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Diabetologie und Stoffwechsel 2020; 15(04): 317-326
DOI: 10.1055/a-1197-6223
Übersicht

Metabolische Wirkungen und kardiovaskuläre Sicherheit einer oralen Dreifachtherapie des Typ-2-Diabetes: das Beispiel Metformin, Empagliflozin und Linagliptin

Metabolic effects and cardiovascular safety of an oral triple therapy of type 2 diabetes: the metformin, empagliflozin, linagliptin example
Baptist Gallwitz
1   Department Innere Medizin, Abt. IV, Diabetologie, Endokrinologie & Nephrologie, Eberhard-Karls-Universität Tübingen, Medizinische Fakultät, Tübingen, Germany
,
Roland Schmieder
2   Medizinische Klinik 4, Universitätsklinikum Erlangen, Germany
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Zusammenfassung

Basierend auf neuen Erkenntnissen und Leitlinien wird die orale Dreifachtherapie des Typ-2-Diabetes am Beispiel der Kombination aus Metformin, Empagliflozin und Linagliptin diskutiert. Der SGLT-2-Hemmstoff Empagliflozin verbessert im Vergleich zu Placebo den kombinierten Endpunkt aus kardiovaskulärem Tod oder nicht tödlichem Myokardinfarkt oder Schlaganfall (MACE-3) und reduziert die Wahrscheinlichkeit einer Klinikaufnahme wegen Herzinsuffizienz sowie die Gesamtsterblichkeit. Eine neu auftretende oder sich verschlechternde Nephropathie wird ebenfalls seltener beobachtet. Der DPP-4-Hemmstoff Linagliptin senkt Blutzucker und HbA1c und hat keine Wirkungen auf den kardiovaskulären Endpunkt MACE-3, während die Progression der Albuminurie im Vergleich zu Placebo vermindert wird. Im Vergleich zum Sulfonylharnstoff Glimepirid sind die kardiovaskulären Wirkungen ähnlich, Hypoglykämien aber deutlich seltener. Die Kombination des insulinotropen Linagliptin mit dem insulinunabhängigen Glukose ausscheidenden Wirkprinzip von Empagliflozin verbessert im Vergleich zu Placebo bei mit Metformin unzureichend behandelten Patienten die metabolische Situation. Bei solchen Patienten ist die Fixkombination aus Empagliflozin und Linagliptin die erste, bei der Langzeitwirkungen der Einzelkomponenten in drei kardiovaskulären Endpunktstudien bestätigt wurden.

Abstract

Based on new evidence and guidelines we discuss the triple therapy of type 2 diabetes using the example of a combination of metformin, empagliflozin and linagliptin. The SGLT-2 inhibitor empagliflozin improves the combined endpoint of cardiovascular death, non-fatal myocardial infarction and stroke (MACE-3) compared to placebo and reduces the incident probability of hospitalization due to heart failure as well as overall mortality. A newly occurring or deteriorating nephropathy is also observed less frequently. The DPP-4 inhibitor linagliptin lowers blood glucose and HbA1c and has no effects on the cardiovascular endpoint MACE-3, but reduces the progression of albuminuria as compared to placebo. In comparison to the sulfonylurea glimepiride cardiovascular outcomes are similar, but hypoglycemia is much less frequent. The combination of the insulinotropic linagliptin and the insulin-independent, glucosuric empagliflozin improves the metabolic function as compared to placebo in patients who are insufficiently treated with metformin. In such patients the fixed combination of empagliflozin and linagliptin is the first for which three long-term outcome studies have demonstrated metabolic, cardiovascular and renal effects.

Schlüsselwörter

Empagliflozin - Hypoglykämie - kardiovaskuläre Endpunktstudie - Linagliptin - Metformin - Nierenfunktion

Key words

cardiovascular outcome study - empagliflozin - hypoglycemia - linagliptin - metformin - renal function


Publikationsverlauf

Eingereicht: 12. Mai 2020

Angenommen: 08. Juni 2020

Artikel online veröffentlicht:
01. Juli 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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