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Neue Konzepte in der Behandlung des Typ-2-Diabetes

New concepts in the treatment of type 2 diabetes

  • Schwerpunkt: Diabetes mellitus
  • Published:
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Zusammenfassung

Die Entwicklung einer Vielzahl neuer Substanzen wird das therapeutische Spektrum beim Typ-2-Diabetes in Zukunft deutlich erweitern. Bereits 2006 wurde der Endocannabinoidrezeptorantagonist Rimonabant für die Therapie übergewichtiger Patienten mit Typ-2-Diabetes zugelassen. Dieses Präparat führt zum einen zu einer deutlichen Reduktion des Körpergewichts, zum anderen aber auch zu einer signifikanten Absenkung der HbA1c-Werte sowie einer Verbesserung des Lipidprofils. Allerdings erschwert die fehlende Kostenerstattung durch die Krankenkassen derzeit einen breiteren Einsatz dieses Präparates. Im April 2007 wurden die jeweils ersten Vertreter der neuartigen Substanzgruppen der GLP-1-Analoga/Inkretinmimetika (Exenatide, Byetta®) und DPP-4-Hemmer (Sitagliptin, Januvia®) in Deutschland zugelassen. Beide Substanzen führen in klinischen Studien zu einer deutlichen Absenkung der HbA1c-Werte. Darüber hinaus führen die Inkretinmimetika zu einer progredienten Gewichtsreduktion, während die DPP-4-Hemmer weitestgehend gewichtsneutral sind. Die Applikation von Sitagliptin erfolgt oral, während Exenatide subkutan verabreicht wird. Aufgrund der Glukoseanhängigkeit ihrer Wirkungen führt die alleinige Gabe der DPP-4-Hemmer und Inkretinmimetika nicht zur Auslösung von Hypoglykämien. Insgesamt stellt die Einführung dieser neuen Substanzgruppen sicherlich eine sinnvolle Erweiterung des therapeutischen Portfolios beim Typ-2-Diabetes dar. Die Auswirkungen dieser neuen Therapieformen auf die Entwicklung diabetischer Folgekomplikationen in Langzeitstudien bleibt abzuwarten.

Abstract

The development of a variety of new substances will considerably expand the therapeutic choices in the treatment of type 2 diabetes. In 2006, the endocannabinoid receptor blocker Rimonabant has been approved for the treatment of type 2 diabetes in Germany. This compound has led to significant reductions of body weight along with improvements of HbA1c levels and lipid profiles, but the lack of health insurance coverage limits its large scale use in germany. In April 2007, the first members of the GLP 1 analogues/incretin mimetics (exenatide, Byetta®) and DPP 4 inhbitors (sitagliptin, Januvia®) have become available for the treatment of type 2 diabetes in Germany. Both drugs have significantly lowered HbA1c levels in clinical studies. In addition, the incretin mimetics have caused a progressive reduction of body weight, while the DPP 4 inhibitors have been rather weight neutral. Sitagliptin can be administered orally, whereas exenatide has to be injected subcutaneously. Neither the DPP 4 inhibitors, nor the incretin mimetics have led to the development of hypoglycaemia, unless combined with sulfonylureas. Overall, the introduction of these new drug classes will certainly broaden our therapeutic choices in the management of type 2 diabetes. The long-term effects of these drugs on the development of diabetic complications in long-term trials remains to be awaited.

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Authors and Affiliations

  1. Medizinische Klinik I, St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland

    J. J. Meier & W. E. Schmidt

  2. Medizinische Klinik I, Berufsgenossenschaftliche Kliniken Bergmannsheil, Klinikum der Ruhr-Universität Bochum, Bochum, Deutschland

    H.-H. Klein

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  1. J. J. Meier
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  2. W. E. Schmidt
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  3. H.-H. Klein
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Correspondence to J. J. Meier.

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Meier, J.J., Schmidt, W.E. & Klein, HH. Neue Konzepte in der Behandlung des Typ-2-Diabetes. Internist 48, 698–707 (2007). https://doi.org/10.1007/s00108-007-1876-z

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  • DOI: https://doi.org/10.1007/s00108-007-1876-z

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