Der Internist

, Volume 48, Issue 3, pp 297–310

Medikamentöse Therapie des Diabetes mellitus Typ 2

Weiterbildung • Zertifizierte Fortbildung

Zusammenfassung

Folgeerkrankungen des Diabetes mellitus Typ 2 können durch eine konsequente Therapie deutlich reduziert bzw. verhindert werden. Heutzutage steht eine Reihe von Möglichkeiten zur differenzierten Therapie zur Verfügung, welche entsprechend der aktuellen Leitlinie der Deutschen Diabetes-Gesellschaft eingesetzt werden sollten. Veränderungen des Lebensstils stehen am Beginn der Therapie und müssen lebenslang beibehalten werden. Wird unter diesen Maßnahmen das Therapieziel (HbA1c <6,5%) nicht erreicht, ist eine medikamentöse Therapie nötig. Initial werden orale Antidiabetika (OAD) als Mono- und später auch als Kombinationstherapie eingesetzt. Die Auswahl der OAD hängt insbesondere vom „body mass index“ (BMI) und den Begleiterkrankungen ab. Wird auch mit diesen Regimes das Therapieziel nicht erreicht oder liegen spezifische Kontraindikationen für OADs vor, so besteht die Indikation zur Insulintherapie. Diese kann in Kombination mit oralen Antidiabetika als Bed-time-Insulin-Regime bzw. basal unterstütze orale Therapie (BOT) mit lang wirksamen Insulinanaloga als prandiale Insulintherapie, bei Bedarf auch als intensivierte Insulintherapie (ICT) durchgeführt werden.

Schlüsselwörter

Diabetes mellitus Typ 2 Therapieleitlinien Orale Antidiabetika Insulintherapie Kombinationstherapie 

Pharmaceutical therapy of diabetes mellitus type 2

Abstract

The sequelae and complications associated with type 2 diabetes mellitus can be reduced or inhibited by optimal therapy. Currently, a variety of medications are available for differentiated therapy, which should be used according to the German Diabetes Association Guidelines. Changes in lifestyle represent the basic therapeutic principle, and it is mandatory to continuously maintain these measures throughout life. If this is not adequately effective (HBA1c <6.5%), treatment with oral antidiabetic drugs (OAD) is necessary. Over time OAD monotherapy frequently fails, so that a combination of several oral antidiabetics is needed. The choice of oral antidiabetics is particularly dependent on the patient’s body mass index and associated diseases. If combination therapy with OAD is not successful in achieving HbA1c values <6.5%, insulin therapy is required either in combination with OADs as a bedtime regimen or as intensive insulin therapy using both basal and short-term acting insulins.

Keywords

Type 2 diabetes Treatment guidelines Oral antidiabetic drugs Insulin therapy Combination therapy 

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Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  1. 1.Abteilung Innere Medizin II, Schwerpunkt Endokrinologie und DiabetologieUniversitätsklinikum FreiburgFreiburgDeutschland

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