Der Diabetologe

, Volume 3, Issue 1, pp 6–14 | Cite as

Typ-2-Diabetes – Therapie mit insulinotropen Substanzen

Leitthema
  • 52 Downloads

Zusammenfassung

Sulfonylharnstoffe spielen bei der Behandlung von Patienten mit Typ-2-Diabetes eine bedeutsame Rolle. Sie modifizieren und verstärken die eingeschränkte glukoseinduzierte Insulinsekretion. Ihre Hauptindikation sind „schlanke“ Typ-2-Diabetes-Patienten mit erhöhten Nüchtern- und postprandialen Blutglukose-Werten. Glibenclamid und Glimepirid unterscheiden sich deutlich in ihren Eigenschaften, insbesondere auch in ihrem Nebenwirkungsspektrum. Die Glinide setzen, durch ihre kurze Halbwertszeit bedingt, v. a. in der postprandialen Phase der Glukoseverstoffwechselung an. Beide Substanzgruppen können mit den nichtinsulinotropen Antidiabetika kombiniert werden, wodurch eine zusätzliche Verbesserung der Insulinresistenz erzielt werden kann.

Schlüsselwörter

Typ-2-Diabetes Sulfonylharnstoffe Glinide Hypoglykämie Ischämische Präkonditionierung 

Treatment of type 2 diabetes with insulinotropic drugs

Abstract

Sulfonureas play an important role in the treatment of type 2 diabetes. Their main effect is enhancement of insulin secretion. The main indication for this group is the lean type 2 patient with elevated fasting and postprandial glucose concentrations. Glibenclamide and glimepiride are different in their clinical attributes, especially in their induction of side effects. Having a short half-life, the glinides mainly regulate postprandial glucose assimilation. Both substance groups can be combined with noninsulinotropic drugs and thereby additionally improve insulin resistance.

Keywords

Type 2 diabetes Sulfonylureas Glinides Hypoglycemia Ischemic precondition 

Notes

Interessenkonflikt

Der Autor hat im Rahmen seiner Vortragstätigkeit Honorare der Firmen Bayer Vital GmbH, Glaxo-Smith-Kline Pharma GmbH, Merck KGaA, Novo Nordisk Pharma GmbH und Sanofi Aventis Pharma GmbH erhalten. Die Präsentation des Themas ist unabhängig. Die Darstellung des Inhalts basiert auf der gegenwärtig zur Verfügung stehenden wissenschaftlichen Literatur.

Literatur

  1. 1.
    Ashcroft FM (1996) Mechanisms of the glycaemic effects of sulfonylureas. Horm Metab Res 28: 456PubMedGoogle Scholar
  2. 2.
    Ashfield R, Gribble FM, Ashcroft SJ et al. (1999) Identification of the high-affinity tolbutamide site on the SUR1 subunit of the K(ATP) channel. Diabetes 48: 1341–1347PubMedGoogle Scholar
  3. 3.
    Asplund K, Wiholm B-E, Lithner F (1983) Glibenclamide-associated hypoglycaemia. A report on 57 cases. Diabetologia 24: 412–417CrossRefPubMedGoogle Scholar
  4. 4.
    Bachmann W, Löbe A, Lacher F (1995) Medikamentös bedingte Hypoglykämien bei Typ 2-Diabetes. Diabetes Stoffwechsel 4: 83Google Scholar
  5. 5.
    DeFronzo RA, Goodman AM and the Multicenter Metformin Study Group (1995) Efficacy of metformin in NIDDM patients poorly controlled on diet alone or diet plus sulfonylurea. N Engl J Med 333: 541–549CrossRefPubMedGoogle Scholar
  6. 6.
    Del Guerra S, Parentini C, Bracci C et al. (2000) Insulin release from isolated human islets after exposure to amaryl. In vito study. Acta Diabetol 37: 139CrossRefPubMedGoogle Scholar
  7. 7.
    Dills DG, Schneider J and the Glimepiride/Glyburide Research Group (1996) Clinical evaluation of glimepiride versus glyburide in NIDDM in a double-blind comparative study. Horm Metab Res 28: 426–429PubMedGoogle Scholar
  8. 8.
    Frandsen KB, Moses R, Gomis R et al. (1999) Efficacy and safety study of repaglinide, a flexible prandial glucose regulator, in type 2 diabetes patients. Diabetologia [Suppl 1] 42: A242, 910Google Scholar
  9. 9.
    Franke H, Fuchs J (1955) Ein neues antidabetisches Prinzip. Dtsch Med Wochensch 80: 1449Google Scholar
  10. 10.
    Fuhlendorff J, Rorsman P, Kofod H et al. (1998) Stimulation of insulin release by repaglinide and glibenclamide involves both common and distinct processes. Diabetes 47: 345–351PubMedGoogle Scholar
  11. 11.
    Furlong NJ, Hulme SA, O’Brien SC et al. (2002) Repaglinide versus metformin in combination with bedtime NPH insulin in patients with type 2 diabetes established on insulin/metformin combination therapy. Diabetes Care 25: 1685–1690PubMedGoogle Scholar
  12. 12.
    Gromada J, Dissing S, Kofod H et al. (1995) Effects of the hypoglycemic drugs repaglinide and glibenclamide on ATP-sensitive potassium-channels and cytosolic calcium levels in beta TC3 cells and rat pancreatic beta cells. Diabetologia 38: 1025–1032PubMedGoogle Scholar
  13. 13.
    Häring H-U, Joost H-G, Laube H et al. (2003) Antihyperglykämische Therapie des Diabetes mellitus Typ 2. Diabetes Stoffwechsel [Suppl 2] 12: 13–31Google Scholar
  14. 14.
    Haupt E, Knick B, Koschinsky T et al. (1991) Oral antidiabetic combination therapy with sulphonylureas and metformin. Diabet Metab 17: 224–231Google Scholar
  15. 15.
    Holman R (2003) Results of the 5-year follow-up of UKPDS. Vortrag, IDF/EASD-Kongress, ParisGoogle Scholar
  16. 16.
    Holstein A, Plaschke A, Egberts EH (2001) Lower incidence of severe hypoglycemia in patients with type 2 diabetes treated with glimepride versus glibenclamide. Diabetes Metab Res Rev 17: 467–473CrossRefPubMedGoogle Scholar
  17. 17.
    Holstein A, Plaschke A, Hamme C et al. (2003) Characteristics and time course of severe glimepride- versus glibenclamide-induced hypoglycemia. Eur J Clin Pharmacol 59: 91–97CrossRefPubMedGoogle Scholar
  18. 18.
    Horton E, Clinkingbeard C, Gatlin M et al. (2000) Nateglinide alone and in combination with metformin improves glycemic control by reducing mealtime glucose levels in type 2 diabetes. Diabetes Care 23: 1660–1665PubMedGoogle Scholar
  19. 19.
    Hu S, Wang S, Fanelli B et al. (2000) Pancreatic beta-cell KATP channel activity and membrane-binding studies with nateglinide: a comparison with sulfonylureas and repaglinide. J Pharmacol Exp Ther 293: 444–452PubMedGoogle Scholar
  20. 20.
    Klepzig H, Kober G, Matter C et al. (1999) Sulfonylureas and ischaemic preconditioning: a doubleblind, placebo-controlled evaluation of glimepiride and glibenclamide. Eur Heart J 20: 439–446CrossRefPubMedGoogle Scholar
  21. 21.
    Malmberg K, Rydén L, Efendic S et al. (1995) Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute mycardial infarction (DIGAMI study): effects on mortality at 1 year. J Am Coll Cardiol 26: 57–65CrossRefPubMedGoogle Scholar
  22. 22.
    Malmberg K for the DIGAMI Study Group (1997) Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. BMJ 314: 1512–1515PubMedGoogle Scholar
  23. 23.
    Moses R, Slobodniuk R, Boyages S et al. (1999) Effect of repaglinide addition to metformin monotherapy on glycemic control in patients with type 2 diabetes. Diabetes Care 22: 119–124PubMedGoogle Scholar
  24. 24.
    Müller G, Satoh Y, Geisen K (1995) Extapancreatic effects of sulfonylureas – a comparison between glimepiride and conventional sulfonylureas. Diabet Res Clin Pract [Suppl] 28: 115–137Google Scholar
  25. 25.
    Niemi M, Backman JT, Neuvonen M et al. (2003) Effects of gemfibrozil, itraconazole, and their combination on the pharmacokinetics and pharmacodynamics of repaglinide: potentially hazardous interaction between gemfibrozil repaglinide. Diabetologia 46: 347–351CrossRefPubMedGoogle Scholar
  26. 26.
    Rosak C (2001) Pharmakatherapie des Diabetes mellitus Typ 2. In: Böhm BO, Palitsch KD, Rosak C et al. (Hrsg) Klinische Diabetologie. Springer, Berlin Heidelberg New YorkGoogle Scholar
  27. 27.
    Rosenstock J, Schwartz SL, Clark Jr CM et al. (2001) Basal insulin therapy in type 2 diabetes: 28-week comparison of insulin glargine (HOE 901) and NPH insulin. Diabetes Care 24: 631–636PubMedGoogle Scholar
  28. 28.
    Schwarz ER, Whyte WS, Kliner RA (1997) Ischemic preconditioning. Curr Opin Cardiol 12: 475–481PubMedGoogle Scholar
  29. 29.
    Simpson SH, Sumit R, Majumdar R et al. (2006) Dose-response relation between sulfonyl urea drugs and mortality in type 2 diabetes mellitus: a population-based cohort study. CMAJ 174: 169–174PubMedGoogle Scholar
  30. 30.
    Smits P, Thien T (1995) Cardiovascular effects of sulphonylurea derivatives. Implications for the treatment of NIDDM? Diabetologia 38: 116–121PubMedGoogle Scholar
  31. 31.
    UK Prospective Diabetes Study (UKPDS) Group (1998) Effect of intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complication in patients with type 2 diabetes (UKPDS 33). Lancet 352: 837–853CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  1. 1.Innere Medizin, EndokrinologieKrankenhaus SachsenhausFrankfurt am MainDeutschland

Personalised recommendations