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Medikamentöse Therapie vs. bariatrische Chirurgie bei Adipositas und Typ-2-Diabetes

Pharmacological therapy versus bariatric surgery for patients with obesity and type 2 diabetes

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Zusammenfassung

Der Zusammenhang zwischen erhöhtem Körpergewicht und erhöhtem Risiko für Typ-2-Diabetes ist epidemiologisch gut belegt, und durch Gewichtsreduktion kann die Manifestation des Typ-2-Diabetes verzögert werden. Zur Basistherapie des Typ-2-Diabetes zählen lebensstilmodifizierende Maßnahmen wie Schulung, Ernährungstherapie, Steigerung der körperlichen Aktivität, Nichtrauchen und Stressbewältigungsstrategien. Wenn die Basistherapie nicht erfolgreich ist, erfolgt eine stufenweise eskalierende Pharmakotherapie bis zum Erreichen individueller Ziele. Allerdings kann auch die medikamentöse Therapie des Typ-2-Diabetes ein Fortschreiten der Erkrankung und die Manifestation von Diabeteskomplikationen häufig nicht verhindern. Eine Gewichtsreduktion gehört zu den Zielen für Patienten mit Typ-2-Diabetes und Adipositas, dauerhaft ist es durch konservative Strategien schwer zu erreichen. Auch deshalb hat sich in den letzten Jahren die bariatrische Chirurgie als eine Alternative insbesondere für Patienten mit adipositasassoziiertem Typ-2-Diabetes etabliert, bei denen durch die medikamentöse Therapie kein HbA1c < 7,5 % erreicht werden kann. Auf der Grundlage der vielversprechenden Ergebnisse mehrerer unabhängiger, randomisierter Studien sollte die bariatrische Chirurgie in Zukunft zu einem früheren Zeitpunkt der Behandlung des Typ-2-Diabetes in Betracht gezogen werden und nicht länger als letzte Therapieoption angesehen werden.

Abstract

There is strong epidemiological evidence for an association between increased body weight and a higher incidence of type 2 diabetes. Moreover, reduction in body weight may delay the onset of type 2 diabetes. The basic therapy of type 2 diabetes includes lifestyle modifications, such as education, nutritional advice, increased physical activity, non-smoking and strategies to cope with stress. If lifestyle modifications are not successful, antidiabetic pharmacotherapy is stepwise intensified to achieve individual therapeutic targets; however, pharmacological treatment of type 2 diabetes frequently fails to prevent the progress of the disease and the manifestation of diabetes complications. Sustained weight reduction belongs to the individual treatment targets for patients with obesity and type 2 diabetes. Because conservative weight reduction strategies are frequently not successful, bariatric surgery has emerged as an effective treatment particularly for those patients with obesity-associated type 2 diabetes in whom a glycosylated hemoglobin (HbA1c) target < 7.5 % could not be achieved with pharmacological therapy. Bariatric surgery should no longer be considered as the last option for patients with obesity-associated type 2 diabetes.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. M. Blüher: Forschungsunterstützung: Boehringer-Ingelheim, Novo Nordisk, Riemser. Honorare für Berater- oder Vortragstätigkeit: AstraZeneca, Bayer, Lilly, Novartis, Novo Nordisk, Sanofi, Boehringer-Ingelheim, Pfizer, Johnson & Johnson, MSD, Daiichi-Sankyo.

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Blüher, M. Medikamentöse Therapie vs. bariatrische Chirurgie bei Adipositas und Typ-2-Diabetes. Internist 56, 143–152 (2015). https://doi.org/10.1007/s00108-014-3534-6

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