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Diabetologie und Stoffwechsel 2015; 10(06): R85-R100
DOI: 10.1055/s-0041-108649
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© Georg Thieme Verlag KG Stuttgart · New York

Prädisposition/Phänotypen des Gestationsdiabetes

Helmut Kleinwechter
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Publication Date:
22 December 2015 (online)

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Einleitung

Gestationsdiabetes mellitus (GDM) gehört heute in den westlichen Industrienationen zu den häufigsten Erkrankungen in der Schwangerschaft. Je nach untersuchter Bevölkerungsgruppe können mehr als 10 % der Schwangeren davon betroffen sein. Der GDM wird als 4. Diabeteserkrankung neben den folgenden 3 anderen Hauptklassen abgegrenzt:

  • Typ-1-Diabetes mellitus. Meist bei jungen, schlanken Menschen vom Autoimmuntyp mit positiven Inselzell-Autoantikörpern, wie z. B. Anti-GAD, Anti-IA2, Anti-ICA, Anti-ZnT8 und assoziierten Symptomen wie Polydipsie, Polyurie, Gewichtsabnahme, mit der Notwendigkeit einer primären Insulinsubstitution infolge Insulinmangels. Nicht selten liegen gleichzeitig weitere Autoimmunerkrankungen vor, wie z. B. Hashimoto-Thyreoiditis, Vitiligo, Zöliakie oder eine perniziöse Anämie.

  • Typ-2-Diabetes mellitus. Vorwiegend ältere und übergewichtige Menschen betreffende Volkskrankheit mit Insulinresistenz und Symptomarmut, die anfangs nur mit Diät und Lebensstiländerung und erst später mit einer Vielzahl zugelassener oraler oder injizierbarer Medikamente behandelt werden kann, bevor Insulin eingesetzt werden muss.

  • Sekundäre Diabeteserkrankungen. Bei ihnen ist die Hyperglykämie Symptom einer anderen zugrunde liegenden Erkrankung (z. B. Mukoviszidose, Hyperthyreose, Morbus Cushing), medikamentös induziert (z. B. Glukokortikoide, Diuretika) oder beruht auf einer Genmutation (z. B. Glukokinase-Genmutation [MODY2], permanenter neonataler Diabetes mellitus (Mutation des KCNJ11-Gens, welches für eine Untereinheit des ATP-sensitiven Kaliumkanals der β-Zelle kodiert).

Ein GDM kann nur diagnostiziert werden, wenn keines der Kriterien der anderen 3 Diabetesklassen vorliegt.

 

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