Insulintherapie bei Typ-2-Diabetes – so früh wie möglich!

Zusammenfassung

Die Leitlinien der führenden nationalen und internationalen Diabetes-Fachgesellschaften ermöglichen den frühzeitigen Einsatz von Insulin bei der Behandlung des Typ-2-Diabetes, insbesondere bei stark erhöhtem HbA_1c oder wenn eine rasche Stoffwechselnormalisierung angestrebt wird. Der frühe Einsatz von Insulin, wie vor allem langwirksamen Analoginsulinen, erweist sich als effektiv und sicher. Eine kurzfristige aggressive Insulinbehandlung als Erstlinientherapie eines neu-diagnostizierten Typ-2-Diabetes kann zu einer anhaltenden Erholung der Betazellfunktion und Verbesserung der Insulinsensitivität führen.

Abstract

The guidelines of the leading national and international diabetes associations enable the early use of insulin in the treatment of type 2 diabetes, in particular, if HbA1c is markedly increased or a rapid metabolic normalisation is aspired. The early use of insulin, and particularly of long-acting insulin analogues, is effective and safe. A short-term aggressive insulin treatment as first-line therapy of a newly diagnosed type 2 diabetes has the potential to induce a prolonged recovery of beta-cell function and improvement of insulin sensitivity.

Schlüsselwörter

Typ-2-Diabetes - Insulin

Keywords

diabetes type 2 - insulin

• Literatur

• 1 Inzucchi SE, Bergenstal RM, Buse JB et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach. Diabetes Care 2015; 38: 140-149
• 2 UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837-853
• 3 Control Group, Turnbull FM, Abraira C, Anderson RJ. et al. Intensive glucose control and macrovascular outcomes in type 2 diabetes. Diabetologia 2009; 52: 2288-2298
• 4 Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, Byington RP. et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358: 2545-2559
• 5 Landgraf R, Kellerer M, Fach E et al. Praxisempfehlungen DDG/DGIM: Therapie des Typ-2-Diabetes. Diabetologie 2015; 10 (Suppl 2) S140-S151
• 6 Rubino A, McQuay L, Gough SC et al. Delayed initiation of subcutaneous insulin therapy after failure of oral glucose-lowering agents in patients with Type 2 diabetes: a population-based analysis in the UK. Diabet Med 2007; 24: 1412-1418
• 7 Fonseca V, Gill J, Zhou R et al. An analysis of early insulin glargine added to metformin with or without sulfonylurea: impact on glycaemic control and hypoglycaemia. Diabetes Obes Metab 2011; 13: 814-822
• 8 ORIGIN Trial Investigators, Gerstein HC, Bosch J, Dagenais GR. et al. Basal insulin and cardiovascular and other outcomes in dysglycemia. N Engl J Med 2012; 367: 319-328
• 9 Kramer CK, Zinman B, Retnakaran R. Short-term intensive insulin therapy in type 2 diabetes mellitus: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 2013; 1: 28-34
• 10 Li Y, Xu W, Liao Z et al. Induction of long-term glycemic control in newly diagnosed type 2 diabetic patients is associated with improvement of beta-cell function. Diabetes Care 2004; 27: 2597-2602