Medikamentöse Prävention des Diabetes mellitus Typ 2 – Wenn eine Lebensstiländerung nicht ausreicht ...

Bereits in prädiabetischen Stadien besteht sowohl ein Defizit der Insulinsekretion als auch eine Insulinresistenz. Auch Komorbiditäten des Typ–2–Diabetes, eine erhöhte inflammatorische Aktivität und arteriosklerotische Gefäßerkrankungen können zu diesem Zeitpunkt schon nachgewiesen werden. Demzufolge fällt der Prävention des Diabetes mellitus Typ 2 eine immer wichtigere Rolle zu. Dieser Artikel stellt hierzu die Endpunktdaten sowohl für nichtmedikamentöse (Lebensstil, „lifestyle”) als auch medikamentöse Interventionen vor. Aus der Sicht von Evidenz und Sicherheit sind dabei Acarbose und Metformin Medikamente der ersten Wahl. Die Einnahme von Acarbose war zudem in der STOP–NIDDM[1] Studie mit signifikant weniger neuen Hypertoniefällen und kardiovaskulären Ereignissen assoziiert.

Already in the prediabetic state we find a deficit in insulin secretion and a decrease in insulin sensitivity typical for clinical type 2 diabetes. Furthermore in about 60  % comorbidities of the metabolic syndrome, increased levels of biomarkers of low grade inflammation and atherosclerotic vascular disease are present. Therefore the prevention of type 2 diabetes is an urgent task. This review presents an up–date of controlled medical prevention trials. So far evidence based data for the prevention of type 2 diabetes are only available for acarbose, metformin, rosiglitazone and pioglitazone with a safety profile in favour of acarbose and metformin. Acarbose in the STOP–NIDDM trial had in addition beneficial effects on incidence of newly diagnosed hypertension and cardiovascular events.

Key words

diabetes mellitus type 2 - prevention - lifestyle - acarbose - metformin - glitazones - orlistat - rimonabant - insulin

1 Study TO Prevent Non–Insulin–Dependent Diabetes Mellitus

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1 Study TO Prevent Non–Insulin–Dependent Diabetes Mellitus

2 KOoperative gesundheitsforschung in der Region Augsburg

3 NAteglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research

4 TRoglitazon In Prevention Of Diabetes

5 Diabetes REduction Assessment with ramipril and rosiglitazone Medication

6 ACTos NOW for Prevention of Diabetes

7 Outcome Reduction with Initial Glargine INtervention

8 XENical in the prevention of Diabetes in Obese Study

9 Rimonabant In Obesity

10 Action to Control CardiOvascular Risk in Diabetes

11 Heart Outcomes PrEvention

12 ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial

13 West Of Scotland COronary Prevention Study

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