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Neue Medikamente

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  • Leitthema
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Der Diabetologe Aims and scope

Zusammenfassung

Die Pathogenese des Typ-2-Diabetes beruht auf einem komplexen Wechselspiel verschiedenster pathophysiologischer Mechanismen einzelner Organe und Gewebe, z. B. endokrines Pankreas, Leber, Fettgewebe, Skelettmuskulatur, Nieren, autonomes Nervensystem, Gastrointestinaltrakt etc. Diese sind auf vielfältige Weise mit der Entstehung einer Insulinresistenz und/oder reduzierten Funktion der Langerhans-Inseln des Pankreas verbunden und können nicht nur den Blutzuckerspiegel, sondern auch das kardiovaskuläre Risiko erhöhen. Die verschiedenen Mechanismen weisen aber auch daraufhin, dass sich hinter dem „Syndrom eines Diabetes mellitus“ einzelne Subtypen verbergen, die möglicherweise unterschiedlicher zielgerichteter Therapiestrategien bedürfen und auch entsprechend unterschiedlich auf bestimmte therapeutische Interventionen ansprechen. Die Zukunft wird darin liegen, das Rätsel dieser Subtypen zu lösen, um nicht nur die Hyperglykämie effektiv zu reduzieren, sondern damit einhergehend die diabetisch-spezifischen mikroangiopathischen Spätkomplikationen und auch das kardiovaskuläre Risiko zu reduzieren. In diesem Beitrag werden neue Entwicklungen in der Insulintherapie und in der oralen antidiabetischen Therapie zusammengefasst.

Abstract

The pathogenesis of type 2 diabetes is a complex interplay between different pathophysiological mechanisms related to altered functions of different organs, e.g. endocrine pancreas, liver, fatty tissue, skeletal muscle, kidneys, autonomic nervous system and gastrointestinal system. These multiple mechanisms with implications for glucose and lipid metabolism are related to features of insulin resistance, impaired islet function and the development of hyperglycemia. The future will have to find solutions to this puzzle and it appears evident that type 2 diabetes covers many different subtypes which might benefit from different therapeutic strategies. The strategies have to focus not only on lowering blood glucose levels but also on reducing specific complications, such as microangiopathy and cardiovascular risks. This review focuses on developments in insulin therapy and oral anti-diabetic drugs are also summarized. Furthermore, different mechanisms and metabolic pathways are outlined which might be potential drug targets driven by the persisting hope to one day cure and prevent diabetes.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Der Autor ist als Referent und Berater in den vergangenen Jahren für die Firmen Novartis GmbH, Sankyo Daiichi, MSD, Bristol-Myers Squibb, AstraZeneca, Roche Pharma und Boehringer Ingelheim tätig gewesen.

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  1. Allgemeine Innere Medizin, Gastroenterologie, Endokrinologie, Diabetes und Stoffwechsel, Asklepios Klinik St. Georg, Medizinische Fakultät der Semmelweis Universität, Lohmühlenstr. 5, 20099, Hamburg, Deutschland

    D. Müller-Wieland

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  1. D. Müller-Wieland
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Correspondence to D. Müller-Wieland.

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Müller-Wieland, D. Neue Medikamente. Diabetologe 9, 296–301 (2013). https://doi.org/10.1007/s11428-012-1019-6

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