Skip to main content
SpringerLink
Log in

Update Typ-2-Diabetes

Type 2 diabetes update

  • Leitthema
  • Published:
Der Diabetologe Aims and scope

Zusammenfassung

Aus der in den Jahren 2020 und 2021 publizierten Literatur zum Typ-2-Diabetes und den im Rahmen des Diabetes Update 2021 referierten Arbeiten werden einige Themen herausgegriffen und im Kontext der bisherigen Befunde diskutiert. Eines dieser Themen ist die Präzisionsmedizin. Sie ist Voraussetzung für eine personalisierte Therapie des Diabetes, lässt sich jedoch bei Typ-2-Diabetes nicht so stringent umsetzen wie bei den monogenetischen Diabetesformen. Neben dem weiterhin unterdiagnostizierten und oft falsch behandelten MODY („maturity onset diabetes of the young“) wird auch auf das Krebsrisiko von Menschen mit Diabetes sowie auf dessen Progression begünstigende Faktoren eingegangen. Zudem werden neue Erkenntnisse zu Metformin, Pioglitazon, SGLT-2-Inhibitoren (SGLT: „sodium glucose linked transporter 2“), DPP-4-Hemmern (DPP: Dipeptidylpeptidase) und GLP-1-Rezeptor-Agonisten (GLP: „glucagon-like peptide“) vorgestellt. Auch die Diabetestherapie bei chronischer Nierenerkrankung, ebenso der Nutzen und die Sicherheit antidiabetischer Kombinationen werden besprochen. Auch auf neue Ergebnisse zu Insulin vs. Insulinanaloga, zum Hypoglykämierisiko unter verschiedenen Insulinen sowie modernen Möglichkeiten der Insulintherapie wird eingegangen. Interessant in diesem Kontext sind die noch länger wirksamen Präparate zur Basalsubstitution, die nur einmal wöchentlich injiziert werden müssen. Sie könnten die Akzeptanz und Adhärenz der Patienten erhöhen.

Abstract

Based on the literature on type 2 diabetes published in 2020 and 2021 and the papers presented at Diabetes Update 2021, a number of topics are highlighted and discussed in the context of current findings. One of these topics is precision medicine. It is a prerequisite for personalized treatment of diabetes, but cannot be implemented as stringently in type 2 diabetes as in the monogenetic forms of diabetes. In addition to MODY (maturity onset diabetes of the young), which continues to be underdiagnosed and often incorrectly treated, the risk of cancer in people with diabetes and factors favoring its progression will also be discussed. In addition, new findings on metformin, pioglitazone, SGLT‑2 (sodium-glucose-linked transporter 2) inhibitors, DPP‑4 (dipeptidyl peptidase-4) inhibitors and GLP‑1 (glucagon-like peptide-1) receptor agonists are presented. Treatment of diabetes in chronic kidney disease, as well as the benefits and safety of antidiabetic combinations will also be discussed. New results on insulin vs. insulin analogues, the risk of hypoglycemia with different insulins, and modern options for insulin therapy are also discussed. Of interest in this context are the even longer-acting preparations for basal substitution, which only need to be injected once a week. They could increase patient acceptance and adherence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Chung WK et al (2020) Precision medicine in diabetes: a consensus report from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes. Diabetes Care 43:1617–1635

    Article  CAS  Google Scholar 

  2. Buse JB et al (2020) 2019 update to: Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 43:487–493

    Article  CAS  Google Scholar 

  3. Buse JB et al (2020) 2019 update to: Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 63:221–228

    Article  Google Scholar 

  4. Delveccio M et al (2020) Treatment options for MODY patients: a systematic review of literature. Diabetes Ther 11:1667–1685

    Article  Google Scholar 

  5. Ling S et al (2020) Association of type 2 diabetes with cancer: a meta-analysis with bias analysis for unmeasured confounding in 151 cohorts comprising 32 million people. Diabetes Care 43:2313–2322

    Article  Google Scholar 

  6. Bizzotto R et al (2021) Processes underlying glycemic deterioration in type 2 diabetes: an IMI DIRECT study. Diabetes Care 44:511–518

    Article  CAS  Google Scholar 

  7. Cosentino F et al (2020) 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 41:255–323

    Article  Google Scholar 

  8. De Boer IH et al (2020) Executive summary of the 2020 KDIGO diabetes management in CKD guideline: evidence-based advances in monitoring and treatment. Kidney Int 98:839–848

    Article  Google Scholar 

  9. Flory JH et al (2020) Reports of lactic acidosis attributed to metformin, 2015–2018. Diabetes Care 43:244–246

    Article  CAS  Google Scholar 

  10. Gnesin F et al (2020) Metformin monotherapy for adults with type 2 diabetes mellitus. Cochrane Database Syst Rev 6:CD12906. https://doi.org/10.1002/14651858.CD012906.pub2

    Article  PubMed  Google Scholar 

  11. Kwon S et al (2020) The long-term effects of metformin on patients with type 2 diabetic kidney disease. Diabetes Care 43:948–955

    Article  CAS  Google Scholar 

  12. Reitz KM et al (2020) Association between preoperative metformin exposure and postoperative outcomes in adults with type 2 diabetes. JAMA Surg 155:e200416. https://doi.org/10.1001/jamasurg.2020.0416

    Article  PubMed  PubMed Central  Google Scholar 

  13. Sinha B et al (2020) Assessing the need for pioglitazone in the treatment of patients with type 2 diabetes: a meta-analysis of its risk and benefits from prospective trials. Sci Rep 10:15781. https://doi.org/10.1038/s41598-020-72967-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Frias JP et al (2021) Efficacy and safety of dulaglutide 3,0 mg and 4,5 mg versus dulaglutide 1,5 mg in metformin-treated patients with type 2 diabetes in a randomized controlled trial (AWARD-11). Diabetes Care. https://doi.org/10.2337/dc20-1473

    Article  PubMed  PubMed Central  Google Scholar 

  15. Mann JFE et al (2020) Effects of once-weekly subcutaneous semaglutide on kidney function and safety in patients with type 2 diabetes: a post-hoc analysis of the SUSTAIN 1‑7 randomised controlled trials. Lancet Diabetes Endocrinol 8:880–893

    Article  CAS  Google Scholar 

  16. Huthmacher JA et al (2020) Efficacy and safety of short- and long-acting glucagon-like peptide 1 receptor agonists on a background of basal insulin in type 2 diabetes: a meta analysis. Diabetes Care 43:2303–2312

    Article  CAS  Google Scholar 

  17. Wilding JPH et al (2021) Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. https://doi.org/10.1056/NEJMoa2032183

    Article  PubMed  Google Scholar 

  18. Cannon CP et al (2020) Cardiovascular outcomes with ertugliflozin in type 2 diabetes. N Engl J Med 383:1425–1435

    Article  CAS  Google Scholar 

  19. Cahn A et al (2020) Efficacy and safety of dapagliflozin in the elderly: analysis from the DECLARE-TIMI 58 study. Diabetes Care 43:468–475

    Article  CAS  Google Scholar 

  20. Kohsaka S et al (2020) Risk of cardiovascular events and death associated with initiation of SGLT2 inhibitors compared with DPP‑4 inhibitors: an analysis from the CVD-REAL 2 multinational cohort study. Lancet Diabetes Endocrinol 8:606–615

    Article  CAS  Google Scholar 

  21. Heerspink HJ et al (2020) Dapagliflozin in patients with chronic kidney disease. N Engl J Med 383:1436–1446

    Article  CAS  Google Scholar 

  22. Heerspink HJL et al (2020) Kidney outcomes associated with use of SGLT2 inhibitors in real world clinical practice (CVD-REAL 3): a multinational observational cohort study. Lancet Diabetes Endocrinol 8:27–35

    Article  CAS  Google Scholar 

  23. Packer M et al (2020) Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med 383:1413–1424

    Article  CAS  Google Scholar 

  24. Meyer EJ et al (2020) Periprocedural euglycemic diabetic ketoacidosis associated with sodium glucose cotransporter 2 inhibitor therapy during colonoscopy. Diabetes Care 43:e181–e184

    Article  CAS  Google Scholar 

  25. Bhatt DL et al (2021) Sotagliflozin in patients with diabetes and chronic kidney disease. N Engl J Med 384:129–139

    Article  CAS  Google Scholar 

  26. Bhatt DL et al (2021) Sotagliflozin in patients with diabetes and recent worsening heart failure. N Engl J Med 384:117–128

    Article  CAS  Google Scholar 

  27. Jensen MH et al (2020) Risk of major adverse cardiovascular events, severe hypoglycemia, and all-cause mortality for widely used antihyperglycemic dual and triple therapies for type 2 diabetes management: a cohort study of all Danish users. Diabetes Care 43:1209–1218

    Article  CAS  Google Scholar 

  28. Cahn A et al (2021) Cardiorenal outcomes with dapagliflozin by baseline glucose-lowering agents: post hoc analysis from DECLARE-TIMI 58. Diabetes Obes Metab 23:29–38

    Article  CAS  Google Scholar 

  29. Ali AM et al (2020) Combination therapy with canagliflozin plus liraglutide exerts additive effect on weight loss, but not on HbA1c in patients with type 2 diabetes. Diabetes Care 43:1234–1241

    Article  CAS  Google Scholar 

  30. Semlitsch T et al (2020) (Ultra-)long-acting insulin analogues versus NPH insulin (human isophane insulin) for adults with type 2 diabetes mellitus. Cochrane Database Syst Rev 11:CD5613. https://doi.org/10.1002/.14651858.CD005613.pub4

    Article  PubMed  Google Scholar 

  31. Philis-Tsimikas A et al (2020) Risk of hypoglycemia with insulin degludec versus insulin glargine U300 in insulin-treated patients with type 2 diabetes: the randomized, head-to-head CONCLUDE trial. Diabetologia 63:698–710

    Article  CAS  Google Scholar 

  32. Rosenstock J et al (2020) Once-weekly insulin for type 2 diabetes without previous insulin treatment. N Engl J Med. https://doi.org/10.1056/NEJMoa2022474

    Article  PubMed  Google Scholar 

  33. Blevins T et al (2020) Randomized double-blind clinical trial comparing ultra rapid lispro with lispro in a basal-bolus regimen in patients with type 2 diabetes: PRONTO-T2D. Diabetes Care 43:2991–2998

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medizinische Klinik IV, Hochtaunus-Kliniken gGmbH, Zeppelinstraße 20, 61352, Bad Homburg v. d. H., Deutschland

    Andreas Hamann

Authors
  1. Andreas Hamann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andreas Hamann.

Ethics declarations

Interessenkonflikt

A. Hamann erklärt, dass er sich bei der Erstellung des Beitrags nicht von wirtschaftlichen Interessen leiten ließ. Er legt die folgenden potenziellen Interessenkonflikte offen: Boehringer Ingelheim, Cheplapharm, Daiichi Sankyo, Lilly, MSD, Novartis, Novo Nordisk, Sanofi (Vortragstätigkeit); Amgen, Bayer, Boehringer Ingelheim, Cheplapharm, Daiichi Sankyo, KV Hessen, Lilly, MSD, Novartis, Novo Nordisk, Sanofi (Beratertätigkeit); Abbott, Dexcom, Novo Nordisk (Aktienbesitz).

Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hamann, A. Update Typ-2-Diabetes. Diabetologe 17, 501–515 (2021). https://doi.org/10.1007/s11428-021-00783-3

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11428-021-00783-3

Schlüsselwörter

Keywords

Search

Navigation