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Neue Möglichkeiten der Differenzialtherapie des Typ-2-Diabetes

New differential therapy of type 2 diabetes

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Zusammenfassung

Zur Therapie des Typ-2-Diabetes mellitus steht eine Vielzahl von Medikamenten mit verschiedenen Ansatzpunkten zur Verfügung. Weitere Substanzen, wie z. B. SGLT2-Hemmer, sind kurz vor der Zulassung. Diese Vielfalt ist nötig, weil oft nur durch sinnvolle Kombinationen eine ausreichende Blutzuckersenkung erreicht werden kann. Ebenso müssen bei der Behandlung der sehr heterogenen und in Stadien verlaufenden Erkrankung individuelle Besonderheiten, Risikoprofile und Kontraindikationen bedacht werden. Insbesondere Auswirkungen auf kardiovaskuläres Risiko, Gewichtsverlauf und Hypoglykämiegefahr sind relevant, aber auch Co-Morbiditäten sowie berufliche und soziale Aspekte sollten berücksichtigt werden. Grundlage jeder Therapie sind Lebensstilinterventionen und, falls möglich, Metformin. Neue Optionen sind Dipeptidylpeptidase-4-Hemmer und Glucagon-like-Peptid-1-Analoga, die den Glukosestoffwechsel ohne Hypoglykämierisiko und Gewichtszunahme verbessern. Der Zulassungsstatus der Einzelsubstanzen ist derzeit sehr inhomogen und reicht von der Mono- bis zur Dreifachtherapie und Kombination mit Insulin. Es ist noch unklar, ob sich die Vorteile dieser Substanzgruppen auch in Endpunktstudien, z. B. zum kardiovakulären Risiko, zeigen.

Abstract

A variety of different drugs with distinct approaches are available for the treatment of type 2 diabetes. Different treatment options, as well as new developments, are needed, since an acceptable quality of glucose control often requires drug combinations. Furthermore, type 2 diabetes is known as a heterogeneous disease that is characterized by different phases and individual characteristics, such as risk profiles and contraindications. In particular the impact of antihyperglycemic therapies on cardiovascular risk, body weight and the risk for hypoglycemia is important, but also the consideration of other co-morbidities, occupational and social aspects plays a role. So far, each therapeutic step is based on lifestyle-interventions and, if possible, metformin. Dipeptidylpeptidase 4 (DPP 4) inhibitors und glucagon-like peptid 1 (GLP 1) mimetics represent a new important tool in the differential therapy of type 2 diabetes. The advantage of incretin-based concepts is an improvement of glucose quality without induction of hypoglycemia and additional weight gain. It is, however, still not known, whether these advantages will still be seen in end point studies, e. g. concerning the cardiovascular risk.

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Interessenkonflikt

Dr. Schütt ist als Referent für die Firmen Novo Nordisk, MSD Sharp & Dohme, Novartis, Pfizer, Berlin-Chemie tätig und erhält ein Beraterhonorar von den Firmen Novo Nordisk, MSD Sharp & Dohme, Bristol-Meyers Squibb, Menarini.

Prof. Dr. Klein erhält Beraterhonorare der Firmen Glaxo Smith Kline, Astra Zeneca, Janssen Cilag.

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  1. Medizinische Klinik I, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    M. Schütt

  2. Medizinische Klinik I, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bochum, Deutschland

    H.H. Klein

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Schütt, M., Klein, H. Neue Möglichkeiten der Differenzialtherapie des Typ-2-Diabetes. Internist 52, 395–404 (2011). https://doi.org/10.1007/s00108-010-2708-0

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