Der Typ-2-Diabetes mellitus gehört zu den häufigsten chronisch-progressiven Krankheiten weltweit. Pathophysiologisch besteht eine Kombination aus Insulinresistenz- und Insulinsekretionsstörung, basierend auf hereditären und exogenen Faktoren. Interventionsstudien der letzten Jahre haben die Effektivität von diätetischen Maßnahmen und körperlicher Aktivität als blutzuckersenkende Basistherapie nachgewiesen. Ergänzend können orale Antidiabetika mit verschiedenen Wirkmechanismen eingesetzt werden.
Die aktuell in Deutschland verfügbaren Substanzen stimulieren entweder die endogene Insulinsekretion (Sulfonylharnstoffe, Meglitinide), hemmen die hepatische Glukoseproduktion (Metformin), vermindern die periphere Insulinresistenz (Thiazolidindione) oder reduzieren die intestinale Glukose-Aufnahme (Acarbose, Miglitol). Entsprechend dem individuellen Krankheitsverlauf können die unterschiedlichen Wirkprinzipien als Mono- oder Kombinationstherapie genutzt werden.
Type 2 diabetes mellitus is one of the most common chronic progressive diseases world-wide. The underlying pathophysiology is a combination of disturbed insulin resistance and insulin secretion, based on hereditary and exogenous factors. Interventional studies carried out in recent years have demonstrated the effectiveness or dietary measures and physical exercise as basic blood-sugar-lowering treatment. Oral antidiabetics with various active principles can be employed as additional measures. The substances currently available in Germany stimulate endogenous insulin secretion (sulfonylureas, meglitinide), inhibit the hepatic production of glucose (metformin), reduce peripheral insulin resistance (thiazolidindione) or reduce intestinal glucose uptake (acarbose, miglitol). Depending upon the course of the disease, the various active principles may be given as monotherapy or combination therapy.
Key words
Type 2 diabetes mellitus - dietary measures - physical exercise - oral antidiabetics
Literatur
-
1
Aas AM, Seljeflot I, Torjesen PA. et al. .
Blood glucose lowering by means of lifestyle intervention has different effects on adipokines as compared with insulin treatment in subjects with type 2 diabetes.
Diabetologia.
2006;
49
872-880
-
2
Boule NG, Haddad E, Kenny GP. et al. .
Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials.
JAMA.
2001;
286
1218-1227
-
3
Chiasson JL, Josse RG, Gomis R. et al. .
Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial.
Lancet.
2002;
359
2072-2077
-
4
Dansinger ML, Gleason JA, Griffith JL. et al. .
Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction: a randomized trial.
JAMA.
2005;
293
43-53
-
5 Deutsche Adipositas Gesellschaft. Leitlinie zur Therapie der Adipositas, Version 2006; www.adipositas-gesellschaft.de
-
6
Diabetes Prevention Program - DPP.
NEJM.
2002;
346
393-403
-
7
Dormandy JA, Charbonnel B, Eckland DJ. et al. .
Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive study: a randomised controlled trial.
Lancet.
2005;
366
1279-1289
-
8
The DREAM Trial Investigators.
Lancet.
2006;
368
1096-1105
-
9
Goodyear LJ, Kahn BB.
Exercise, glucose transport, and insulin sensitivity.
Annu Rev Med.
1998;
49
235-261
-
10
Hu FB, Manson JE, Stampfer MJ. et al. .
Diet, lifestyle, and the risk of type 2 diabetes mellitus in women.
NEJM.
2001;
345
790-797
-
11
Hu FB, Sigal RJ, Rich-Edwards JW. et al. .
Walking compared with vigorous physical activity and risk of type 2 diabetes in women: A prospective Study.
JAMA.
1999;
282
1433-1439
-
12
Kahn SE, Haffner SM, Heise MA. et al. .
Glycemic durability of rosiglitazon, metformin or glyburide monotherapy.
NEJM.
2006;
355
2427-2443
-
13
Klein S, Sheard NF, Pi-Sunyer X. et al. .
Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies.
Am J Clin Nutr.
2004;
80
257-263
-
14
Lindström J, Ilanne-Parikka P, Peltonen M. et al. .
Sustained reduction in the incidence of typ 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study.
Lancet.
2006;
368
1673-1679
-
15
Sigal GP RJ Kenny, Wasserman DH, Castaneda-Sceppa C.
Physical activity/exercise and type 2 diabetes.
Diabetes Care.
2004;
27
2518-2539
-
16 Toeller M. Evidenzbasierte Ernährungsempfehlungen. Diabetes und Stoffwechsel 2005: 14
-
17
Tuomilehto J, Lindstrom J, Eriksson JG. et al. .
Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.
NEJM.
2001;
344
1343-1350
-
18
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
-
19
UKPDS Group .
Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33).
Lancet.
1998;
352
837-853
Korrespondenz
Dr. med. Cornelia Jaursch-Hancke
Endokrinologie, Diabetologie und Stoffwechsel, Deutsche Klinik für Diagnostik
Aukammallee 31-33
65191 Wiesbaden
Fax: 0611/577666
Email: jaursch-hancke.end@dkd-wiesbaden.de
