Orale Antidiabetika – Welche Kombinationen sind bei Typ-2-Diabetes sinnvoll?

Nationale und internationale Leitlinien zur antihyperglykämischen Therapie des Typ-2-Diabetes empfehlen ein stufenweises Vorgehen. Am Anfang einer solchen Therapie stehen Basismaßnahmen wie Diabetesschulung und allgemeine Anleitungen zu einem gesunden Lebensstil. Entweder gleichzeitig oder zu einem späteren Zeitpunkt (je nach diabetischer Stoffwechselentgleisung und Ansprechen der Basismaßnahmen) werden orale Antidiabetika eingesetzt. Hier beginnt man in der Regel mit einer Monotherapie und kombiniert später je nach Krankheitsstadium unterschiedliche orale Antidiabetika mit oder ohne Insulin. Der Einsatz von oralen Antidiabetika, die Kombination unterschiedlicher Stoffklassen und Insulininjektionen sind im Verlauf des Typ-2-Diabetes meist unausweichlich, da es sich hierbei um eine fortschreitende Erkrankung handelt.

National and international guidelines on antihyperglycemic therapy for type 2 diabetes recommend a stepwise procedure. At the start of such a therapy are the basic measures such as diabetes training and general guidelines for a healthy life-style. Either simultaneously or at a later stage (depending on the extent of metabolic dysfunction and response to the basic measures) oral antidiabetic agents are administered. As a rule one starts with a monotherapy and later, depending on the disease stage, combines this with other oral antidiabetic agents with or without insulin. The use of oral antidiabetic agents, the combination of different substance classes and the injection of insulin are usually inevitable in the course of type 2 diabetes because it is a progressive disease. Type 2 diabetes develops mainly from insulin resistance, loss of beta cell mass and defects of insulin secretion. These disorders are caused by an interaction of genetic factors and an increase of visceral fat. The continuous decrease of beta cell mass and function forms the pathophysiological background for the fact that, with progressing course of type 2 diabetes, a monotherapy is no longer adequate and that combination with other oral antidiabetic agents or insulin becomes necessary.

Key words

type 2 diabetes - insulin resistance - beta cell mass - beta cell function - oral antidiabetic agents - insulin

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