Zusammenfassung
Die verschiedenen Lebensphasen mit typischen biologischen Veränderungen sowie unterschiedliche Lebensziele von Frauen interagieren auch mit der Diabetesbehandlung. In der Pubertät ist aus physiologischen und psychologischen Gründen die optimale Diabeteseinstellung erschwert, die Menarche setzt oft verspätet ein, und Zyklusstörungen sind häufiger. Frauen mit Typ-1-Diabetes sollten wegen der hohen Komplikationsrate bei schlechter Stoffwechseleinstellung bei Konzeption nur geplant schwanger werden. Trotzdem sind ungeplante Schwangerschaften gerade bei Teenagern mit Typ-1-Diabetes häufiger, was die Bedeutung einer adäquaten Beratung zu Schwangerschaft und Verhütung unterstreicht. Kontrazeption mit kombinierten oralen Kontrazeptiva ist in Abwesenheit von Gefäßschäden möglich. Einer möglichen gestagenbedingten Verschlechterung der Diabeteseinstellung kann durch Erhöhung der Insulindosis, hormonfreie Verhütung oder gestagenbeschichtete IUD („intrauterine device“) begegnet werden. Die Schwangerschaft stellt aufgrund der empfohlenen strengen Stoffwechseleinstellung und des wechselnden Insulinbedarfs eine besondere Herausforderung dar, die vieler Unterstützung sowohl in fachlicher als auch emotionaler und motivierender Hinsicht bedarf. Bestehende Spätkomplikationen und eine höhere Prävalenz geburtshilflicher Komplikationen erfordern eine engmaschige interdisziplinäre Betreuung. Die Geburt sollte in einem Perinatalzentrum geplant werden, möglichst mit Erfahrung in der Betreuung von Frauen mit Typ-1-Diabetes. Stillen wird für diese Mütter besonders empfohlen. Im Klimakterium kann die starke Fluktuation der Östrogenspiegel vor der Menopause zu Problemen bei der Blutzuckereinstellung führen, postmenopausal wirkt eine gleichmäßig dosierte Hormonsubstitution eher einer Insulinresistenz entgegen.
Abstract
The treatment of diabetes in females is influenced by the different phases of life with their typical biological changes as well as the aims and needs of these patients. During puberty, optimal glycemic control is often difficult due to physiological and psychological factors, menarche is often delayed and cycle disorders are more common than in teens without diabetes. Since the complication rate is high in pregnancy if diabetic control is not optimal prior to conception, women with type 1 diabetes should ideally plan their pregnancy. Nevertheless, unplanned pregnancies are even more common among young women with diabetes, which underlines the importance of adequate counselling regarding the topics of pregnancy and contraception. Hormonal contraception is possible in the absence of angiopathy. Progestins may slightly worsen glucose tolerance which may require adjustment of insulin dose; alternatives are hormone-free contraception or progestin-coated intrauterine devices (IUD) which cause extremely low systemic serum levels of progestin. Because pregnancy poses a special challenge due to the tight metabolic control needed for healthy maternal and fetal outcome and variable insulin requirements in the different stages of pregnancy, close medical, emotional and motivational support are extremely important. Late complications, particularly nephropathy and the higher prevalence of obstetrical complications require frequent interdisciplinary monitoring and counselling. Delivery should be planned in a perinatal center with experience in managing type 1 diabetic pregnancies. Breast-feeding should be encouraged for these mothers. During perimenopause, increased fluctuations of estradiol levels prior to menopause may cause problems in glycemic control, while during the postmenopausal years, continuous hormone therapy in physiological doses may help to improve insulin sensitivity.
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U. Schäfer-Graf und V. Seifert-Klauss geben an, dass kein Interessenkonflikt besteht.
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Schäfer-Graf, U., Seifert-Klauss, V. Typ-1-Diabetes – besondere Herausforderungen für Frauen. Diabetologe 18, 122–130 (2022). https://doi.org/10.1007/s11428-022-00857-w
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DOI: https://doi.org/10.1007/s11428-022-00857-w