Skip to main content
Log in

Kombination oraler Antidiabetika bei Typ-2-Diabetes

Was passt, was nicht?

Combination of oral antidiabetic drugs: What fits together?

  • FORTBILDUNG . SEMINAR
  • Published:
MMW - Fortschritte der Medizin Aims and scope

Bei der Behandlung des Typ-2-Diabetes kann der Arzt heute auf verschiedene Substanzklassen zurückgreifen. Über Stärken und Schwächen dieser Substanzen und über Konsequenzen für die individualisierte Therapie informiert der folgende Beitrag.

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

Access this article

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

Instant access to the full article PDF.

Abb. 1

Literatur

  1. Gerstein HC, Miller ME, Byington RP et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358: 2545–2559

    Article  CAS  PubMed  Google Scholar 

  2. Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015;38(1):140–9.

    Article  PubMed  Google Scholar 

  3. Garber, AJ, PhD, Abrahamson MJ, Barzilay JI et al. Consensus Statement by the American Association of Clinical Endocrinologists and the American College of Endocrinology on the comprehensive Type 2 Diabetes Management Algorithm 2017, Executive Summary. Endocrine Practice 2017; (23)2:207–38.

    Article  Google Scholar 

  4. Zinman B, Wanner C, Lachin JM, et al. EMPA-REG OUTCOME Investigators. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015;373(22):2117–28.

    Article  CAS  PubMed  Google Scholar 

  5. Marso SP, Daniels GH, Brown-Frandsen K, et al. LEADER Trial Investigators. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2016;375(4):311–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Wanner C, Inzucchi SE, Lachin JM, et al. Empagliflozin and progression of kidney disease in type 2 diabetes. N Engl J Med 2016; 375: 323–334

    Article  CAS  PubMed  Google Scholar 

  7. Gregg EW, Li Y, Wang J, et al. Changes in diabetes-related complications in the United States, 1990–2010. N Engl J Med 2014; 370: 1514–1523

    Article  CAS  PubMed  Google Scholar 

  8. UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998; 352: 854–865

    Article  Google Scholar 

  9. Crowley MJ, Diamantidis CJ, McDuffie JR, et al. Clinical Outcomes of Metformin Use in Populations With Chronic Kidney Disease, Congestive Heart Failure, or Chronic Liver Disease: A Systematic Review. Ann Intern Med. 2017;166(3):191–200.

    Article  PubMed  Google Scholar 

  10. Eurich DT, Majumdar SR, McAlister FA et al. Improved clinical outcomes associated with metformin in patients with diabetes and heart failure. Diabetes Care 2005; 28: 2345–2351

    Article  CAS  PubMed  Google Scholar 

  11. Eurich DT, Weir DL, Majumdar SR et al. Comparative safety and effectiveness of metformin in patients with diabetes mellitus and heart failure: systematic review of observational studies involving 34,000 patients. Circulation Heart failure 2013; 6: 395–402

    Article  CAS  PubMed  Google Scholar 

  12. http://www.deutsche-diabetes-gesellschaft.de/fileadmin/Redakteur/Leitlinien/Evidenzbasierte_Leitlinien/NVL_Therapie_DM2_lang_Aug_13_geae_Nov_2014.pdf

  13. Monami M, Genovese S, Mannucci E. Cardiovascular safety of sulfonylureas: a meta-analysis of randomized clinical trials. Diabetes Obes Metab. 2013; 15(10):938–53.

    Article  CAS  PubMed  Google Scholar 

  14. Roumie CL, Min JY, D’Agostino McGowan L, et al. Comparative Safety of Sulfonylurea and Metformin Monotherapy on the Risk of Heart Failure: A Cohort Study. J Am Heart Assoc. 2017; 6(4).

  15. Bain S, Druyts E, Balijepalli C, et al. Cardiovascular events and all-cause mortality associated with sulphonylureas compared with other antihyperglycaemic drugs: A Bayesian meta-analysis of survival data. Diabetes Obes Metab. 2017;19(3):329–335.

    Article  CAS  PubMed  Google Scholar 

  16. Simpson SH, Lee J, Choi S, et al. Mortality risk among sulfonylureas: a systematic review and network meta-analysis. Lancet Diabetes Endocrinol. 2015; 3(1):43–51.

    Article  CAS  PubMed  Google Scholar 

  17. Wilding JPH: The role of the kidneys in glucose homeostasis in type 2 diabetes: Clinical implications and therapeutic significance through sodium glucose co-transporter 2 inhibitors. Metabolism 63: 1228–1237, 2014.

    Article  CAS  PubMed  Google Scholar 

  18. Vasilakou D, Karagiannis T, Athanasiadou E, et al. Sodium-glucose cotransporter 2 inhibitors for type 2 diabetes: A systematic review and meta-analysis. Ann Intern Med 159: 262–274, 2013

    Article  PubMed  Google Scholar 

  19. Skrtić M, Yang GK, Perkins BA, et al. Characterisation of glomerular haemodynamic responses to SGLT2 inhibition in patients with type 1 diabetes and renal hyperfiltration. Diabetologia 2014; 57: 2599–602.

    Article  PubMed  Google Scholar 

  20. Hilton R, Tikkanen I, Cannon CP, et al. Effects of empagliflozin on blood pressure and markers of arterial stiffness and vascular resistance in patients with type 2 diabetes. Diabetes Obes Metab 2015; 17: 1180–93.

    Article  Google Scholar 

  21. Cherney DZ, Perkins BA, Soleymanlou N, et al. The effect of empagliflozin on arterial stiffness and heart rate variability in subjects with uncomplicated type 1 diabetes mellitus. Cardiovasc Diabetol 2014; 13: 28.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Cherney DZ, Perkins BA, Soleymanlou N, et al. Sodium glucose cotransport-2 inhibition and intrarenal RAS activity in people with type 1 diabetes. Kidney Int 2014; 86: 1057–8.

    Article  CAS  PubMed  Google Scholar 

  23. Jordan J, Tank J, Heusser K, et al. Empagliflozin has no discernable effect on muscle sympathetic nerve activity in patients with type 2 diabetes despite reductions in blood pressure and weight. Diabetes 2014; 63: Suppl 1: A265 (poster).

    Google Scholar 

  24. Lewis EJ, Hunsicker LG, Clarke WR, et al. Renoprotective effect of the angiotensin- receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001; 345: 851–60.

    Article  CAS  PubMed  Google Scholar 

  25. Brenner BM, Cooper ME, de Zeeuw D, et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 2001; 345: 861–9.

    Article  CAS  PubMed  Google Scholar 

  26. Parving H-H, Brenner BM, McMurray JJV, et al. Cardiorenal end points in a trial of aliskiren for type 2 diabetes. N Engl J Med 2012; 367: 2204–13.

    Article  CAS  PubMed  Google Scholar 

  27. Brown NJ, Vaughan DE. Angiotensinconverting enzyme inhibitors. Circulation 1998; 97: 1411–20.

    Article  CAS  PubMed  Google Scholar 

  28. Kobori H, Nangaku M, Navar LG, Nishiyama A. The intrarenal renin-angiotensin system: from physiology to the pathobiology of hypertension and kidney disease. Pharmacol Rev 2007; 59: 251–87.

    Article  CAS  PubMed  Google Scholar 

  29. Pfeffer MA, Claggett B, Diaz R et.al. Lixisenatide in Patients with Type 2 Diabetes and Acute Coronary Syndrome. N Engl J Med. 2015;373(23):2247-57

  30. Muskiet MH, Smits MM, Morsink LM, Diamant M. The gut-renal axis: do incretin-based agents confer renoprotection in diabetes? Nat Rev Nephrol 2014;10:88- 103.

  31. Tanaka T, Higashijima Y, Wada T, Nangaku M. The potential for renoprotection with incretin-based drugs. Kidney Int 2014;86:701-11.

  32. Bisgaard LS, Bosteen MH, Fink LN, et al. Liraglutide Reduces Both Atherosclerosis and Kidney Inflammation in Moderately Uremic LDLr-/- Mice. PLoS One}. 2016;11(12):e0168396

  33. Marso SP, Bain SC, Consoli A, et al; SUSTAIN-6 Investigators.. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med. 2016 Nov 10;375(19):1834–1844.

    Article  CAS  PubMed  Google Scholar 

  34. Ussher JR, Drucker DJ. Cardiovascular biology of the incretin system. Endocr Rev 2012; 33: 187–215

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Deacon CF, Marx N. Potential cardiovascular effects of incretin-based therapies. Expert Rev Cardiovasc Ther 2012; 10: 337–351

    Article  CAS  PubMed  Google Scholar 

  36. Hocher B, Sharkovska Y, Mark M et al. The novel DPP-4 inhibitors linagliptin and BI 14 361 reduce infarct size after myocardial ischemia / reperfusion in rats. Int J Cardiol 2013; 167: 87–93

    Article  PubMed  Google Scholar 

  37. Monami M, Ahren B, Dicembrini I, Mannucci E. Dipeptidyl peptidase-4 inhibitors and cardiovascular risk: a meta-analysis of randomized clinical trials. Diabetes Obes Metab 2013; 15: 112–120

    Article  CAS  PubMed  Google Scholar 

  38. Scirica BM, Bhatt DL, Braunwald E, et al. SAVOR-TIMI 53 Steering Committee and Investigators. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med. 2013;369(14):1317–26.

    Article  CAS  PubMed  Google Scholar 

  39. White WB, Cannon CP, Heller SR et al. Alogliptin after acute coronary syndrome in patients with type 2 diabetes. N Engl J Med 2013; 369: 1327–1335.

    Article  CAS  PubMed  Google Scholar 

  40. Green JB, Bethel MA, Armstrong PW, et al. TECOS Study Group. Effect of Sitagliptin on Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2015;373(3):232–42.

    Article  CAS  PubMed  Google Scholar 

  41. Udell JA, Bhatt DL, Braunwald E, et al. SAVOR-TIMI 53 Steering Committee andInvestigators. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes and moderate or severe renal impairment: observations from the SAVOR-TIMI 53 Trial. Diabetes Care. 2015;38(4):696–705.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Thorsten Siegmund.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Siegmund, T. Was passt, was nicht?. MMW - Fortschritte der Medizin 159, 47–52 (2017). https://doi.org/10.1007/s15006-017-9902-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15006-017-9902-0

Keywords

Navigation