Wann mit der intensivierten Insulintherapie beginnen? – Der BeAM-Wert zur besseren Abschätzung einer prandialen Insulintherapie bei Typ-2-Diabetes mellitus

Zusammenfassung

Der BeAM-Wert ist ein kumulatives Maß der postprandialen Hyperglykämie. Er lässt sich aus der Blutglukosekonzentration vor dem Zubettgehen (Be) und der darauf folgenden Nüchternglukose am Morgen (AM) errechnen. In zwei retrospektiven Auswertungen von Daten aus Phase-III- und -IV-Studien wurde der Nutzen des BeAM-Wertes als Entscheidungshilfe für den Beginn der intensivierten Insulintherapie bei Typ-2-Diabetes mellitus (T2DM) Patienten unter basalinsulinunterstützter oraler Therapie (BOT) dargelegt.

Bei Patienten, deren Therapie von einer oralen antidiabetischen Therapie (OAD) auf eine basalinsulinunterstützte orale Therapie umgestellt wird, steigen Ausmaß der postprandialen Hyperglykämie und der BeAM-Wert an bei gleichzeitig sinkendem HbA_1c-Wert und Nüchternglukose. Nach Umstellung auf eine intensivierte Insulintherapie fällt der BeAM-Wert und das Ausmaß der postprandialen Hyperglykämie geht zurück.

Insbesondere Patienten mit einem BeAM-Wert > 50 mg/dl profitieren von der Umstellung auf eine intensivierte Insulintherapie. Ein negativer BeAM-Wert spricht gegen den Einstieg in die prandiale Insulintherapie.

Abstract

The extent of postprandial hyperglycaemia may be adequately assessed using the BeAM value. This parameter is calculated from bedtime (Be) and morning (AM) glucose concentrations. Two retrospective analyses of Phase III and IV data revealed that the BeAM value is a valuable tool to support the decision when to initiate prandial insulin therapy in patients with type 2 diabetes mellitus (T2DM) receiving basal insulin and oral antidiabetic drug therapy (BOT).

When antidiabetic therapy is switched from oral antidiabetic drugs to BOT, fasting blood glucose and HbA1c improve but the extent of postprandial hyperglycaemia and the BeAM value increase. Further intensification of insulin therapy by addition of prandial insulin results in normalisation of postprandial glucose and decrease of the BeAM value.

Patients on BOT with BeAM values > 50 mg/dl most likely benefit from prandial insulin therapy, whereas those with a negative BeAM value do not.

Schlüsselwörter

Glargin - Glulisin - Typ-2-Diabetes - Prandiales Insulin - Basal-Plus

Key words

glargine - glulisine - Type 2 diabetes - prandial insulin - basal-plus

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