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Medikamente und Diabetes

Drug-associated diabetes mellitus

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Der Diabetologe Aims and scope

Zusammenfassung

Zahlreiche Medikamente werden mit Gewichtszunahme und Entwicklung eines Diabetes mellitus Typ 2 in Verbindung gebracht. Zu diesen zählen insbesondere die Antipsychotika Clozapin und Olanzapin, die Antidepressiva Paroxetin und Mirtazapin sowie das Antiepileptikum Valproinsäure. Im Gegensatz zu den ebenfalls mit Insulinresistenz assoziierten Betablockern, bei denen der positive kardiovaskuläre Effekt überwiegt, können bei Behandlung mit den genannten Medikamenten Übergewicht und Störungen der Glukosehomöstase ein gesundheitliches Risiko darstellen.

Die metabolischen Nebenwirkungen sollten deshalb bereits in der Planung einer Behandlung mit diesen Medikamenten berücksichtigt werden. Ebenso sollten regelmäßige Kontrollen von BMI, Bauchumfang, Nüchternglukose und Lipidprofil nach Therapiebeginn durchgeführt werden. Die effektivste Behandlung einer medikamenteninduzierten Gewichtszunahme stellt der Wechsel auf eine Substanz mit einem besseren metabolischen Risikoprofil dar. Lebensstilmodifizierende Maßnahmen zur Gewichtsabnahme und glykämischen Kontrolle zeigten sich ähnlich effektiv wie die pharmakologische Intervention mit geeigneten Medikamenten, wie Metformin, Topiramat, Histaminantagonisten, dopaminergen oder serotonergen Substanzen.

Übergewicht und Diabetes bei psychiatrischen oder neurologischen Erkrankungen sollten als zwei chronische Krankheiten betrachtet werden, die jeweils entsprechender Behandlung bedürfen.

Abstract

Numerous drugs are associated with weight gain and the development of type 2 diabetes mellitus, particularly the second generation antipsychotics clozapine and olanzapine, the antidepressants paroxetine and mirtazapine, as well as the anticonvulsant valproic acid. In contrast to β-blockers, which are also associated with insulin resistance but where the cardiovascular benefit outweighs the risk for metabolic disturbances, obesity and diabetes induced by the aforementioned drugs can pose a serious health risk.

The drugs’ impact on weight and glucose homeostasis should already be taken into account when planning a patient’s treatment regimen. Baseline screening and regular follow-up monitoring of BMI, waist, fasting glucose and lipid levels following therapy initiation are advised. Switching to a different medication with a better metabolic risk profile has proven to be the most successful strategy for the treatment of psychotropic drug-induced weight gain. Lifestyle changes to reduce weight and achieve better glycemic control have been shown to be as effective as pharmacological intervention with relevant drugs, i.e. metformin, topiramate, histamine antagonists and dopaminergic or serotonergic substances.

When obesity and/or diabetes co-occur in patients with psychiatric or neurologic diseases both diseases should be regarded as two chronic illnesses that each require long-term management.

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  1. Department für Innere Medizin I, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich

    A. Tschoner &  C. Ebenbichler

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  1. A. Tschoner
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  2. C. Ebenbichler
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Correspondence to C. Ebenbichler.

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Tschoner, A., Ebenbichler, C. Medikamente und Diabetes. Diabetologe 6, 37–43 (2010). https://doi.org/10.1007/s11428-009-0439-4

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