Diabetes mellitus Typ 2 - ein Risikofaktor für kolorektale Karzinome

 

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Zusammenfassung

Kolorektale Karzinome gehören zu den häufigsten Tumoren in den westlichen Industrienationen. Risikofaktoren für kolorektale Karzinome stellen gleichzeitig Risikofaktoren für Diabetes mellitus Typ 2 dar. Neuere epidemiologische Studien zeigen, dass Patienten mit Diabetes mellitus Typ 2 ein erhöhtes Risiko für kolorektale Karzinome aufweisen, das sich mit Sulfonylharnstoff- und Insulinbehandlung weiter erhöht. Patienten mit Insulintherapie haben ein gegenüber der Normalbevölkerung etwa 3fach gesteigertes Risiko für kolorektale Karzinome. Die Hyperinsulinämie-Hypothese beinhaltet, dass hierfür erhöhte Insulinspiegel und erhöhte Spiegel von freiem IGF-1 verantwortlich sind, die zu rascherer Proliferation und zu einem Überlebensvorteil transformierter Kolonkarzinomzellen führen. Dies zeigt sich auch in einer veränderten Tumorbiologie; Diabetiker weisen eine raschere Krankheitsprogression und eine höhere karzinomspezifische Mortalität auf. Kolorektale Karzinome stellen eine durch konsequentes Screening prinzipiell vermeidbare Erkrankung dar. In den Screeningempfehlungen für Patienten mit Diabetes mellitus Typ 2 sollten die aktuellen epidemiologischen Erkenntnisse berücksichtigt werden. Allen Patienten mit Diabetes mellitus Typ 2 sollte vor Beginn einer Insulintherapie eine Koloskopie empfohlen werden und die Screeningintervalle dann auf 5 Jahre verkürzt werden. Hier wird die aktuelle Datenlage vorgestellt und diskutiert, und ein Algorithmus für ein nach neuen Erkenntnissen modifiziertes Darmkrebs-Screening vorgestellt.

Abstract

Colorectal carcinoma is one of the most common tumour entities in Western countries. Colorectal carcinoma and type 2 diabetes mellitus share common risk factors. Recent epidemiological studies show an increased risk for colorectal carcinomas in patients with type 2 diabetes mellitus, even more pronounced at therapy with sulfonylureas or insulin. Moreover, a 3-fold risk increase for patients with insulin-dependent type 2 diabetes mellitus in comparison to the general population has been observed. The hyperinsulinaemia hypothesis is based on the premise that elevated plasma levels of insulin and free IGF-1 promote the proliferation of colon cells and lead to a survival benefit of transformed colon carcinoma cells. This is reflected by an altered tumour biology; in patients with type 2 diabetes, tumour progression is more rapid and tumour-associated mortality is increased. Colorectal carcinoma represents an entity that is well amenable to and can potentially be avoided by screening colonoscopy. Recommendations for colorectal carcinoma screening should employ the recent epidemiologic evidence. All patients with type 2 diabetes should be recommended to undergo colonoscopy before starting insulin therapy, and screening intervals should not exceed 5 years. This work provides a review of the evidence, and an algorithm is proposed for a modified screening in patients with type 2 diabetes.

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Prof. Dr. Burkhard Göke

Medizinische Klinik und Poliklinik II, Klinikum Großhadern

Marchioninistr.15

81377 München

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Email: Burkhard.Goeke@med.uni-muenchen.de