GLP-1-Rezeptoragonisten in der Therapie des Typ-2-Diabetes

Zusammenfassung

Glucagon-like-Peptide-1 (GLP-1)-Rezeptoragonisten sind in der Therapie des Diabetes mellitus Typ 2 zunehmend etabliert. Diese Inkretin-basierten Arzneimittel wirken über die Aktivierung von GLP-1-Rezeptoren. Sie wirken streng Glukose-abhängig insulinotrop und glukagonostatisch und ermöglichen eine effiziente Senkung des HbA1c-Werts bei gleichzeitig geringem Hypoglykämierisiko. Darüber hinaus vermitteln sie über zentralnervöse Mechanismen eine Reduktion des Körpergewichts. Die derzeit zugelassenen sechs GLP-1-Rezeptoragonisten weisen unterschiedliche strukturelle und pharmakokinetische Eigenschaften auf, die eine Unterteilung in kurzwirksame und langwirksame Präparate erlauben. Direkte Vergleichsstudien dieser Substanzen konnten Unterschiede und Gemeinsamkeiten hinsichtlich zentraler therapeutischer Parameter wie der Blutzuckereinstellung, des Hypoglykämierisikos, der Auswirkungen der Therapie auf das Körpergewicht und Substanz-spezifischer Nebenwirkungen herausarbeiten. Diese Ergebnisse können dem Diabetologen dabei helfen, unter sorgfältiger Nutzen-Risiko-Abwägung Präferenzen im Sinne eines individualisierten Therapieansatzes zu definieren.

Abstract

Glucagon-like-peptide-1 (GLP-1) receptor agonists are now established as an integral option for the treatment of type 2 diabetes. These incretin-based substances activate specific GLP-1 receptors, and provide insulinotropic and glucagonostatic actions in a strictly glucose-dependent manner, thus allowing effective control of HbA_1c levels with a low risk of hypoglycemia. Moreover, they contribute to weight reduction through actions in the brain. Currently there are six GLP-1 receptor agonists approved in Germany. They demonstrate different structural and pharmacokinetic properties and can be grouped into long-acting and short-acting substances. Several head-to-head trials have revealed differences and similarities regarding key therapeutic parameters such as glycemic control, risk of hypoglycemia, effect on body weight and substance-specific side effects. These results can provide helpful support for the diabetologist in defining preferences for an individualized therapeutic approach, based on a careful risk-benefit-analysis.

Schlüsselwörter

Diabetes mellitus Typ 2 - GLP-1-Rezeptoragonisten - Pharmakokinetik - Head-to-Head-Studien

Key words

type 2 Diabetes - GLP-1 receptor agonists - pharmacokinetics - head-to-head trials

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