Einfluss der Stoffwechselverbesserung durch Pioglitazon auf die Herzratenvariabilität (HRV) bei Patienten mit Typ-2-Diabetes

Zusammenfassung

In der vorliegenden multizentrischen Praxis­beobachtung wurden konsekutiv hausärztlich ­betreute Patienten mit Typ-2-Diabetes, einer Diabetesanamnese unter 4 Jahren und mit antidia­betischen Behandlung ohne Insulin einer kardio­vaskulären Risikostratifizierung unterzogen und mittels Spektralanalyse der Herzratenvariabilität (HRV) auf das Vorliegen einer kardialen auto­nomen diabetischen Neuropathie (KADN) untersucht. Nachfolgend wurde bei 227 Patienten über einen Zeitraum von 12 Monaten die Veränderung der HRV unter dem Einfluss des Insulinsensiti­zers Pioglitazon ermittelt und mit Stoffwechsel- und Kreislaufparametern korreliert. Dabei zeigten sich eine signifikante Verbesserung der HRV und der Stoffwechsel- und Kreislaufparameter. Zum Vergleich wurden 88 Patienten ohne Glitazon­behandlung auf die gleiche Weise untersucht. Bei diesen Patienten ließ sich keine Verbesserung der HRV zeigen. Die gewonnenen Daten zeigen, dass die Messung der HRV mittels Spektralanalyse eine gute Methode ist, um in der hausärztlichen Praxis aus der Klientel der Typ-2-Diabetiker Hoch-Risiko-Patienten zu identifizieren und um eine adäquate präventive Therapie einzuleiten. 

Abstract

In this open multicenter user observation, patients with type 2 diabetes, diabetes duration < 4 years, without insulin therapy were recruited by general practitioners with the aim of stratification for cardiovascular risk. Laboratory param­eters of metabolic control, blood pressure and ­heart rate variability (HRV) were determined. ­Investigated was the influence of pioglitazone on these parameters during 12 months in 227 patients. For comparison, a group with 88 diabetics without glitazone was investigated. Under pio­glitazone therapy a significant increasing of HRV and a improvement of metabolic control were observed, which was not evident in the group with­out pioglitazone. This investigation showed that the spectral analysis of HRV is a suitable method for the detection of high risk patients with cardiovascular autonomic diabetic neuropathy, which then can receive closer follow-up and a more sufficient medical therapy. 

Schlüsselwörter

Screening in Hausarztpraxen - Typ-2-Diabetes - kardiale autonome diabetische Neuropathie (KADN) - Herzratenvariabiliät (HRV) - modifizierter Orthostasetest - Pioglitazon

Key words

general practitioners - cardiovascular autonomic diabetic neuropathy (CADN) - heart rate variability (HRV) - modified orthostase test - pioglitazone

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