Zusammenfassung
Die zwei wichtigsten Aspekte bei der Wahl eines Antidiabetikums sind dessen Kapazität
zur Blutzuckereinstellung und das Hypoglykämierisiko. Mit der heutigen großen Auswahl
an Antidiabetika wird das Therapieziel (HbA1c < 7 %) aber in 40–50 % der Fälle nicht erreicht. Einer der Gründe dafür ist die Angst
vor Hypoglykämien, die häufig bei der klassischen antidiabetischen Therapie mit Sulfonylharnstoffen
und Insulinen auftreten können. Die Angst verzögert die Initiierung von effektiven
Therapien und deren notwendiger Intensivierung und bewirkt einen konstant schlecht
eingestellten Blutzuckerspiegel. Durch die neuartigen Behandlungsansätze mit inkretinbasierten
Therapeutika (GLP-1-Rezeptoragonisten und DPP-IV-Hemmer) lassen sich klinisch relevante
Hypoglykämien vermeiden. Insbesondere die GLP-1-Rezeptoragonisten bewirken zudem eine
effektive glykämische Kontrolle und bieten weiteren zusätzlichen Nutzen durch die
Reduktion des Körpergewichtes und die Verbesserung von Surrogatmarkern der β-Zellfunktion.
Damit bieten sie möglicherweise eine alternative Therapieoption zu den gängigen Therapien.
Exenatid war das erste zugelassene inkretinbasierte Medikament, das zu der Klasse
der GLP-1-Rezeptoragonisten gehört. Im Juli 2009 wurde mit Liraglutid ein weiterer
GLP-1-Rezeptoragonist in den deutschen Markt eingeführt. Ergebnisse aus dem Phase-3-Liraglutid-Studienprogramm
(LEAD), v. a. im Hinblick auf Hypoglykämien, sollen hier zusammengefasst werden.
Abstract
The most important aspect for the optimal choice of diabetes treatment is its capacity
for effective glycemic control and a low risk of hypoglycemia. However, approximately
40–50 % of patients do not reach the glycemic control target (HbA1c < 7 %) with the currently available treatment options. One of the reasons for this
is the fear of hypoglycemia which often occurs with conventional diabetes medications
such as sulfonylurea and insulin. This fear entails a reluctance to initiate or intensify
more effective therapies in a timely manner, resulting in prolonged periods of poor
glycemic control. The new incretin-based therapy of type 2 diabetes (GLP-1-receptor
agonists and DPP-4-inhibitors) avoids clinically relevant hypoglycaemia. Particularly,
GLP-1-receptor agonists are advantageous in terms of glycemic control, reduction of
body weight and β-cell function, and are therefore a useful alternative treatment
option to currently available therapies. Exenatide was the first approved GLP-1mimetic.
Since July 2009, another GLP-1 receptor agonist, liraglutide, was launched in Germany.
This article reviews results from the phase 3 liraglutide study program (LEAD), with
particular emphasis on hypoglycemia.
Schlüsselwörter
GLP-1-Rezeptoragonisten - Hypoglykämie - humanes GLP-1-Analogon - Liraglutid - HbA1c
Key words
GLP-1 receptor agonists - hypoglycemia - human GLP-1 analogue - liraglutide - HbA1c
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Professor Dr. W. Kern
MVZ Endokrinologikum Ulm
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