Zusammenfassung
Typ-2-Diabetiker weisen eine signifikant höhere Morbidität bzw. Mortalität im Bezug
auf kardiovaskuläre Ereignisse auf als die gesunde, nichtdiabetische Bevölkerung.
Bereits bei der Diagnosestellung eines Typ-2-Diabetes sind bei etwa der Hälfte aller
Patienten manifeste makro- und mikroangiopathische Veränderungen zu sehen. Als Initialstadium
im Prozess der Atherosklerose gelten Funktionsstörungen des Endothels. Tatsächlich
zeigen Personen mit einer gestörten Glukosetoleranz oder gar einer noch normoglykämischen
Insulinresistenz bereits eine deutlich höhere Prävalenz einer so genannten „endothelialen
Dysfunktion” als Insulinsensible. Gerade diese Patienten weisen ein erhöhtes Risiko
im Hinblick auf die Gefahr eines frühen Herzinfarktes auf. Da der Gefäßschaden und
die Insulinresistenz eng korrelieren, ist zur Abschätzung des Risikos nicht nur die
rechtzeitige Diagnose einer gestörten Glukosetoleranz von Bedeutung, sondern auch
das klinische Profil einer vorliegenden Insulinresistenz. In diesem Zusammenhang scheint
vor allem der Körperfettverteilung und darüber hinaus chronisch inflammatorischen
Markern eine relevante Bedeutung zuzukommen.
Summary
Type 2 diabetics show a significantly higher risk for cardiovascular morbidity and
mortality, compared to the non-diabetic population. Already at the time of diagnosis,
almost 50 % of the diabetics show macro- or microvascular alterations. Indeed, people
with an impaired glucose tolerance, or even normoglycemic insulin resistance already
show a higher prevalence of endothelial dysfunction than insulin sensible controls.
The endothelial dysfunction shows strong correlation to manifest atherosclerosis as
well as to isolated coronary heart disease. Furthermore, endothelial dysfunction is
highly predictive for cardiovascular events. Due to the strong association of insulin
resistance and endothelial dysfunction, the early identification of disturbances in
the homeostasis of insulin metabolism is of high importance in identifying patients
at high risk for atherosclerosis.
Key Words
insulin resistance - cardiovascular morbidity and mortality - impaired glucose tolerance
- insulin resistance - endothelial dysfunction - atherosclerosis
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1 UK Prospective Diabetes Study
2 Tübinger-Lebensstil-Interventions-Programm
Anschrift für die Verfasser
OA Dr. B. Balletshofer
Medizinische Klinik, Abteilung IV, Universität Tübingen
Otfried-Müller-Straße 10
72076 Tübingen