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α-Glukosidase-Hemmer und Thiazolidindione (Glitazone)

Kardiovaskuläre Effekte

α-Glucosidase inhibitors and thiazolidinediones (glitazones)

Cardiovascular effects

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Der Diabetologe Aims and scope

Zusammenfassung

α-Glukosidase-Inhibitoren

Die kardiovaskulären Effekte der in Deutschland zugelassenen α‑Glukosidase-Hemmer Acarbose und Miglitol können wegen der noch ungenügenden Datenlage bei fehlenden Outcomestudien nicht sicher eingeschätzt werden. Ein positiver Effekt ist bei dieser Substanzklasse von Antidiabetika nicht sicher belegt; ein kardiovaskuläres Risiko scheint nicht vorzuliegen.

Glitazone

Der Einsatz des zugelassenen Sensitizers Pioglitazon geht mit einem eindeutig erhöhten Risiko für eine Herzinsuffizienz einher, was aber nach der aktuellen Datenlage nicht mit einer gesteigerten kardiovaskulären oder Gesamtmortalität verbunden ist.

Abstract

α-Glucosidase inhibitors

The cardiovascular effects of the α‑glucosidase inhibitors acarbose and miglitol, which are licensed in Germany, cannot be safely judged because of insufficient data and a lack of appropriate outcome trials. A positive cardiovascular effect is as yet uncertain in this class of antidiabetic drugs; they do not appear to be associated with a cardiovascular risk.

Glitazones

The use of the licensed sensitizer pioglitazone is clearly associated with an increased risk for heart failure which, however, does not appear to cause an increase of cardiovascular or all-cause mortality.

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Literatur

  1. Narita T, Yokoyama H, Yamashita R et al (2012) Comparisons of the effects of 12-week administration of miglitol and voglibose on the responses of plasma incretins after a mixed meal in Japanese type 2 diabetic patients. Diabetes Obes Metab 14(3):283–287. doi:10.1111/j.1463-1326.2011.01526.x

    Article  CAS  PubMed  Google Scholar 

  2. Qualmann C, Nauck MA, Holst JJ (1995) Glucagon-like peptide 1 (7-36 amide) secretion in response to luminal sucrose from the upper and lower gut. A study using alpha-glucosidase inhibition (acarbose. Scand J Gastroenterol 30(9):892–896. doi:10.3109/00365529509101597

    Article  CAS  PubMed  Google Scholar 

  3. Aoki K, Kamiyama H, Yoshimura K et al (2012) Miglitol administered before breakfast increased plasma active glucagon-like peptide-1 (GLP-1) levels after lunch in patients with type 2 diabetes treated with sitagliptin. Acta Diabetol 49(3):225–230. doi:10.1007/s00592-011-0322-9

    Article  PubMed  Google Scholar 

  4. Zhu Q, Tong Y, Wu T et al (2013) Comparison of the hypoglycemic effect of acarbose monotherapy in patients with type 2 diabetes mellitus consuming an Eastern or Western diet: a systematic meta-analysis. Clin Ther 35(6):880–899. doi:10.1016/j.clinthera.2013.03.020

    Article  PubMed  Google Scholar 

  5. Yang W, Liu J, Shan Z et al (2014) Acarbose compared with metformin as initial therapy in patients with newly diagnosed type 2 diabetes: an open-label, non-inferiority randomised trial. Lancet Diabetes Endocrinol 2(1):46–55. doi:10.1016/S2213-8587(13)70021-4

    Article  CAS  PubMed  Google Scholar 

  6. Patel SS (2016) Cerebrovascular complications of diabetes: alpha glucosidase inhibitor a potential therapy. Horm Metab Res 48:83–91

    CAS  PubMed  Google Scholar 

  7. Wascher TC, Schmoelzer I, Wiegratz A et al (2005) Reduction of postchallenge hyperglycaemia prevents acute endothelial dysfunction in subjects with impaired glucose tolerance. Eur J Clin Invest 35(9):551–557. doi:10.1111/j.1365-2362.2005.01550.x

    Article  CAS  PubMed  Google Scholar 

  8. Shimabukuro M, Higa N, Chinen I et al (2006) Effects of a single administration of acarbose on postprandial glucose excursion and endothelial dysfunction in type 2 diabetic patients: a randomized crossover study. J Clin Endocrinol Metab 91(3):837–842. doi:10.1210/jc.2005-1566

    Article  CAS  PubMed  Google Scholar 

  9. Kato T, Inoue T, Node K (2010) Postprandial endothelial dysfunction in subjects with new-onset type 2 diabetes: an acarbose and nateglinide comparative study. Cardiovasc Diabetol 9:12 doi:10.1186/1475-2840-9-12

    Article  PubMed  PubMed Central  Google Scholar 

  10. Pistrosch F, Schaper F, Passauer J et al (2009) Effects of the alpha glucosidase inhibitor acarbose on endothelial function after a mixed meal in newly diagnosed type 2 diabetes. Horm Metab Res 41(2):104–108. doi:10.1055/s-0028-1103276

    Article  CAS  PubMed  Google Scholar 

  11. Kitano D, Chiku M, Li Y et al (2013) Miglitol improves postprandial endothelial dysfunction in patients with acute coronary syndrome and new-onset postprandial hyperglycemia. Cardiovasc Diabetol 12:92 doi:10.1186/1475-2840-12-92

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Geng DF, Jin DM, Wu W et al (2011) Effect of alpha-glucosidase inhibitors on the progression of carotid intima-media thickness: a meta-analysis of randomized controlled trials. Atherosclerosis 218(1):214–219. doi:10.1016/j.atherosclerosis.2011.05.004

    Article  CAS  PubMed  Google Scholar 

  13. Patel YR, Kirkman MS, Considine RV et al (2013) Effect of acarbose to delay progression of carotid intima-media thickness in early diabetes. Diabetes Metab Res Rev 29(7):582–591

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Rudofsky G, Reismann P, Schiekofer S et al (2004) Reduction of postprandial hyperglycemia in patients with type 2 diabetes reduces NF-kappaB activation in PBMCs. Horm Metab Res 36(9):630–638. doi:10.1055/s-2004-825904

    Article  CAS  PubMed  Google Scholar 

  15. Hanefeld M, Schaper F, Koehler C et al (2009) Effect of acarbose on postmeal mononuclear blood cell response in patients with early type 2 diabetes: the AI (I) DA study. Horm Metab Res 41(2):132–136. doi:10.1055/s-0028-1119407

    Article  CAS  PubMed  Google Scholar 

  16. Lu JM, Wang X, Pan C (2003) Comparison of serum C‑reactive protein level in different glucose tolerance subjects and the change in serum CRP level in IGT subjects with acarbose. Chin J Endocrinol Metab 19:254–256

    Google Scholar 

  17. Hanefeld M, Cagatay M, Petrowitsch T et al (2004) Acarbose reduces the risk for myocardial infarction in type 2 diabetic patients: meta-analysis of seven long-term studies. Eur Heart J 25(1):10–16. doi:10.1016/S0195-668X(03)00468-8

    Article  CAS  PubMed  Google Scholar 

  18. Chiasson JL, Josse RG, Gomis R et al (2002) Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Lancet 359:2072–2077

    Article  CAS  PubMed  Google Scholar 

  19. Chiasson JL, Josse RG, Gomis R et al (2003) Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NDDM trial. JAMA 290:486–494

    Article  CAS  PubMed  Google Scholar 

  20. Kaiser T, Sawicki PT (2004) Acarbose for prevenion of diabetes, hypertension and cardiovascular events? A critical analysis of the STOP-NIDDM data. Diabetologia 47:575–580

    Article  CAS  PubMed  Google Scholar 

  21. Holman RR (2016) Acarbose Cardiovascular Evaluation Trial (ACE). http://clinicaltrials.gov/show/NCT00829660. Zugegriffen: 19.04.2016

    Google Scholar 

  22. Lewis JD, Ferrara A, Peng T et al (2011) Risk ofbladder cancer among diabetic patients treated with Pioglitazone. Diabetes Care 34:916–922

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Tseng C‑H (2012) Pioglitazone and bladder cancer- A population-based study of Taiwanese. Diabetes Care 35:2278–2280

    Google Scholar 

  24. Tuccori M, Filion KB, Yin H et al (2016) Pioglitazone use and risk of bladder cancer: population based cohort study. BMJ 352:i1541. doi:10.1136/bmj.i1541

    PubMed  PubMed Central  Google Scholar 

  25. Kahn SE, Haffner SM, Heise MA et al (2006) Glycemic durability of rosiglitazone, etformin, or glyburide monotherapy. N Engl J Med 355:2427–2743

    Article  CAS  PubMed  Google Scholar 

  26. Nissen SE, Wolski K (2007) Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med 356(4):2457–2471

    Article  CAS  PubMed  Google Scholar 

  27. Dormandy JA, Carbonnel B, Eckland DJA et al (2005) Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial. Lancet 366:1279–1289

    Article  CAS  PubMed  Google Scholar 

  28. Yki-Järvinnen H (2005) Comment: the PROactive study: some answers, many questions. Lancet 366:1241–1242

    Article  Google Scholar 

  29. Freemantle N (2005) How well does the evidence on pioglitazone back up researchers’ claims for a reduction in macrovascular events? BMJ 331:836–838

    Article  PubMed  PubMed Central  Google Scholar 

  30. Ceriello A (2005) PROactive study: ®evolution in the therapy of diabetes? Diabet Med 22:1463–1464

    Article  PubMed  Google Scholar 

  31. Erdmann E, Song E, Spanheimer R et al (2014) Observational follow-up oft he PROactive study: a 6‑year update. Diabetes Obes Metab 16:63–74

    Article  CAS  PubMed  Google Scholar 

  32. Lago RM, Singh PP, Nesto RW (2007) Congestive heart failure and cardiovascular death in patients with prediabetes and type 2 diabetes given thiazolidinediones: a metanalysis of randomised clinical trials. Lancet 370:1129–1136

    Article  CAS  PubMed  Google Scholar 

  33. Lincoff AM, Wolski K, Nicholls SJ et al (2007) Pioglitazone and risk of cardiovascular events in patients with type 2 diabetes mellitus: meta-analysis of randomized trials. JAMA 298:1180–1188

    Article  CAS  PubMed  Google Scholar 

  34. Singh S, Loke YK, Furberg CD (2007) Long-term risk of cardiovascular events with rosiglitazone: a meta-analysis. JAMA 298:1189–1195

    Article  CAS  PubMed  Google Scholar 

  35. Kernan WN, Viscoli CM, Furie KL et al (2016) Pioglitazone after ischemic stroke or transient ischemic attack. NEJM. doi:10.1056/NEJMoal1506930

    PubMed  Google Scholar 

  36. DeFronzo RA, Tripathy D, Schwenke DC et al (2011) Pioglitazone for diabetes prevention in impaired glucose tolerance. N Engl J Med 364:1104–1115

    Article  CAS  PubMed  Google Scholar 

  37. Tuomilehto J, Lindström J, Eriksson JG et al (2001) Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344:343–350

    Article  Google Scholar 

  38. Knowler WC, Barrett-Connor E, Fowler SE et al (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or Metformin. N Engl J Med 346:393–403

    Article  CAS  PubMed  Google Scholar 

  39. Li G, Zhang P, Wang J et al (2008) The long-term effect of lifestyle intervention to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Lancet 37:1783–1789

    Article  Google Scholar 

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Correspondence to W. A. Scherbaum.

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Interessenkonflikt

W.A. Scherbaum gibt an, dass er Koautor der PROactive-Studie ist und dadurch ein Interessenkonflikt bestehen könnte.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Scherbaum, W.A. α-Glukosidase-Hemmer und Thiazolidindione (Glitazone). Diabetologe 12, 178–183 (2016). https://doi.org/10.1007/s11428-016-0085-6

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