Blutzuckerkontrolle und Hypoglykämierisiko bei der Behandlung des Typ-2-Diabetes mit dem neuen GLP-1-Rezeptoragonisten Liraglutid

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 (HbA_1c < 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 (HbA_1c < 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 - HbA_1c

Key words

GLP-1 receptor agonists - hypoglycemia - human GLP-1 analogue - liraglutide - HbA_1c

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