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Adipositas und Prädiabetes

Therapie mit GLP‑1 Rezeptoragonisten

Obesity and prediabetes

Treatment using GLP‑1 receptor agonists

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Der Diabetologe Aims and scope

Zusammenfassung

Hintergrund

Seit dem Jahr 2007 sind in Deutschland GLP-1-Rezeptor-Agonisten (GLP: „glucagon-like peptide“) für die Behandlung des Diabetes mellitus Typ 2 zugelassen. Ein wesentlicher Fortschritt gegenüber vorhandenen Therapien war, dass diese Behandlung bei vielen Patienten mit einer Gewichtsreduktion von etwa 1–4 kg einhergeht.

Adipositas- und Prädiabetestherapie

Hauptmechanismus bei der Gewichtsabnahme unter GLP-1-Rezeptor-Agonisten ist die physiologische Funktion von GLP-1, den Appetit und die Nahrungsaufnahme zu regulieren. Die entsprechenden Effekte können grundsätzlich auch bei Personen ohne Diabetes mellitus beobachtet werden, sodass eine medikamentöse Therapie der Adipositas möglich ist. In Kombination mit der insulinotropen und glukagonostatischen Wirkung an der pankreatischen Insel resultiert insgesamt eine wirksame Behandlung des Prädiabetes. Es erscheint jedoch fraglich, ob durch die Aktivierung der GLP-1-Rezeptoren eine nachhaltige Diabetesprävention erzielt werden kann, d. h. eine langfristige Normalisierung des Glukosestoffwechsels auch nach Beendigung der aktiven Therapie. Es gilt daher, GLP-1-Rezeptor-Agonisten mit etablierten Therapieprinzipien der Adipositas und des Prädiabetes zu kombinieren, in erster Linie mit der Lebensstilintervention, um die langfristigen Ergebnisse der Therapie von Adipositas und Prädiabetes zu verbessern.

Abstract

Background

Glucagon-like peptide 1 (GLP-1) receptor agonists receptor agonists have been available for the treatment of type 2 diabetes mellitus in Germany since 2007. One improvement over existing therapies was the induction of weight loss of approximately 1–4 kg in the majority of patients.

Obesity and prediabetes treatment

The underlying mechanism is the physiologic function of GLP-1 to regulate appetite and food intake in humans. These therapeutic effects are also present in non-diabetic individuals, thus providing a new approach to treating obesity. In addition, effective treatment of prediabetes and hyperglycemia is achieved by regulation of islet hormone levels (insulin and glucagon). However, GLP-1 receptor agonist treatment does not have a disease modifying effect to induce long-term normalization of glucose metabolism even after discontinuation of active therapy. Therefore it is necessary to combine GLP-1 receptor agonists with established therapies for obesity and prediabetes, primarily lifestyle intervention, in order to improve the long-term results of obesity and prediabetes treatment.

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Authors and Affiliations

  1. Klinik für Endokrinologie, Diabetologie und Suchtmedizin, Klinikum Schwabing, Städtisches Klinikum München GmbH, Kölner Platz 1, 80804, München, Deutschland

    R. A. Ritzel

  2. Klinik für Endokrinologie, Diabetologie und Angiologie, Klinikum Bogenhausen, Städtisches Klinikum München, München, Deutschland

    R. A. Ritzel

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Interessenkonflikt

R. A. Ritzel gibt an, als Berater für MSD, Novo Nordisk, Sanofi, Servier tätig zu sein und Honorare für Vorträge bei Astra Zeneca, MSD, Lilly, Novartis, Novo Nordisk, Sanofi erhalten zu haben.

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

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Ritzel, R.A. Adipositas und Prädiabetes. Diabetologe 13, 482–486 (2017). https://doi.org/10.1007/s11428-017-0274-y

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