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Dtsch Med Wochenschr 2009; 134(18): 949-954
DOI: 10.1055/s-0029-1220255
Konsensus | Review article
Diabetologie, Pharmakotherapie
© 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 controlG. Schernthaner1 , T. Forst2 , D. Gulba3 , W. Haberbosch4 , M. Hanefeld5 , G. Linß6 , W. März7 , H. Mehnert8 , C. Rosak9 , O. Schnell8 , J. Seufert10 , D. Tschöpe11 , E. Erdmann12
  • 11. Medizinische Abteilung, Krankenanstalt Rudolfstiftung, Wien
  • 2Institut für klinische Forschung und Entwicklung GmbH, Mainz
  • 3Kardiologie, Angiologie und Pulmologie, Innere Medizin I, Krankenhaus Düren GmbH
  • 4Klinik für Innere Medizin I, SRH Zentralklinikum Suhl GmbH
  • 5Forschungsbereich Endokrinologie und Stoffwechsel, Zentrum für Klinische Studien, GWT-TUD mbH, Dresden
  • 6Praxis für Kardiologie und Hypertensiologie, Oranienburg
  • 7Synlab Heidelberg, Medizinisches Versorgungszentrum für Labordiagnostik, Eppelheim
  • 8Institut für Diabetesforschung, München
  • 9Diabetologie, Krankenhaus Sachsenhausen des Deutschen Gemeinschafts-Diakonieverbandes GmbH, Frankfurt am Main
  • 10Schwerpunkt Endokrinologie und Diabetologie, Abteilung Innere Medizin II, Universitätsklinikum Freiburg
  • 11Herz- und Diabeteszentrum NRW, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen
  • 12Klinik III für Innere Medizin, Klinikum der Universität zu Köln
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Publikationsverlauf

eingereicht: 9.10.2008

akzeptiert: 2.4.2009

Publikationsdatum:
21. April 2009 (online)

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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 Abteilung

Juchgasse 25

A-1030 Wien

Telefon: 0043/1711 65–2108

Fax: 0043/1711 65–2109

eMail: guntram.schernthaner@meduniwien.ac.at