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DOI: 10.1055/s-0029-1220255
© Georg Thieme Verlag KG Stuttgart · New York
Herausforderung Diabetestherapie: Effekte der Glitazone jenseits der Blutzuckerkontrolle
Challenge in diabetes therapy: Effects of thiazolidinediones beyond blood glucose controlPublication History
eingereicht: 9.10.2008
akzeptiert: 2.4.2009
Publication Date:
21 April 2009 (online)
![](https://www.thieme-connect.de/media/dmw/200918/lookinside/thumbnails/10.1055-s-0029-1220255-1.jpg)
Zusammenfassung
Nicht erst mit den Ergebnissen von ACCORD, ADVANCE und VADT wird deutlich, dass eine antihyperglykämische Therapie allein nicht ausreicht, um das kardiovaskuläre Risiko von Typ-2-Diabetikern zu reduzieren. Viele Untersuchungen weisen vielmehr darauf hin, dass manche Therapiestrategien sogar kontraproduktiv sein können. Für eine adäquate Therapie des Typ-2-Diabetes müssen zudem die Komorbiditäten wie diabetische Dyslipidämie, Hypertonie oder Nephropathie berücksichtigt werden.
Glitazone verringern die Insulinresistenz und ermöglichen so eine pathophysiologisch orientierte Therapie des Typ-2-Diabetes mellitus. Aufgrund ihres Wirkprinzips zeigen Glitazone über die Blutzuckerkontrolle hinaus günstige Effekte auf inflammatorische und atherogene Parameter, den Blutdruck sowie die Mikroalbuminurie. Pioglitazon verbessert zudem die Dyslipidämie und reduziert Tod, Herzinfarkt und Schlaganfall bei Hochrisikopatienten. Unsicherheit bezüglich des kardiovaskulären Risikos besteht noch bei Rosiglitazon. Zahlreiche randomisierte, kontrollierte Studien dokumentieren die Wirksamkeit und Sicherheit der Glitazone und bilden die Grundlage für eine evidenzbasierte Therapie, die über die Blutzuckerkontrolle hinausgeht.
Summary
Not just since the results of ACCORD, ADVANCE and VADT were published, it is clear that lowering blood glucose alone does not reduce the cardiovascular risk of patients with type 2 diabetes. In fact, many studies also indicate that some treatment strategies may even have adverse effects. To treat type 2 diabetes appropriately, the co-morbidities such as diabetic dyslipidaemia, hypertension or nephropathy must also be taken into account.
Thiazolidinediones reduce insulin resistance thus allowing to direct the treatment of type 2 diabetes towards its pathophysiologic origin. Due to their mechanism of action, thiazolidinediones not only lower blood glucose but have also beneficial effects on inflammatory and atherogenic parameters, blood pressure and microalbuminuria. Furthermore pioglitazone improves dyslipidaemia and reduces mortality, myocardial infarction and stroke in high risk patients. Effects of rosiglitazone on the cardiovascular risk are yet unclear. Numerous studies document the efficacy and safety of thiazolidinediones and provide a basis for an evidence-based therapeutic approach beyond blood glucose control.
Schlüsselwörter
Typ-2-Diabetes - Pioglitazon - Rosiglitazon - orale Antidiabetika - Insulin - Evidenz - kardiovaskuläres Risiko - Komorbiditäten
Keywords
type 2 diabetes - pioglitazone - rosiglitazone - oral antidiabetic drugs - insulin - evidence - cardiovascular risk - comorbidities
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Prof. Dr. Guntram Schernthaner
Krankenanstalt Rudolfstiftung, 1. Medizinische
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