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Orale Diabetestherapie

Welche Substanz ist wann indiziert?

Oral diabetes treatment: Which substance is indicated at which time?

  • Schwerpunkt: Was ist gesichert in der Therapie?
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Zusammenfassung

Die Prävalenz des Typ-2-Diabetes zeigt in Deutschland weiterhin eine deutlich steigende Tendenz. Was in früheren Zeiten als „harmloser Alterszucker“ galt, wird zunehmend als Erkrankung mit hohem Risiko für vaskuläre Folgeschäden und eine Verkürzung der verbleibenden Lebenserwartung erkannt, sofern keine adäquate Therapie erfolgt. Neben der Korrektur einer Hyperglykämie gehört hierzu die konsequente Behandlung begleitender Risikofaktoren, wie Hypertonie, Dyslipidämie sowie Adipositas infolge Fehlernährung und Bewegungsmangel. Bei der großen Mehrzahl von übergewichtigen Typ-2-Diabetikern ist Metformin das orale Antidiabetikum der ersten Wahl, sofern nicht die wichtige Kontraindikation einer Niereninsuffizienz besteht. Im Gegensatz zu dieser durch eine Endpunktstudie abgesicherten Empfehlung für die Monotherapie übergewichtiger Typ-2-Diabetiker gibt es bisher keine gleichwertige Evidenz für eine der möglichen Optionen einer oralen Kombinationstherapie.

Abstract

The prevalence of type 2 diabetes continues to show a clear upward trend in Germany. In earlier days it was considered the “harmless diabetes of old age,” but has become increasingly recognized as a disease carrying a high risk of vascular sequelae as well as shortening the diabetic’s remaining life expectancy if adequate therapy is not initiated. In addition to correcting hyperglycemia, treatment consists in effective management of concomitant risk factors such as hypertension, dyslipidemia, and adiposity resulting from faulty nutrition and lack of exercise. In the large majority of overweight type 2 diabetics, metformin is the oral antidiabetic agent of first choice provided the patient does not exhibit renal insufficiency, which represents the most important contraindication. This recommendation for monotherapy of overweight type 2 diabetics is supported by an endpoint study. In contrast, no equivalent evidence is available on any of the possible options for oral combination therapy.

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Authors and Affiliations

  1. Abteilung Innere Medizin I, Universitätsklinikum Heidelberg

    A. Hamann, M. Morcos & P. Nawroth

  2. Abteilung Innere Medizin I, Medizinische Klinik und Poliklinik, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg

    A. Hamann

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  1. A. Hamann
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  2. M. Morcos
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  3. P. Nawroth
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Correspondence to A. Hamann.

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Hamann, A., Morcos, M. & Nawroth, P. Orale Diabetestherapie. Internist 45, 1356–1363 (2004). https://doi.org/10.1007/s00108-004-1306-4

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  • DOI: https://doi.org/10.1007/s00108-004-1306-4

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