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
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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
Korrespondenz
Prof. Dr. Markolf Hanefeld
Zentrum für Klinische Studien, Forschungsbereich Endokrinologie und Stoffwechsel,
GWT, Technische Universität Dresden GmbH,
Fiedlerstraße 34
01307 Dresden
Email: hanefeld@gwtonline-zks.de
