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Der Diabetologe

, Volume 13, Issue 2, pp 123–136 | Cite as

Strategien zur Gewichtsreduktion bei Typ-2-Diabetes

CME
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Zusammenfassung

Gewichtsreduzierende Maßnahmen zählen zur Basistherapie des Typ-2-Diabetes. Die individuell festzulegenden Therapieziele werden jedoch selten durch sie allein – einschließlich Empfehlungen zur Ernährungsumstellung, erhöhter körperlicher Aktivität und Verhaltensänderungen – erfüllt, sodass eine stufenweise eskalierende Strategie empfohlen wird. Bei nicht erreichten individuellen Therapiezielen unter der Basistherapie wird auf eine konservative Behandlung, die niedrigkalorische Kostformen, Pharmakotherapien und endoskopische Verfahren beinhalten kann, umgestellt. Nach deren Ausschöpfung kann unter Berücksichtigung von Nutzen-Risiko-Abwägungen die Indikation zur metabolischen Chirurgie bei einem BMI (Body-Mass-Index) >35 kg/m2 gestellt werden. Diese ist im Vergleich zur konservativen Therapie hinsichtlich Gewichtsreduktion, langfristiger Gewichtsstabilität und Blutzuckersenkung deutlich wirksamer, geht aber auch mit höheren akuten und längerfristigen Risiken einher.

Schlüsselwörter

Blutglukosespiegel Adipositas Ernährungstherapie Bewegungstherapie Bariatrische Chirurgie 

Weight reduction strategies for patients with type 2 diabetes

Abstract

Therapeutic weight reduction is a basic component of type 2 diabetes treatment. Individual goals—body weight reduction and weight maintenance after weight loss—are frequently not achieved with nutritional advice, recommendations to increase physical activity, and behavior changes. To achieve these goals, a conservative treatment strategy with energy-reduced diet, increased physical activity, behavioral modifications or treatment is primarily recommended. If individual targets are not achieved, stepwise intensification should be initiated with very low calorie diets, pharmacotherapy, and/or endoscopic obesity therapies. Metabolic surgery may be considered in patients with a body mass index (BMI) >35 kg/m2 if conservative treatment strategies fail. In addition, it has been shown to be more effective than conservative approaches with regard to weight reduction, long-term weight maintenance, blood glucose lowering, and reduced mortality, but is associated with considerable acute and long-term risks.

Keywords

Blood glucose Obesity Nutrition therapy Physical activity Bariatric surgery 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

Der Autor erklärt, dass er Honorare für Vorträge und/oder Beratertätigkeiten von Amgen, AstraZeneca, Bayer, Berlin-Chemie, Boehringer-Ingelheim, Lilly, Novartis, Novo Nordisk, Pfizer und Sanofi erhalten hat.

Dieser Beitrag beinhaltet keine vom Autor durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag Berlin 2017

Authors and Affiliations

  1. 1.Department für Innere MedizinUniversität LeipzigLeipzigDeutschland

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