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ZFA (Stuttgart) 2004; 80(5): 204-209
DOI: 10.1055/s-2004-822621
Kardiovaskuläre Prävention

© Georg Thieme Verlag Stuttgart · New York

Prädiabetes - eine erfundene Krankheit?

Pre-Diabetes - An Invented Disease?G. Egidi, U. Popert
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Publication History

Publication Date:
26 May 2004 (online)

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Zusammenfassung

Auf der Basis neuerer epidemiologischer und interventioneller Studien wird die Notwendigkeit von Screening-Untersuchungen und Therapie für Prädiabetes diskutiert. In diesem Artikel werden die Grundlagen dafür nach Evidenz-Kriterien untersucht.
Hierbei wird auf die makrovaskulären Komplikationen fokussiert, da diese die Prognose eines Diabetikers am stärksten bestimmen.
Zwar steigt die Häufigkeit makrovaskulärer Organschäden in Abhängigkeit von Dauer und Intensität der häufig lange nicht bemerkten Stoffwechselstörung schon vor der Diabetes-Diagnose an, bislang konnte aber durch Studien eine Prognoseverbesserung durch strengere Stoffwechselkontrolle nicht bewiesen werden.
Ein generelles Screening auf Prädiabetes ist auf dem Boden der derzeit vorliegenden Studien deswegen nicht empfehlenswert.

Abstract

The results of recent epidemiological and interventional studies lead to a discussion about screening and treatment for pre-diabetes. This article reviews the relevant evidence for such a new strategy.
Although the rise in degree and frequency of macrovascular complications correlates with time of impaired glucose metabolism before manifestation of diabetes type 2, no trials could show any significant effect of intensive blood sugar control against these complications. Screening for pre-diabetes is therefore not generally recommended.

Schlüsselwörter

Diabetes mellitus - NIDDM - Diabetes Prävention - gestörte Glukose-Toleranz - Prädiabetes - Kardiovaskuläres Risiko - Arcabose - Melformin - Nüchtern-Blutzucker

Key words

Diabetes mellitus - NIDDM - diabetes prevention - impaired glucose tolerance - prediabetes - cardiovascular risk - acarbose - metformin - impaired fasting glucose

Literatur

  • 1 Blech J. Erfundene Krankheiten. „Der Spiegel” 33/2003
    Google Scholar
  • 2 JNC-7-Report mit der Empfehlung, nur Blutdruckwerte < 120/80 mm Hg als normal zu bezeichnen.  JAMA. 2003;  289 2560-2572
    CrossrefPubMedGoogle Scholar
  • 3 American Diabetes Association . Diabetes Care. 2003;  26 645-649
    PubMed
  • 4 NCEP 2001. NIH Publication No. 01-3305. Mai 2001
    Google Scholar
  • 5 US Preventive Services Task Force . Screening for Type 2 Diabetes Mellitus in Adults: Recommendations and Rationale.  Ann Intern Med. 2003;  138 212-214
    PubMedGoogle Scholar
  • 6 American Diabetes Association and National Institute of Diabetes, Digestive And Kidney Diseases . The Prevention or Delay of Type 2 Diabetes.  Diabetes Care. 2002;  25 742-749
    PubMedGoogle Scholar
  • 7 WHO .Screening for Type II Diabetes. http://www.who.int/ncd/dia/dia_publications.htm besucht am 15.11.2003
    Google Scholar
  • 8 Hauner. et al . Schätzung der Diabeteshäufigkeit in der Bundesrepublik Deutschland anhand von Krankenkassendaten.  DMW. 1992;  117 645-650
    PubMedGoogle Scholar
  • 9 Ratzmann. Eine Analyse von alters- und geschlechtsspezifischer Diabetesprävalenz.  Akt Endokr Stoffw. 1991;  12 220-223
    PubMedGoogle Scholar
  • 10 Rathmann, Löwel. High prevalence of undiagnosed diabetes mellitus in Southern Germany: The KORA survey 2000.  Diabetologia. 2003;  46 182-189
    CrossrefPubMedGoogle Scholar
  • 11 Stövring. et al . Rising prevalence of diabetes: evidence from a Danisk pharmaco-epidemiological database.  Lancet. 2003;  362 537-538
    CrossrefPubMedGoogle Scholar
  • 12 Haffner, Lehto, Rönnemaa, Pyörälä, Laakso. Mortality from coronary heart disease in subjects with type 2 diabetes and nondiabetic subjects with and without prior myocardial infarction.  N Engl J Med. 1998;  339 229-234
    CrossrefPubMedGoogle Scholar
  • 13 Evans, Wang, Morris. Comparison of cardiovascular risk between patients with type 2 diabetes and those who had ha a myocardial infarction.  BMJ. 2002;  324 939-944
    CrossrefPubMedGoogle Scholar
  • 14 Coutinho, Wang, Gerstein, Yusuf. The relationship between glucose and incident cardiovascular events. A metaregression analyses of published data from 20 studies of 95 783 individuals followed for 12.4 years.  Diabetes Care. 1999;  22 233-240
    CrossrefPubMedGoogle Scholar
  • 15 Stratton. et al . Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35).  BMJ. 2000;  321 405-412
    CrossrefPubMedGoogle Scholar
  • 16 Hu. et al . Elevated risk of cardiovascular disease prior to clinical diagnosis of type 2 diabetes. The Nurses Health Study.  Diabetes Care. 2002;  25 1129-1134
    CrossrefPubMedGoogle Scholar
  • 17 NCEP ATP III.  JAMA. 2001;  285 2486-2497
    CrossrefPubMedGoogle Scholar
  • 18 The Metabolic Syndrome. Diabetes Mellitus Interagency Coordinating Committee Meeting. National Institutes of Health Campus. Natcher Conference Center, Conference Room A. Bethesda, Maryland, February 25, 2003
    Google Scholar
  • 19 World Health Organisation Study Group . Diabetes Mellitus.  WHO Tech Rep Ser. 1985;  727
    PubMedGoogle Scholar
  • 20 The expert committee on the diagnosis and classification of diabetes mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus.  Diabetes Care. 1997;  20 1183-1197
    PubMedGoogle Scholar
  • 21 Nationale Versorgungsleitlinie Diabetes Version 1.7.2002.  www.akdae.de oder www.awfm-online.de
    Google Scholar
  • 22 DECODE study group . Glucose tolerance and mortality: comparison of WHO and American Diabetic Association diagnostic criteria.  Lancet. 1999;  354 617-621
    CrossrefPubMedGoogle Scholar
  • 23 RR = Relatives Risiko: Die Wahrscheinlichkeit, vorzeitig zu versterben, ist bei einem RR 1,8 um den Faktor 1,8 erhöht. 
    Google Scholar
  • 24 Haffner. et al . Cardiovascular risk factors in confirmed prediabetic individuals. Does the clock for coronary heart disease start ticking before the onset of clinical diabetes?.  JAMA. 1990;  263 2893-2898
    CrossrefPubMedGoogle Scholar
  • 25 Fasting and postchallenge glycemia and cardiovascular disease risk - the Framingham offspring study.  Diabetes Care. 2002;  25 1845-1850
    CrossrefPubMedGoogle Scholar
  • 26 DECODE Study group . Will the new diagnostic criteria for diabetes melltus change phenotype of patients with diabetes? Reanalysis of European epidemiological data.  BMJ. 1998;  317 371-375
    PubMedGoogle Scholar
  • 27 Feskens. et al . Intra- and interindividual variability of glucose tolerance in an elderly population.  J Clin Epidemiology. 1991;  40 947-953
    PubMedGoogle Scholar
  • 28 Mc Donald. et al . Reproducibility of the oral glucose tolerance test.  Diabetes. 1965;  14 473-480
    PubMedGoogle Scholar
  • 29 Olefsky. et al . Insulin and glucose responses to identical oral glucose tolerance tests performed forty-eight hours apart.  Diabetes. 1974;  23 449-453
    PubMedGoogle Scholar
  • 30 Mooy. et al . Intra-individual variation of glucose, specific insulin and proinsulin concentrations measured by two oral glucose tolerance tests in a general Caucasian population: the Hoorn Study.  Diabetologia. 1996;  39 298-305
    CrossrefPubMedGoogle Scholar
  • 31 Ko. et al . The reproducibility and usefulness of the oral glucose tolerance test in screening for diabetes and other cardiovascular risk factors.  Ann Clin Biochem. 1998;  35 62-67
    CrossrefPubMedGoogle Scholar
  • 32 Burke. et al . Reversion from type 2 diabetes to nondiabetic status: influence of the 1997 American Diabetes Association criteria.  Diabetes Care. 1998;  21 1266-1270
    CrossrefPubMedGoogle Scholar
  • 33 Eschwege. et al . Reproducibility of the diagnosis of diabetes over a 30-month follow-up: the Paris Prospective Study.  Diabetes Care. 2001;  24 1941-1944
    PubMedGoogle Scholar
  • 34 Eschwege. et al . From Policemen to policies: what is the future for 2-h glucose? The Kelly West Lecture.  Diabetes Care. 2001;  24 1945-1950
    PubMedGoogle Scholar
  • 35 Gabir. et al . The 1997 American Diabetes Association and 1999 World Health Organization Criteria for hyperglycaemia in the diagnosis and prediction of diabetes.  Diabetes Care. 2000;  23 1108-1112
    CrossrefPubMedGoogle Scholar
  • 36 Pan, Li, Hu, Wang, Yang, An, Hu, Lin, Xiao. et al . Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Quing IGT and Diabetes Study.  Diabetes Care. 1997;  20 537-544
    CrossrefPubMedGoogle Scholar
  • 37 Tuomilehto, Lindström, Eriksson, Valle. et al . Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.  N Engl J Med. 2001;  344 1343-1350
    CrossrefPubMedGoogle Scholar
  • 38 Diabetes Prevention Program Research Group . Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.  N Engl J Med. 2002;  346 393-402
    CrossrefPubMedGoogle Scholar
  • 39 Chiasson, Josse, Gomis, Hanefeld, Karasik, Laakso. Acarbose for prevention of type 2 diabetes: the STOP-NIDDM randomised trial.  Lancet. 2002;  359 2072-2077
    CrossrefPubMedGoogle Scholar
  • 40 NN. STOP-NIDDM-Studie mit Acarbose. Schlamperei, Manipulation, Irreführung. Arzneimitteltelegramm 2003; 8: 73
    Google Scholar
  • 41 UKPDS 33.  Lancet. 1998;  352 837-851
    CrossrefPubMedGoogle Scholar
  • 42 UK Prospective Diabetes Study Group . Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34).  Lancet. 1998;  352 854-865
    CrossrefPubMedGoogle Scholar
  • 43 de Lorgeril. et al . Lyon Diet Heart Study.  Circulation. 1999;  99 779-785
    CrossrefPubMedGoogle Scholar
  • 44 Singh. et al . Indo-Mediterranean Diet Heart Study.  Lancet. 2002;  360 1455-1461
    CrossrefPubMedGoogle Scholar
  • 45 Ornish. et al . JAMA. 1998;  280 2001-2007
    CrossrefPubMed
  • 46 Haskell. et al . SCRIP = Stanford Coronary Risk Intervention Project.  Circulation. 1994;  89 975-990
    PubMedGoogle Scholar
  • 47 Eriksson K F, Lindgäde P. No excess 12-year mortality in men with impaired glucose tolerance who participated in the Malmo Preventive Trial with diet and exercise.  Diabetologia. 1998;  41 1010-1016
    CrossrefPubMedGoogle Scholar

Günther Egidi

Huchtinger Heerstr. 41

28259 Bremen

Phone: 04 21-5 79 76 75

Email: familie-egidi@nord-com.net