Diabetes und Schlaganfall – eine schwierige Beziehung, akut, wie im Langzeitbereich

Abstract

The diabetic metabolic state has two different implications for the neurologist engaged in stroke treatment. An ideal treatment of diabetes mellitus is of enormous concern due to its significance as a risk factor for emerging atherosclerotic diseases such as stroke, as well as in acute stroke, owing to its relevance for the clinical outcome. Intensified blood glucose lowering regimens using i. v. insulin are currently being replaced by a more liberal therapy on the Stroke Unit. Blood glucose levels beyond 200 mg% will be treated by fractionated s. c. insulin administration, only in the case of failure is i. v. continuous insulin to be used. In spite of available epidemiological data for the correlation between glycated haemoglobin and stroke prevalence, as well as the existence of numerous drugs effective in reducing HBA1c, many intervention studies (ACCORD, ADVANCE, V-ADT) have failed to show a close connection for reducing clinical endpoints. The data from STENO-2 and the UKPDS have led to the idea that in the long run the positive effects of antidiabetic strategies will be better revealed. The primarily disappointing data from the intervention studies challenged the diabetes treatment. It seems clear that there is no magic optimum of a target HBA1c which fits for all patients. Instead of this approach we will need an individualised therapy taking into account age, comorbidity, duration of diabetes and side effects of drugs. Besides the early start of an optimised diabetes therapy, the additional treatment of the metabolic syndrome is essential for the best care. This has best been shown by studies which have shown the positive effects of life-style modifications and blood pressure treatment in diabetic patients.