Diabeteskomplikationen – Diabetes und Nervensystem

Diabetes mellitus ist eine chronische Stoffwechselerkrankung, deren multiple Langzeitkomplikationen auch das Nervensystem betreffen. Rund 30 % der Diabetespatienten leiden unter den starken Beeinträchtigungen des subjektiven Wohlbefindens einer Polyneuropathie. Auch das Risiko für die Entwicklung kognitiver Einschränkungen und Demenz ist bei älteren Diabetespatienten erhöht. Eine schlechte Glukosestoffwechsellage über viele Jahre scheint ein entscheidender Risikofaktor für die Entwicklung dieser Diabeteskomplikationen zu sein.

Abstract

Diabetes mellitus is a chronic metabolic disease associated with multiple long-term complications. Besides macro- and microvascular complications, patient’s well-being can be severely impaired by complications affecting the nervous system. About 50 % of patients with diabetes suffer from polyneuropathy. Moreover, the risk of developing cognitive impairment and dementia is also increased in older people with diabetes. Insufficient glycemic control, young age at diagnosis of diabetes are discussed as risk factors for developing diabetes complications. The early identification and prevention of factors predicting diabetes complications that affect the nervous system are still challenging and in need for further research.

Schlüsselwörter

Diabeteskomplikationen - Polyneuropathie - distal-symmetrische sensomotorische Polyneuropathie (DSPN) - Neurodegeneration - GLP-1-Rezeptoragonist

Key words

diabetes complications - polyneuropathy - distal Symmetrical Sensorimotor Polyneuropathy (DSPN) - neurodegeneration - GLP-1 receptor agonist.

Publication History

Article published online:
03 November 2020

• Literatur

• 1 Ziegler D, Keller J, Maier C. et al Diabetische Neuropathie. Diabetol Stoffwechsel 2018; 13: S230-S236 . doi.org/10.1055/a-0598-0551
• 2 Bongaerts BWC, Rathmann W, Kowall B. et al Postchallenge hyperglycemia is positively associated with diabetic polyneuropathy: The KORA F4 Study. Diabetes Care 2012; 35: 1891-1893 . doi.org/10.2337/dc11-2028
• 3 Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale VersorgungsLeitlinie Neuropathie bei Diabetes im Erwachsenenalter – Langfassung. 2011 Version 1.2. Im Internet (Stand: 08.07.2020): https://www.deutsche-diabetes-gesellschaft.de/fileadmin/Redakteur/Leitlinien/Evidenzbasierte_Leitlinien/nvl-t2d-neuro-lang.pdf
• 4 Pop-Busui R, Boulton AJM, Feldman EL. et al Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care 2017; 40: 136-154 . doi.org/10.2337/dc16-2042
• 5 Panosyan FB, Mountain JM, Reilly MM. et al Rydel-Seiffer fork revisited: Beyond a simple case of black and white. Neurology 2016; 87: 738-740 . doi.org/10.1212/WNL.0000000000002991
• 6 Kumar S, Fernando DJS, Veves A. et al Semmes-Weinstein monofilaments: a simple, effective and inexpensive screening device for identifying diabetic patients at risk of foot ulceration. Diabetes Res Clin Pract 1991; 13: 63-67 . doi.org/10.1016/0168-8227(91)90034-B
• 7 Ziegler D, Keller J, Maier C e. et al Diabetische Neuropathie. Diabetol Stoffwechsel 2017; 12: S101-S114 . doi.org/10.1055/s-0043-115955
• 8 Dyck PJ, Albers JW, Andersen H. et al Diabetic polyneuropathies: update on research definition, diagnostic criteria and estimation of severity: Diabetic polyneuropathies. Diabetes Metabolism Res Rev 2011; 27: 620-628 . doi.org/10.1002/dmrr.1226
• 9 Boulton AJ, Gries FA, Jervell JA. Guidelines for the diagnosis and outpatient management of diabetic peripheral neuropathy. Diabetes Med 1998; 15: 508-514 . doi.org/10.1002/(SICI)1096-9136(199806)15: 6<508: : AID-DIA613>3.0.CO;2-L
• 10 Haslbeck M, Luft D, Neundörfer B. et al. Diagnostik, Therapie und Verlaufskontrolle der Neuropathie bei Diabetes mellitus Typ 1 und Typ 2. Evidenzbasierte Leitlinie DDG — Aktualisierung 05/2004. 2004 http://www.deutsche-diabetes-gesellschaft.de/
• 11 Schönauer M, Thomas A, Morbach S. et al Cardiac autonomic diabetic neuropathy. Diabetes and Vascular Disease Res 2008; 5: 336-344 . doi.org/10.3132/dvdr.2008.047
• 12 Greco D, Gambina F, Maggio F. Ophthalmoplegia in diabetes mellitus: a retrospective study. Acta Diabetologica 2009; 46: 23-26 . doi.org/10.1007/s00592-008-0053-8
• 13 Al Kahtani ES, Khandekar R, Al-Rubeaan K. et al Assessment of the prevalence and risk factors of ophthalmoplegia among diabetic patients in a large national diabetes registry cohort. BMC Ophthalmology 2016; 16: 118 . doi.org/10.1186/s12886-016-0272-7
• 14 Tesfaye S. Diabetic neuropathy: achieving best practice. Br J Diabetes Vasc Dis 2003; 3: 112-117 . doi.org/10.1177/14746514030030020601
• 15 Gibbons CH, Freeman R. Treatment-induced neuropathy of diabetes: an acute, iatrogenic complication of diabetes. Brain 2015; 138: 43-52 . doi.org/10.1093/brain/awu307
• 16 American Diabetes Association. Standards of medical care in diabetes--2012. Diabetes Care 2012; 35: S11-S63 . doi.org/10.2337/dc12-s011
• 17 Wong M, Chung JWY, Wong TKS. Effects of treatments for symptoms of painful diabetic neuropathy: systematic review. BMJ 2007; 335: 87 . doi.org/10.1136/bmj.39213.565972.AE
• 18 Yaffe K. Association between hypoglycemia and dementia in a biracial cohort of older adults with diabetes mellitus. JAMA Intern Med 2013; 173: 1300 . doi.org/10.1001/jamainternmed.2013.6176
• 19 Bremer JP, Jauch-Chara K, Hallschmid M. et al Hypoglycemia unawareness in older compared with middle-aged patients with type 2 diabetes. Diabetes Care 2009; 32: 1513-1517 . doi.org/10.2337/dc09-0114
• 20 Biessels GJ, Despa F. Cognitive decline and dementia in diabetes mellitus: mechanisms and clinical implications. Nature Reviews Endocrinology 2018; 14: 591-604 . doi.org/10.1038/s41574-018-0048-7
• 21 Arnold SE, Arvanitakis Z, Macauley-Rambach SL. et al Brain insulin resistance in type 2 diabetes and Alzheimer disease: concepts and conundrums. Nat Rev Neurol 2018; 14: 168-181 . doi.org/10.1038/nrneurol.2017.185
• 22 Kleinridders A, Ferris HA, Cai W. et al Insulin action in brain regulates systemic metabolism and brain function. Diabetes 2014; 63: 2232-2243 . doi.org/10.2337/db14-0568
• 23 Benedict C, Hallschmid M, Schmitz K. et al Intranasal Insulin Improves Memory in Humans: Superiority of Insulin Aspart. Neuropsychopharmacology 2007; 32: 239-243 . doi.org/10.1038/sj.npp.1301193
• 24 Palleria C, Leporini C, Maida F. et al Potential effects of current drug therapies on cognitive impairment in patients with type 2 diabetes. Frontiers Neuroendocrinol 2016; 42: 76-92 . doi.org/10.1016/j.yfrne.2016.07.002
• 25 Gault VA, Hölscher C. GLP-1 receptor agonists show neuroprotective effects in animal models of diabetes. Peptides 2018; 100: 101-107 . doi.org/10.1016/j.peptides.2017.11.017
• 26 Andersen ST, Witte DR, Dalsgaard E-M. et al Risk factors for incident diabetic polyneuropathy in a cohort with screen-detected type 2 diabetes followed for 13 years: ADDITION-Denmark. Dia Care 2018; 41: 1068-1075 . doi.org/10.2337/dc17-2062
• 27 Lee HJ, Seo HI, Cha HY. et al Diabetes and Alzheimer’s disease: mechanisms and nutritional aspects. Clinical Nutrit Res 2018; 7: 229 . doi.org/10.7762/cnr.2018.7.4.229