Skip to main content
SpringerLink
Log in

Aktuelle Therapie des Typ-2-Diabetes

Current treatment of type 2 diabetes

  • Schwerpunkt
  • Published:
Der Internist Aims and scope Submit manuscript

Zusammenfassung

Der Typ-2-Diabetes ist eine komplexe Stoffwechselerkrankung, die mit einem deutlich erhöhten Risiko für kardiovaskuläre Erkrankungen und bestimmte Krebserkrankungen einhergeht. Eine früh einsetzende multifaktorielle Intervention ist notwendig, um die Prognose der Patienten zu verbessern. Die höchste Priorität hat dabei die optimale Senkung des Low-density-Lipoprotein(LDL)-Cholesterins (Zielwert: <100 mg/dl bzw. <70 mg/dl, wenn vaskuläre Komplikationen vorliegen) und der sehr häufig erhöhten Blutdruckwerte (Zielwert: 130–135/80 mmHg). Eine erfolgreiche blutzuckersenkende Diabetestherapie ist oft nur mit einer medikamentösen Kombinationstherapie möglich. In Abhängigkeit vom Patientenalter und von Komorbiditäten sollte diese hinsichtlich des HbA1c-Zielwerts und der Auswahl antidiabetischer Medikamente individualisiert werden. Schwere Hypoglykämien gilt es dabei möglichst zu vermeiden, da sie mit einem erhöhten kardiovaskulären Risiko und einer erhöhten Mortalität assoziiert sind.

Abstract

Type 2 diabetes is a complex metabolic disease associated with a high risk of vascular disease and certain entities of cancer. An early starting multifactoriel intervention is mandatory in order to improve the prognosis of the patients. Of highest priority is the lowering of LDL-cholesterol (Target value < 100 mg/dl or < 70 mg/dl when vascular complications are present) and of the very often increased blood pressure values (target values 130–135/80 mm Hg). A successful blood glucose lowering therapy is often only possible when antidiabetic drugs are used in combination. The antidiabetic therapy has to be individualized concerning the HbA1target value and the selection of the antidiabetic drugs in relation to age of the patients and presence or absence of co-morbidities. Severe events of hypoglycemia should be avoided, since these are associated with an increased cardiovasvcular risk and mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. ACCORD Study Group, Gerstein HC, Miller ME et al (2011) Long-term effects of intensive glucose lowering on cardiovascular outcomes. N Engl J Med 364:818–828

    Google Scholar 

  2. Aroda VR, Henry RR, Han J et al (2012) Efficacy of GLP-1 receptor agonists and DPP-4 inhibitors: meta-analysis and systematic review. Clin Ther 34:1247–1258

    Article  PubMed  CAS  Google Scholar 

  3. Ashrafian H, Ahmed K, Rowland SP et al (2011) Metabolic surgery and cancer: protective effects of bariatric procedures. Cancer 117:1788–1799

    Article  PubMed  Google Scholar 

  4. Carlsson LM, Peltonen M, Ahlin S et al (2012) Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. N Engl J Med 367:695–704

    Google Scholar 

  5. Charbonnel B, Schernthaner G, Brunetti P et al (2005) Long-term efficacy and tolerability of add-on pioglitazone therapy to failing monotherapy compared with addition of gliclazide or metformin in patients with type 2 diabetes. Diabetologia 48:1093–1104

    Article  PubMed  CAS  Google Scholar 

  6. Coca SG, Ismail-Beigi F, Haq N et al (2012) Role of intensive glucose control in development of renal end points in type 2 diabetes mellitus: systematic review and meta-analysis intensive glucose control in type 2 diabetes. Arch Intern Med 172:761–769

    Article  PubMed  Google Scholar 

  7. Currie CJ, Peters JR, Tynan A et al (2012) Survival as a function of HbA1c in people with type 2 diabetes: a retrospective cohort study. Lancet 375:481–489

    Article  Google Scholar 

  8. Dixon JB, le Roux CW, Rubino F et al (2012) Bariatric surgery for type 2 diabetes. Lancet 379:2300–2311

    Article  PubMed  Google Scholar 

  9. Dormandy JA, Charbonnel B, Eckland DJ 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  PubMed  CAS  Google Scholar 

  10. Frier BM, Schernthaner G, Heller SR (2011) Hypoglycemia and cardiovascular risks. Diabetes Care 34(Suppl 2):S132–S137

    Article  PubMed  Google Scholar 

  11. Gaede P, Lund-Andersen H, Parving HH, Pedersen O (2008) Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med 358:580–591

    Google Scholar 

  12. Gallwitz B, Guzman J, Dotta F et al (2012) Exenatide twice daily versus glimepiride for prevention of glycaemic deterioration in patients with type 2 diabetes with metformin failure (EUREXA): an open-label, randomised controlled trial. Lancet 379:2270–2278

    Article  PubMed  CAS  Google Scholar 

  13. Gallwitz B, Rosenstock J, Rauch T et al (2012) 2-year efficacy and safety of linagliptin compared with glimepiride in patients with type 2 diabetes inadequately controlled on metformin: a randomised, double-blind, non-inferiority trial. Lancet 380:475–478

    Article  PubMed  CAS  Google Scholar 

  14. Gregg EW, Garfield S, Cheng J et al (2012) Trends in death rates among U.S. adults with and without diabetes between 1997 and 2006. Findings from the National Health Interview Survey. Diabetes Care 35:1252–1257

    Article  PubMed  Google Scholar 

  15. Inoue M, Tsugane S (2012) Insulin resistance and cancer: epidemiological evidence. Endocr Relat Cancer 5:F1–F8

    Article  Google Scholar 

  16. Inzucchi SE, Bergenstal RM, Buse JB et al (2012) Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 35:1364–1379

    Article  PubMed  CAS  Google Scholar 

  17. Ismail-Beigi F, Moghissi E, Tiktin M et al (2011) Individualizing glycemic targets in type 2 diabetes mellitus: implications of recent clinical trials. Ann Intern Med 154:554–559

    PubMed  Google Scholar 

  18. Juutilainen A, Lehto S, Rönnemaa T et al (2008) Similarity of the impact of type 1 and type 2 diabetes on cardiovascular mortality in middle-aged subjects. Diabetes Care 31:714–719

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  20. Morgan CL, Poole CD, Evans M et al (2012) What next after metformin? A retrospective evaluation of the outcome of second-line, glucose-lowering therapies in people with type 2 diabetes. J Clin Endocrinol Metab (im Druck)

  21. Nathan DM, Buse JB, Davidson MB et al (2009) Medical management of hyperglycaemia in type 2 diabetes mellitus: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia 52:17–30

    Article  PubMed  CAS  Google Scholar 

  22. ORIGIN Trial Investigators, Gerstein HC, Bosch J et al (2012) Basal insulin and cardiovascular and other outcomes in dysglycemia. N Engl J Med 367:319–328

    Google Scholar 

  23. Patil HR, Al Badarin FJ, Al Shami HA et al (2012) Meta-analysis of effect of dipeptidyl peptidase-4 inhibitors on cardiovascular risk in type 2 diabetes mellitus. Am J Cardiol 110:826–833

    Article  PubMed  CAS  Google Scholar 

  24. Preis SR, Hwang SJ, Coady S et al (2009) Trends in all-cause and cardiovascular disease mortality among women and men with and without diabetes mellitus in the Framingham Heart Study, 1950–2005. Circulation 119:1728–1735

    Article  PubMed  Google Scholar 

  25. Romeo S, Maglio C, Burza MA et al (2012) Cardiovascular events after bariatric surgery in obese subjects with type 2 diabetes. Diabetes Care (im Druck)

  26. Russell-Jones D, Cuddihy RM, Hanefeld M et al (2012) Efficacy and safety of exenatide once weekly versus metformin, pioglitazone, and sitagliptin used as monotherapy in drug-naive patients with type 2 diabetes (DURATION-4): a 26-week double-blind study. Diabetes Care 35:252–258

    Article  PubMed  CAS  Google Scholar 

  27. Schernthaner G (2010) Diabetes and cardiovascular disease: is intensive glucose control beneficial or deadly? Lessons from ACCORD, ADVANCE, VADT, UKPDS, PROactive, and NICE-SUGAR. Wien Med Wochenschr 160:8–19

    Article  PubMed  Google Scholar 

  28. Schernthaner G, Barnett AH, Betteridge DJ et al (2010) Is the ADA/EASD algorithm for the management of type 2 diabetes (January 2009) based on evidence or opinion? A critical analysis. Diabetologia 53:1258–1269

    Article  PubMed  CAS  Google Scholar 

  29. Schernthaner G, Brix JM, Kopp HP et al (2011) Cure of type 2 diabetes by metabolic surgery? A critical analysis of the evidence in 2010. Diabetes Care 34(Suppl 2):S355–S360

    Article  PubMed  Google Scholar 

  30. Schernthaner G, Currie C, Schernthaner GH (2012) Do we still need pioglitazone in the treatment of patients with type 2 diabetes? A critical risk-benefit analysis in 2012. Diabetes Care (im Druck)

  31. Schernthaner G, Matthews DR, Charbonnel B et al (2004) Efficacy and safety of pioglitazone versus metformin in patients with type 2 diabetes mellitus: a double-blind, randomized trial. J Clin Endocrinol Metab 89:6068–6076

    Google Scholar 

  32. Schernthaner G, Ritz E, Schernthaner GH (2010) Strict glycaemic control in diabetic patients with CKD or ESRD: beneficial or deadly? Nephrol Dial Transplant 25:2044–2047

    Article  PubMed  Google Scholar 

  33. Stevens RJ, Ali R, Bankhead CR et al (2012) Cancer outcomes and all-cause mortality in adults allocated to metformin: systematic review and collaborative meta-analysis of randomised clinical trials. Diabetologia 55:2593–2603

    Article  PubMed  CAS  Google Scholar 

  34. Tzoulaki I, Molokhia M, Curcin V et al (2009) Risk of cardiovascular disease and all cause mortality among patients with type 2 diabetes prescribed oral antidiabetes drugs: retrospective cohort study using UK general practice research database. BMJ 339:b4731

    Article  PubMed  Google Scholar 

  35. Yau JW, Rogers SL, Kawasaki R et al (2012) Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care 35:556–564

    Article  PubMed  Google Scholar 

  36. Yudkin JS, Richter B, Gale EAM (2010) Intensified glucose lowering in type 2 diabetes: time for a reappraisal. Diabetologia 53:2079–2085

    Article  PubMed  CAS  Google Scholar 

  37. Zhao Y, Campbell CR, Fonseca V et al (2012) Impact of hypoglycemia associated with antihyperglycemic medications on vascular risks in veterans with type 2 diabetes. Diabetes Care 35:1126–1132

    Article  PubMed  Google Scholar 

  38. Zoungas S, Patel A, Chalmers J et al (2010) Severe hypoglycemia and risks of vascular events and death. N Engl J Med 363:1410–1418

    Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor weist für sich und seinen Koautor auf folgende Beziehungen hin: Teilnahme an globalen, EU- und nationalen „Advisory Bord Meetings“ sowie internationale Vortragstätigkeit: Amgen, AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Eli Lilly, Johnson & Johnson, Merck, Novartis, Novo Nordisk, Sanofi-Aventis, Servier, Takeda.

Author information

Authors and Affiliations

  1. 1. Medizinische Abteilung, Krankenanstalt Rudolfstiftung, Juchgasse 25, 1030, Wien, Österreich

    G. Schernthaner

  2. Universitätsklinik für Innere Medizin II, Wien, Österreich

    G.-H. Schernthaner

Authors
  1. G. Schernthaner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G.-H. Schernthaner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Schernthaner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schernthaner, G., Schernthaner, GH. Aktuelle Therapie des Typ-2-Diabetes. Internist 53, 1399–1410 (2012). https://doi.org/10.1007/s00108-012-3203-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00108-012-3203-6

Schlüsselwörter

Keywords

Search

Navigation