Spinar J, Vítovec J
II. interní klinika Lékarské fakulty MU a FN u sv. Anny, Brno.
Vnitr Lek. 2003 Dec;49(12):927-34.
Diabetes mellitus is one of the significant risk factors for many cardiovascular diseases. Diabetes mellitus is 3-4 times more frequent in patients with heart failure compared to patients without heart failure. Prognosis of patients with heart failure and diabetes mellitus is worse than prognosis of non-diabetic patients with the same left ventricular dysfunction. The term diabetic cardiomyopathy refers to a relation between diabetes mellitus and heart disease, but it probably isn't a separate morphology unit. In treatment of patients with diabetes mellitus general rules apply to heart failure management. The effect of ACE inhibitors was in majority of studies stronger in diabetics than in non-diabetics, the effect of beta blockers was comparable or smaller. Treatment is based on good compensation of metabolic parameters, blood pressure, titration of ACE inhibitors into recommended doses, and an optimal dose of a beta blocker. Type II diabetics with heart failure will, due to decreased resorption and metabolism, need insulin more often than diabetics without heart failure.
糖尿病是许多心血管疾病的重要危险因素之一。与无心力衰竭的患者相比，心力衰竭患者中糖尿病的发病率高出3至4倍。心力衰竭合并糖尿病患者的预后比具有相同左心室功能障碍的非糖尿病患者更差。术语“糖尿病性心肌病”指的是糖尿病与心脏病之间的关系，但它可能不是一个独立的形态学单元。在糖尿病患者的治疗中，心力衰竭管理的一般规则适用。在大多数研究中，ACE抑制剂对糖尿病患者的作用比对非糖尿病患者更强，β受体阻滞剂的作用相当或更小。治疗基于代谢参数的良好代偿、血压、将ACE抑制剂滴定至推荐剂量以及β受体阻滞剂的最佳剂量。患有心力衰竭的II型糖尿病患者由于吸收和代谢减少，比无心力衰竭的糖尿病患者更常需要胰岛素。
