Top

Huisarts en wetenschap

Gepubliceerd in:

01-02-2013

Genezing van diabetes mellitus type 2?

Auteurs: Marc Huls, Mattees van Dijk, Maril Boesten

Gepubliceerd in: Huisarts en wetenschap | Uitgave 2/2013

Samenvatting

Huls MHJ, Van Dijk MJ, Boesten ML. Genezing van diabetes mellitus type 2? Huisarts Wet 2013;56(2):70-3.

Binnen de huisartsenpraktijk bereiken steeds meer diabeten langdurige normoglykemie door leefstijlinterventies of bariatrische chirurgie. Er zijn geen landelijke richtlijnen die aangeven hoe huisartsen hiermee om moeten gaan. Uit de literatuur en onderzoek blijkt dat het beter is om van remissie, dan van genezing te spreken. Dit heeft te maken met de onderliggende pathofysiologische mechanismen, maar ook met de kans op recidief van de diabetes na remissie. Daarnaast impliceert de term ‘genezing’ dat alle tijdens de diabetes ontstane orgaanschade ook verdwenen is na realisering van normoglykemie. Ziektespecifieke (microvasculaire) en generieke complicaties (macrovasculair/cardiovasculair) blijven echter in verschillende mate bestaan, ook als er langdurig sprake is van normoglykemie. Ook lijkt er onomkeerbare weefselschade te zijn, de zogenaamde ‘metabolic memory’. Bij bariatrische chirurgie heeft men in verschillende onderzoeken aangetoond dat de mortaliteit en morbiditeit na remissie afnemen. Bij leefstijlinterventies bleek dit vooralsnog niet aantoonbaar. Wij bevelen de huisarts aan om bij remissie van diabetes mellitus type 2 de consensusrichtlijnen van de American Diabetes Association te volgen. Dit sluit aan bij de NHG-Standaarden Diabetes mellitus en CVRM, die ook verschillende risicofactoren meenemen in de overwegingen. Hierbij blijft follow-up op macrovasculaire complicaties noodzakelijk en kan men follow-up op microvasculaire complicaties verminderen, maar niet staken.

vorige artikel Ranglijst

volgende artikel Hemangiomen: wanneer en hoe te behandelen

Griffin SJ, Borch-Johnsen K, Davies MJ, Khunti K, Rutten GE, Sandbak A, et al. Effect of early intensive multifactorial therapy on 5-year cardiovascular outcomes in individuals with type 2 diabetes detected by screening (ADDITION-Europe): a cluster-randomised trial. Lancet 2011;378:156-67.PubMedCrossRef

Buchwald H, Williams SE. Bariatric surgery worldwide 2003. Obes Surg 2004;14:1157-64.PubMedCrossRef

Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2008. Obes Surg 2009;19:1605-11.CrossRef

Pories WJ, Swanson MS, MacDonald KG, Long SB, Morris PG, Brown BM, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 1995;222:332-9.CrossRef

Rutten GEHM, De Grauw WJC, Nijpels G, Goudswaard AN, Uitewaal PJM, Van Der Does FEE, et al. NHG-Standaard Diabetes mellitus type 2. Huisarts Wet 2006;49:137-52.

Buse JB, Caprio S, Cefalu WT, Ceriello A, Del Prato S, Inzucchi SE, et al. How do we define cure of diabetes? Diabetes Care 2009;32:2133-5.PubMedCrossRef

Butler A, Janson J, Bonner-Weir S, Ritzel R. β-Cell deficit and increased β-cell apoptosis in humans with type 2 diabetes. Diabetes 2003;52:102-10.PubMedCrossRef

UK Prospective Diabetes Study Group. UK prospective diabetes study 16. Overview of 6 years’ therapy of type II diabetes: a progressive disease. Diabetes 1995;44:1249-58.CrossRef

Lim EL, Hollingsworth KG, Aribisala BS, Chen MJ, Mathers JC, Taylor R. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia 2011;54:2506.PubMedCrossRef

10.

Expert Committee. Report of the Expert Committee on the Description of Diabetes Categories of Glucose. Diabetes 2003;26:5-20.

11.

Gale EA. Declassifying diabetes. Diabetologia 2006;49:1989-95.PubMedCrossRef

12.

Expert Committee. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. National Diabetes Data Group. Diabetes 1979;28:1039-57.

13.

Expert Committee. WHO Expert Committee on Diabetes Mellitus: second report. World Health Organ Tech Report Ser 1980;646:1-80.

14.

Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complcations of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000;321:405-12.PubMedCrossRef

15.

Danaei G, Lawes CMM, Vander Hoorn S, Murray CJL, Ezzati M. Global and regional mortality from ischaemic heart disease and stroke attributable to higher-than-optimum blood glucose concentration: comparative risk assessment. Lancet 2006;368:1651-9.PubMedCrossRef

16.

Tapp R, Shaw J, Zimmet P, Balkau B. Albuminuria is evident in the early stages of diabetes onset: results from the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). Am J Kindney Dis 2004;44:792-8.

17.

Colagiuri S, Cull CA, Holman RR. Are lower fasting plasma glucose levels at diagnosis of type 2 diabetes associated with improved outcomes? U.K. prospective diabetes study 61. Diabetes care 2002;25:1410-7.PubMedCrossRef

18.

Ceriello A. Hypothesis: the ‘metabolic memory’, the new challenge of diabetes. Diabetes Res Clin Pract 2009;86:S2-6.PubMedCrossRef

19.

Goh S-Y, Cooper ME. Clinical review: The role of advanced glycation end products in progression and complications of diabetes. J Clin Endocrinol Metab 2008;93:1143-52.PubMedCrossRef

20.

Sjöström L, Lindroos A-K, Peltonen M, Torgerson J, Bouchard C, Carlsson B, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004;351:2683-93.PubMedCrossRef

21.

Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, et al. Weight and type 2 diabetes after bariatric surgery: Systematic review and meta-analysis. Am J Med 2009;122:248-56.e5.PubMedCrossRef

22.

Chatziralli IP, Sergentanis TN, Keryttopoulos P, Vatkalis N, Agorastos A, Papazisis L. Risk factors associated with diabetic retinopathy in patients with diabetes mellitus type 2. BMC Res Notes 2010;3:153.PubMedCrossRef

23.

Mehlsen J, Erlandsen M, Poulsen PL, Bek T. Identification of independent risk factors for the development of diabetic retinopathy requiring treatment. Acta Ophthalmol 2011;89:515-21.PubMedCrossRef

24.

Colagiuri S, Lee CMY, Wong TY, Balkau B, Shaw JE, Borch- Johnsen K, et al. Glycemic thresholds for diabetes-specific retinopathy. Diabetes Care 2011;34:145.PubMedCrossRef

25.

Cheng YJ, Gregg EW, Geiss LS, Imperatore G, Williams DE, Zhang X, et al. Association of A1C and fasting plasma glucose levels with diabetic retinopathy prevalence in the U.S. population: Implications for diabetes diagnostic thresholds. Diabetes care 2009;32:2027-32.PubMedCrossRef

26.

Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories WJ, Fahrbach K, et al. Bariatric surgery: A systematic review and meta-analysis. JAMA 2004;292:1724-37.PubMedCrossRef

27.

Jazet IM, De Groot GH, Tuijnebreyer WE, Fogteloo AJ, Vandenbroucke JP, Meinders AE. Cardiovascular risk factors after bariatric surgery: Do patients gain more than expected from their substantial weight loss? Eur J Intern Med 2007;18:39-43.PubMedCrossRef

28.

Angermayr L, Melchart D, Linde K. Multifactorial lifestyle interventions in the primary and secondary prevention of cardiovascular disease and type 2 diabetes mellitus – a systematic review of randomized controlled trials. Ann Behav Med 2010;40:49-64.PubMedCrossRef

29.

Iaconelli A, Panunzi S, De Gaetano A, Manco M, Guidone C, Leccesi L, et al. Effects of bilio-pancreatic diversion on diabetic complications: a 10-year follow-up. Diabetes care 2011;34:561-7.PubMedCrossRef

30.

Sjostrom L. Bariatric surgery and reduction in morbidity and mortality: experiences from the SOS study. Int J Obes 2008;32:S93-7.CrossRef

31.

Sjöström L, Peltonen M, Jacobson P, Sjöström CD, Karason K, Wedel H, et al. Bariatric surgery and long-term cardiovascular events. JAMA 2012;307:56-65.PubMedCrossRef

32.

Kahn SE, Prigeon RL, Schwartz RS, Fujimoto WY, Knopp RH, Brunzell JD, et al. Obesity, body fat distribution, insulin sensitivity and islet β-cell function as explanations for metabolic diversity. J Nutr 2001;131:354S-360.PubMed

33.

MacDonald KG, Long SD, Swanson MS, Brown BM, Morris P, Dohm GL, et al. The gastric bypass operation reduces the progression and mortality of non-insulin-dependent diabetes mellitus. J Gastrointest Surg 1997;1:213-20.PubMedCrossRef

34.

Christou NV, Sampalis JS, Liberman M, Look D, Auger S, McLean APH, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg 2004;240:416-24.PubMedCrossRef

35.

Flum DR, Dellinger EP. Impact of gastric bypass operation on survival: a population-based analysis. J Am Coll Surg 2004;199:543-51.PubMedCrossRef

36.

Hofso D, Nordstrand N, Johnson LK, Karlsen TI, Hager H, Jenssen T, et al. Obesity-related cardiovascular risk factors after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle intervention. Eur J Endocrinol 2010;163:735-45.PubMedCrossRef

37.

Janssen PG, Gorter KJ, Stolk RP, Rutten GE. Randomised controlled trial of intensive multifactorial treatment for cardiovascular risk in patients with screen-detected type 2 diabetes: 1-year data from the ADDITION Netherlands study. Br J Gen Pract 2009;59:43-8.PubMedCrossRef

38.

Janssen PGH, Gorter KJ, Stolk RP, Akarsubasi M, Rutten GEHM. Three years follow-up of screen-detected diabetic and non-diabetic subjects: who is better off? The ADDITION Netherlands study. BMC Fam Pract 2008;9:67.PubMedCrossRef

39.

Banga JD, Van Dijk JL, Van Dis I, Giepmans U, Goudswaard AN, et al. NHGStandaard Cardiovasculair risicomanagement (eerste herziening). Huisarts Wet 2012;55:14-28.

40.

Coördinatieplatform Zorgstandaarden. Tussentijds rapport Standaard voor zorgstandaarden. Den Haag: ZonMw; 2009.

41.

Van Binsbergen J, Langens F, Dapper T, Van Halteren M, Mekenkamp-Oei S, Cleyndert G, et al. NHG-Standaard Obesitas. Huisarts Wet 2010;53:609-25.

Titel: Genezing van diabetes mellitus type 2?
Auteurs: Marc Huls
Mattees van Dijk
Maril Boesten
Publicatiedatum: 01-02-2013
Uitgeverij: Bohn Stafleu van Loghum
Gepubliceerd in: Huisarts en wetenschap / Uitgave 2/2013
Print ISSN: 0018-7070
Elektronisch ISSN: 1876-5912
DOI: https://doi.org/10.1007/s12445-013-0040-3

Bohn Stafleu van Loghum

Deel dit onderdeel of sectie (kopieer de link)

Samenvatting

Log in om toegang te krijgen

Andere artikelen Uitgave 2/2013

Hemangiomen: wanneer en hoe te behandelen

Screening leidt tot lijden?

Kennistoets: Antwoorden

Risicofactoren bij off label voorschrijven

Fusidinezuurcrème blijft eerste keus bij impetigo

Burn-out, een eigen keuze?