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DOI: 10.1055/s-0037-1618661
Antidiabetische Therapie und Gewichtskontrolle
Antidiabetic treatment and weight controlPublikationsverlauf
Publikationsdatum:
21. Dezember 2017 (online)
Zusammenfassung
Mehr als 90 Prozent der Menschen mit Typ-2-Diabetes sind übergewichtig und adipös. Hieraus ergibt sich der Rat zu einer Lebensstilmodifikation mit energiereduzierter Ernährung und vermehrter körperlicher Bewegung, um über eine Gewichtsreduktion die Stoffwechsellage günstig zu beeinflussen. Gelingt das nicht, ist eine antidiabetische Pharmakotherapie erforderlich. Leider führen etliche der dabei verordneten Präparate zu einer signifikanten Gewichtszunahme. Dieses gilt für Sulfonylharnstoffe, Glinide, Glitazone und insbesondere auch Insulin. Andere Präparate, wie Metformin, Acarbose, DPP-4-Hemmer oder Inkretin-Mimetika haben einen eher günstigen Effekt auf das Körpergewicht und können zum Teil sogar eine Gewichtsabnahme begünstigen. Mehr als bisher sollte die Entwicklung des Körpergewichts in Planung und Auswahl antidiabetischer Therapiestrategien einbezogen werden.
Summary
More than 90 % of all type 2 diabetic patients are overweight or obese. Therefore, advice for lifestyle modification with a hypocaloric diet and increased physical activity is given to these patients in order to improve metabolism via a moderate weight loss. If this strategy does not succeed, an antidiabetic pharmacotherapy is needed. Unfortunately, numerous antidiabetic compounds result in significant weight gain, for which a variety of different mechanisms can be identified. Weight gain is a side effect of treatment with sulfonylureas, rapid-acting insulin secretagogues (glinides), glitazones and especially insulin. In contrast, metformin, acarbose, DPP-4-inhibitors and incretin mimetics have a more favourable effect on body weight and can even promote weight loss. The effect on body weight should more than before be included in the design of the individual antidiabetic treatment strategy
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Literatur
- 1 United Kingdom Prospective Diabetes Study (UKPDS) Group. Relative efficacy of randomly allocated diet, sulphonylurea, insulin, or metformin in patients with newly diagnosed non-insulin dependent diabetes followed for three years (UKPDS 13). BMJ 1995; 310: 83-88.2.
- 2 The DCCT Research Group. Weight gain associated with intensive therapy in the diabetes control and complications trial. Diabetes Care 1988; 11: 567-573.
- 3 The Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358: 2545-2559.
- 4 Hamann A. Entwicklung des Körpergewichs unter antidiabetischer Therapie. Dtsch Med Wochenschr 2006; 131 (Suppl. 08) S255-S258.
- 5 United Kingdom Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998; 352: 854-865.
- 6 Knowler WC, Barrett-Connor E, Fowler SE. et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393-403.
- 7 Levri KM, Slaymaker E, Last A. et al. Metformin as treatment for overweight and obese adults: a systematic review. Ann Fam Med 2005; 03: 457-461.
- 8 van de Laar FA, Lucassen PL, Akkermans RP. et al. Alpha-glucosidase inhibitors for patients with type 2 diabetes: results from a Cochrane systematic review and meta-analysis. Diabetes Care 2005; 28: 154-163.
- 9 Kahn SE, Haffner SM, Heise MA. et al. Glycemic durability of rosiglitazone, metformin or glyburide monotherapy. N Engl J Med 2005; 355: 2427-2443.
- 10 Dormandy JA, Charbonnel B, Eckland DJ. et al. Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macro-Vascular Events): a randomised controlled trial. Lancet 2005; 366: 1279-1289.
- 11 Hamann A, Garcia-Puig J, Paul G. et al. Comparison of fixed-dose rosiglitazone/metformin combination therapy with sulfonylurea plus metformin in overweight individuals with type 2 diabetes inadequately controlled on metformin alone. Exp Clin Endocrinol Diabetes 2008; 116: 6-13.
- 12 Martin S, Kolb H, Beuth J. et al. Change in patients body weight after 12 months of treatment with glimepiride or glibenclamide in Type 2 diabetes: a multicentre retrospective cohort study. Diabetologia 2003; 46: 1611-1617.
- 13 Rosenstock J, Hassman DR, Madder RD. et al. Repaglinide versus nateglinide monotherapy: a randomized, multicenter study. Diabetes Care 2004; 27: 1265-1270.
- 14 Pi-Sunyer FX. The effects of pharmacological agents for type 2 diabetes mellitus on body weight. Postgrad Med 2008; 120: 5-17.
- 15 Nauck MA, Meininger G, Sheng D. et al. Efficacy and safety of the dipeptidyl peptidase-4 inhibitor, sitagliptin, compared with the sulfonylurea, glipizide, in patients with type 2 diabetes inadequately controlled on metformin alone: a randomized, double-blind, non-inferiority trial. Diabetes Obes Metab 2007; 09: 194-205.
- 16 Goudswaard AN, Furlong NJ, Rutten GE. et al. Insulin monotherapy versus combinations of insulin with oral hypoglycaemic agents in patients with type 2 diabetes mellitus. Cochrane Database Syst Rev 2004; CD003418.
- 17 Holman RR, Thorne KI, Farmer AJ. et al. Addition of biphasic, prandial, or basal insulin to oral therapy in type 2 diabetes. N Engl J Med 2007; 357: 1716-1730.
- 18 Bretzel RG, Nuber U, Landgraf W. et al. Once-daily basal insulin glargine versus thrice-daily prandial insulin lispro in people with type 2 diabetes on oral hypoglycemic agents (APOLLO): an open randomised controlled trial. Lancet 2008; 371: 1073-1084.
- 19 Bazzano LA, Lee LJ, Shi L. et al. Safety and efficacy of glargine compared with NPH insulin for the treatment of type 2 diabetes: a meta-analysis of randomized controlled trials. Diabetes Med 2008; 25: 924-932.
- 20 Rosenstock J, Davies M, Home PD. et al. A randomised, 52-week, treat-to-target trial comparing insulin detemir with insulin glargine when administered as add-on to glucose lowering drugs in insulin-naive people with type 2 diabetes. Diabetologia 2008; 51: 408-416.