate.com
    Google Scholar
  • 38 www.diabetes-auge.de
  • 39 Hammes HP.. Diabetische Retinopathie.  Der Diabetologe. 2007;  3 143-153
    CrossrefGoogle Scholar
  • 40 DCCT Research Group. . The effect of intensive treatment of diabetes on the development and progression of long–term complications in insulin–dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group.  N Engl JMed. 1993;  329 977-986
    CrossrefGoogle Scholar
  • 41 UKPDS Group. . Intensive blood–glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type2 diabetes (UKPDS 33).  Lancet. 1998;  352 837-853
    CrossrefGoogle Scholar

Korrespondenz

Dr. med. Esther Preuß

Diabetes Zentrum Mergentheim Theodor–Klotzbücher

Straße 12

97980 Bad Mergentheim

Fax: 07931/594-111

      >