Tipps und Tricks zur Behandlung des pankreatopriven Diabetes mellitus

Kempf, Patrick; Laimer, Markus; Stettler, Christoph (2016). Tipps und Tricks zur Behandlung des pankreatopriven Diabetes mellitus. Therapeutische Umschau, 73(9), pp. 495-499. Huber 10.1024/0040-5930/a000824

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Zusammenfassung. Verschiedenste Erkrankungen des exokrinen Pankreas können auch Störungen des endokrinen Pankreasanteils verursachen. Der resultierende Diabetes mellitus wird als pankreatopriver (Typ-3c-Diabetes) bezeichnet. Mangel an funktionierendem Pankreasgewebe heisst nicht nur Insulinmangel sondern insbesondere auch Mangel an Glukagon, womit die Zuckereinstellung erschwert wird und die Gefahr schwerer Hypoglykämien unter Insulintherapie steigt. Obwohl es sich beim Typ 3c Diabetes um eine relativ seltenere Diabetesform handelt, ist er in der Häufigkeit dennoch nicht zu unterschätzen. Bedingt durch seine metabolische Komplexizität mit hoher Glukosevariabilität stellt er eine schwierig einzustellende Diabetesform dar. Eine frühzeitige und gute Therapie ist bei den oftmals schwer kranken Patienten mit pankreatoprivem Diabetes dafür umso wichtiger, um ein gutes kurz-, mittel- und langfristiges Outcome zu erreichen.

Treatment of Pancreatic Diabetes
Abstract. A broad variety of pathologies of the exocrine pancreas, such as pancreatitis, pancreatic cancer or pancreas resection, may be associated with impaired beta cell function and, subsequently, the development of so-called pancreatic (type 3c) diabetes. While representing a comparably rare cause of diabetes (when opposed to type 2 diabetes), the prevalence of this often overlooked subtype may still be substantially higher than previously estimated. The combined loss of insulin and glucagon secreting cells as well as the frequently associated changes in nutrient absorption typically result in a high metabolic instability and glucose variability, translating into an increased risk for hypoglycemia as well as difficulties in achieving good glycemic control. Depending on the underlying condition, which may be associated with limited life expectancy, low HbA1c values may not represent the sole therapeutic target, and other goals (i. e. weight maintenance, quality of life, etc) may be of high priority in some patients. . Although non-insulin glucose-lowering agents may be considered in some situations of pancreatic diabetes, insulin represents a therapeutic cornerstone since it not only targets the loss of beta-cells in pancreatic disease, but also induces a potent anabolic state (which may be of particular importance for patients with malignant or chronic pancreatic disease). Increased awareness, early diagnosis, and adequate treatment of pancreatic diabetes are of uttermost importance for improving short- as well as long-term outcomes in these patients.

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