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Diabetes aktuell 2014; 12(6): 270-274
DOI: 10.1055/s-0034-1396346
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© Georg Thieme Verlag Stuttgart · New York

Neue therapeutische Option bei der Behandlung des Diabetes mellitus – SGLT-2-Inhibitoren

New therapeutic option in the treatment of diabetes mellitus – SGLT-2 inhibitors
Stephan Martin
1   Verbund der Katholischen Kliniken Düsseldorf (VKKD), Westdeutsches Diabetes- und Gesundheitszentrum (WDGZ), Düsseldorf
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Publication Date:
18 November 2014 (online)

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Die Niere ist ganz wesentlich an der Glukosehomöostase beteiligt. Diese Erkenntnis hat dazu beigetragen, ein innovatives Therapiekonzept zur Reduktion der Blutglukose zu entwickeln. Dieses basiert auf der Inhibition der durch SGLT-2 vermittelten Glukoserückresorption in der Niere. Dieser neuartige, insulinunabhängige Mechanismus ist unabhängig vom Krankheitsstadium mit anderen Antidiabetika einschließlich Insulin kombinierbar. Die Vielzahl an publizierten Arbeiten zeigen, dass über Studienzeiträume von bis zu 2 Jahren anhaltende HbA1c-Senkung bei gleichzeitiger Gewichtsabnahme nachweisbar sind. Die wesentlichen Nebenwirkungen sind eine erhöhte Rate an Harnwegs- bzw. Genitalinfektionen. Ob die Erhöhung der LDL- und HDL-Cholesterinwerte bei unverändertem HDL / LDL-Quotienten eine klinische Bedeutung haben, werden die laufenden Endpunktstudien zeigen. Die leichte diuretische Wirkung der SGLT-2-Inhibitoren wirkt sich positiv auf die Blutdruckeinstellung aus, jedoch sollte diese Substanzklasse daher nicht bei Hypovolämie-gefährdeten Patienten eingesetzt werden.

The kidneys play a major role in glucose homeostasis. This finding has contributed to the development of an innovative therapeutic concept for the reduction of blood glucose levels. This is based on the inhibition of the reabsorption of glucose in the kidneys mediated by SGLT-2. This novel, insulin-independent mechanism can be combined with other antidiabetic agents including insulin irrespective of the stage of the disease. The many published reports show that over an observation period of up to 2 years a persisting reduction of the HbA1c level with concomitant loss of weight is realizable. The major side effects are increased rates of urinary or, respectively, genital infections. Whether or not the elevated LDL and HDL cholesterol levels with unchanged HDL/LDL ratios are of clinical relevance will be revealed by the ongoing end-point trials. The mild diuretic action of SGLT-2 inhibitors has a positive effect on the control of blood pressure, however, this class of substances should not be administered to patients at risk for hypovolemia.

Key words

Type 2 diabetes - kidney - SGLT-2 inhibitors - insulin-indepent mechanism
 

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