Therapie mit GLP-1-Rezeptoragonisten bei Typ-2-Diabetes in speziellen Behandlungssituationen

Zusammenfassung

Inkretinbasierte antidiabetische Therapien ermöglichen eine wirksame glykämische Kontrolle bei vergleichsweise niedrigem Hypoglykämierisiko und günstiger Wirkung auf das Körpergewicht. Als Hormonderivate zeigen sie über den antihyperglykämischen Effekt hinausgehende Wirkungen auf verschiedene Organsysteme des Körpers und haben sich als fester Bestandteil im Behandlungskonzept bei Patienten mit Typ-2-Diabetes (T2DM) etabliert. Allerdings bestehen beim Einsatz bei Patienten verschiedener Risikogruppen, z. B. niereninsuffiziente Patienten, noch Unsicherheiten. Wenngleich limitiert, erlaubt die gegenwärtige Datenlage eine Einschätzung des Nutzen-Risiko-Verhältnisses GLP-1-basierter Therapien bei diesen Patienten. Dabei erweisen sich die Inkretinmimetika, besonders bei T2DM-Patienten mit kardiovaskulären Komorbiditäten und bei älteren T2DM-Patienten, als günstig. Bei Risikopatienten mit gastrointestinalen Komorbiditäten, mit Leberfunktionsstörungen und mit eingeschränkter Nierenfunktion sind sie bislang nur unter Vorbehalt anzuwenden. Bei Bestehen einer Pankreatitis oder manifester Pankreasproliferation ist aufgrund aktuell nicht vorhandener Sicherheitsdaten zu diesem Aspekt von einer inkretinbasierten Therapie abzusehen.

Abstract

Incretin-based antidiabetic therapies allow efficient glycemic control with a relatively low risk for hypoglycemia and a positive effect on body weight. As hormone derivatives these products exert functions in several organ systems. They have become a widely accepted therapeutic option in the treatment of type 2 diabetes. However, their routine clinical use is often associated with uncertainty when it comes to certain risk groups, such as patients with renal impairment. Although limited, current data allows a risk-benefit-analysis of GLP-1-based therapies for individual patient groups. Incretin mimetics proved beneficial especially in type 2 diabetes patients with cardiovascular comorbidities and in the elderly. In patients with gastrointestinal comorbidities and liver disease they should be used with caution. As safety data on incretin-based therapies in patients with confirmed pancreatitis or pancreas proliferation is currently missing, use in these patients is not recommended at present.

Schlüsselwörter

Typ-2-Diabetes - Inkretinmimetika - Risikopatientengruppen - GLP-1-Rezeptoragonisten

Key words

type 2 diabetes - incretin mimetics - risk patient groups - GLP-1-receptor agonists

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