Zusammenfassung
Kinder mit Diabetes mellitus sind in erhöhtem Maße gefährdet, in späteren Jahren Komplikationen
einer akzelerierten und generalisierten Atherosklerose zu erleiden. Myokardinfarkt,
ischämischer Insult, Nierenversagen und die periphere arterielle Verschlusskrankheit
sind als Endpunkte der diabetischen Makroangiopathie zu sehen – deren Wurzeln jedoch
in einem über Jahre verlaufenden Umbauprozess der Gefäßwand zu sehen sind. Das heutige
Verständnis chronischer Erkrankungen wie Diabetes mellitus sieht nicht nur eine möglichst
optimale Therapie des Grundleidens vor, sondern liegt in einem multidisziplinären
Ansatz zur Optimierung der Lebensqualität dieser Kinder. Es gilt daher, die kardiovaskulären
Risikofaktoren bei diesen Kindern frühzeitig zu diagnostizieren, deren Auswirkungen
möglichst zuverlässig darzustellen und entsprechend präventiv tätig zu werden. Zusätzlich
zu den klassischen Risikofaktoren wie Übergewicht, Hypertonie, Dyslipidämie und Rauchen
wurden in den letzten Jahren zahlreiche mögliche kardiovaskuläre Risikofaktoren untersucht.
Daneben wurden nicht invasive Methoden wie die Messung der Intima-Media-Dicke oder
die Messung der Endothelfunktion entwickelt, welche auch im Kindesalter den Gefäßstatus
zuverlässig abbilden. Diese neue Sicht des kardiovaskulären Risikos hat dazu geführt,
dass Kinder mit Diabetes mellitus in die Gruppe chronisch kranker Kinder mit dem höchsten
Risiko für atherosklerotische Erkrankungen eingruppiert werden. Die aktuelle Literatur
sowie die zu erwartenden kardiovaskulären Aspekte in der Betreuung von Kindern mit
Diabetes mellitus werden in dieser Übersicht zusammengefasst. Anhand eigener Daten
werden biochemische und bildgebende diagnostische Möglichkeiten zur Abschätzung des
kardiovaskulären Risikos des Kindes mit Diabetes mellitus präsentiert. Schließlich
geben wir einen Überblick über die aktuellen Therapieempfehlungen, welche zur Optimierung
der kardiovaskulären Gesundheit berücksichtigt werden sollten.
Abstract
Children with diabetes mellitus show a markedly increased cardiovascular risk. Coronary
artery disease, stroke, renal failure or peripheral vascular disease are among the
complications which occur more frequently in diabetic patients and are the consequence
of diabetic macroangiopathy. The current guidelines on the management of children
with chronic diseases recommend not only to optimize the therapy of the underlying
disease, but also to improve the quality of life. Thus, vascular disease should be
diagnosed as early as possible to prevent atherosclerotic complications. Beyond the
classical atherosclerotic risk factors such as obesity, hypertension, dyslipidemia
and tobacco smoking some newer risk factors have been evaluated during the past years.
Non invasive diagnostic methods such as the measurement of the intima medial thickening
of the arteries or of endothelial function have emerged and have been validated also
for children. According to these findings, the recommendations for the management
of children with diabetes mellitus have changed. The actual guidelines enclose these
children in the group with the highest risk for cardiovascular disease. The actual
literature and the cardiovascular aspects of the management of these children are
presented. The possibilities using biochemical and imaging diagnostic methods for
the cardiovascular risk assessment of the patients are illustrated using also data
of our own patient group. We give an overview regarding the actual therapeutic recommendations
which should be taken into account in the multidisciplinary approach for the best
care for children with diabetes mellitus.
Schlüsselwörter
Diabetes mellitus - Intima-Media-Dicke - Atherosklerose
Key words
diabetes mellitus - intima-medial-thickness - atherosclerosis
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R. Dalla Pozza
Abteilung für Kinderkardiologie und Pädiatrische Intensivmedizin · Klinikum Großhadern
· Ludwig-Maximilians-Universität München
Marchioninistr. 15
81377 München
Email: Robert.DallaPozza@med.lmu.de
