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Diabetologie und Stoffwechsel 2009; 4(3): 177-182
DOI: 10.1055/s-0028-1098897
Übersicht

© Georg Thieme Verlag Stuttgart ˙ New York

Diabetes mellitus im Kindesalter aus kardiovaskulärer Sicht – Implikationen für das klinische Management

Diabetes in Childhood – Cardiovascular ConsequencesR. Dalla Pozza1 , H. Netz1 , H.-P. Schwarz2 , S. Bechtold2
  • 1Abteilung für Kinderkardiologie und Pädiatrische Intensivmedizin, Klinikum Großhadern, Ludwig-Maximilians-Universität München
  • 2Kinderendokrinologie und Diabetologie, Dr. v. Haunersches Kinderspital, Ludwig-Maximilans-Universität München
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Publication History

Publication Date:
16 June 2009 (online)

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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

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