Antidiabetische Therapie und kardiovaskuläre Prognose

Insulin, Metformin und Sulfonylharnstoffe gelten als etablierte Substanzen zur Therapie des Diabetes mellitus Typ 2. Die verfügbaren wissenschaftlichen Daten zu kardiovaskulären Effekten dieser Substanzen sind jedoch lückenhaft. Während für Metformin ein kardiovaskulär protektiver Effekt angenommen wird, sind die kardiovaskulären Effekte von Insulin und Sulfonylharnstoffen Gegenstand kontroverser Diskussionen. Zahlreiche neue Medikamente wie DPP-4-Inhibitoren, GLP-1-Rezeptoragonisten und SGLT2-Inhibitoren wurden in den vergangenen Jahren für die Therapie des Diabetes mellitus zugelassen und haben das Spektrum der pharmakologischen Interventionsmöglichkeiten erheblich erweitert. Inzwischen liegen für einige Medikamente dieser Substanzklassen erste positive Endpunktstudien vor, die kardioprotektive Eigenschaften belegen.

Even if the scientific evidence about cardiovascular effects of insulin, metformin and sulfonylurea is weak, these drugs are considered as the best established pharmacological treatments for patients with diabetes mellitus type 2. While metformin is widely perceived as a drug with cardioprotective effects, insulin and sulfonylurea are the topic of controversial debates. Recently, numerous new drugs like DPP-4 inhibitors, GLP-1 receptor agonists and SGLT-2 inhibitors have been approved for the treatment of diabetes mellitus type 2. With them the pharmacological armamentarium for the treatment of type 2 diabetes mellitus has been markedly expanded. Recently, first studies reported a positive cardiovascular outcome with some of the new molecules.

Key words

cardiovascular effects - insulin - metformin - sulfonylurea - DPP-4 inhibitor - GLP-1 receptor agonist - SGLT2 inhibitor

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