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Inkretinbasierte Therapien

Incretin-based therapies

  • Leitthema
  • Published:
Der Diabetologe Aims and scope

Zusammenfassung

Inkretinbasierte Therapien zur Behandlung des Typ-2-Diabetes haben sich seit ihrer Einführung 2006 etabliert. Die „Glucagon-like-peptide-1“-Rezeptor-Agonisten (GLP-1-RA) zur Injektion und die oral-wirksamen Dipeptidylpeptidase(DPP)-4-Inhibitoren haben eine streng glukoseabhängige Wirkung sowohl auf die Insulin- als auch auf die Glukagonsekretion. Daher gehen sie mit einem vernachlässigbaren intrinsischen Hypoglykämierisiko einher. Die GLP-1-RA wirken nur über die Stimulation des GLP-1-Rezeptors und stimulieren ihn mit Rezeptorligandenkonzentrationen, die im pharmakologischen Bereich liegen. Sie verlangsamen abhängig von ihrer Wirkdauer die Magenentleerung und stimulieren ferner das Sättigungsgefühl im zentralen Nervensystem; dies führt konsekutiv zu einer Körpergewichtsabnahme. Die DPP-4-Inhibitoren erhöhen v. a. endogene GLP-1-Konzentrationen um das etwa 2- bis 3-Fache. Sie sind gewichtsneutral, da sie keine zentralnervösen Effekte oder Wirkung auf die gastrointestinale Motilität haben. Jüngste Studien weisen auf günstige kardiovaskuläre Effekte inkretinbasierter Therapien hin. Dieser Beitrag gibt einen Überblick über neue Entwicklungen auf diesem Therapiegebiet.

Abstract

Incretin-based therapies have become established for the treatment of type 2 diabetes since the introduction in 2006. The injectable glucagon-like peptide 1 receptor-agonists (GLP-1-RA) and the orally active dipeptidyl peptidase 4 (DPP-4) inhibitors have a strict glucose dependent action on insulin and glucagon secretion resulting in a negligible intrinsic hypoglycemia risk. The GLP-1-RAs only act by directly stimulating GLP-1 receptors by receptor ligand concentrations in the pharmacological range. They slow gastric emptying dependent on the duration of action and also act directly by stimulating satiety signals in the central nervous system. These effects lead to a loss of body weight. The DPP-4 inhibitors primarily elevate endogenous GLP-1 plasma concentrations two to threefold. They are body weight neutral as they do not have effects on the central nervous system or gastrointestinal motility. Novel studies suggest beneficial cardiovascular effects of incretin-based therapies. This article gives an overview about novel developments in this therapeutic field.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Der Autor hat Honorare für Vorträge und Mitarbeit in Advisory-Boards von denFirmen AstraZeneca, Boehringer Ingelheim, Bristol-Myers Sqibb, Eli Lilly, Merck Sharp & Dohme, Novartis, NovoNordisk, Roche, Takeda und Sanofi erhalten.

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  1. Medizinische Klinik IV, Eberhard-Karls-Universität, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland

    B. Gallwitz

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Correspondence to B. Gallwitz.

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Gallwitz, B. Inkretinbasierte Therapien. Diabetologe 9, 283–288 (2013). https://doi.org/10.1007/s11428-012-1018-7

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  • DOI: https://doi.org/10.1007/s11428-012-1018-7

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