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Diabetische Notfallsituationen – die Hypoglykämie

Diabetic emergencies—hypoglycemia

  • Leitthema
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Zusammenfassung

Bei Patienten mit Typ-1-Diabetes mellitus (T1DM) und Typ-2-Diabetes mellitus (T2DM) stellt die Hypoglykämie nach wie vor einen relevanten limitierenden Faktor für die Erreichung des HbA1c-Zielwertes dar. Neben der akuten Notfallsituation hat die Hypoglykämie prognostische Relevanz hinsichtlich kardiovaskulärer oder zerebrovaskulärer Morbidität bis hin zur Mortalität. Symptomatische und v. a. schwere Hypoglykämien sind für die betroffenen Patienten eine große Belastung, auch stellen sie einen nicht unerheblichen Kostenfaktor für das Gesundheitssystem dar. Mit der kontinuierlichen Glucosemessung (CGM) sind komplexe Abläufe perihypoglykämischer Episoden besser nachvollziehbar. Auch konnte gezeigt werden, dass neben den offensichtlichen symptomatischen Hypoglykämien auch eine nicht unerhebliche Zahl an inapparenter Hypoglykämien auftreten, die u. a. mitverantwortlich sind für die bei vielen Patienten vorliegende hohe Glucosevariabilität und Instabilität des Glucosestoffwechsels. Gefährdet sind nicht nur Patienten mit T1DM, sondern v. a. Patienten mit langjährigem T2DM unter einer Therapie mit Sulfonylharnstoffen oder Insulin. Ein weiterer behandelbarer Risikofaktor stellt eine gestörte Gegenregulation verbunden mit Hypoglykämiewahrnehmungsstörung dar. Ziel muss es sein, neben dem optimierten Management (Schulung) einen Schwerpunkt auf die Hypoglykämieprävention durch Optimierung und Vermeidung möglicher Auslöser oder Risikofaktoren zu setzen. Hierzu gehören neben individualisierten Therapiezielen auch die Wahl effektiver, aber gleichzeitig in Hinsicht auf das Hypoglykämierisiko sicherer Therapiestrategien.

Abstract

In patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM), hypoglycemia remains a relevant limiting factor in achieving the HbA1c target value. In addition to the acute emergency situation, hypoglycemia is of prognostic relevance for cardiovascular or cerebrovascular morbidity, which may also include mortality. Symptomatic and especially severe hypoglycemia are a burden not only for the affected patients, but they also represent a significant cost factor for the health care system. With the help of continuous glucose monitoring (CGM) the complex processes of perihypoglycemic episodes are better understood. CGM uncovered that besides obvious symptomatic hypoglycemia, a significant number of unrecognized hypoglycemia episodes occur, which are responsible for the high glucose variability and instability of glucose metabolism present in many patients. At risk are not only patients with T1DM, but also patients with long-standing T2DM under therapy with sulfonylureas or insulin. Another treatable risk factor is impaired counter-regulation with hypoglycemia unawareness. In addition to optimized management (training), the focus must be on hypoglycemia prevention by optimizing and avoiding potential triggers or risk factors. To achieve this, both individualized therapy goals and the choice of effective but safer therapeutic strategies regarding hypoglycemia risk are needed.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. P.-M. Schumm-Draeger gibt an, dass kein Interessenkonflikt besteht. T. Siegmund gibt an, Vortragshonorare von Abbott, Astra Zeneca/BMS, Berlin Chemie, Boehringer Ingelheim, Eli Lilly, Medtronic, MSD, Novatis, Novo Nordisk, Roche und Sanofi sowie Beraterhonorare von Abbott, Becton Dickinson, Boehringer Ingelheim, Eli Lilly, Janssen, Medtronic, MSD, Novo Nordisk und Sanofi zu erhalten. Des Weiteren bezieht er Forschungsförderung von Eli Lilly, MSD, Novo Nordisk und Sanofi. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Siegmund, T., Schumm-Draeger, PM. Diabetische Notfallsituationen – die Hypoglykämie. Diabetologe 10, 628–637 (2014). https://doi.org/10.1007/s11428-014-1264-y

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