Verbesserung der Insulinsensitivität - Möglichkeiten und Grenzen der Pharmakotherapie

Zusammenfassung

Hintergrund Sprechen Zielorgane vermindert auf Insulin an, so spricht man von Insulinresistenz. Kann dieser Zustand von den pankreatischen β-Zellen über eine Mehrproduktion von Insulin nicht mehr kompensiert werden, so kann sich ein Diabetes mellitus Typ 2 entwickeln. Des Weiteren ist die Insulinresistenz selbst eigenständiger Risikofaktor für die Entwicklung kardiovaskulärer Erkrankungen. Goldstandard zur genauen Bewertung der Insulinsensitivität ist der euglykämische-hyperinsulinämische Glukose-Clamp, der in der klinischen Routine jedoch kaum Bedeutung besitzt. Ziel Dieser Artikel fasst medikamentöse Strategien in der Behandlung der Insulinresistenz zusammen und stellt sie konventionellen Therapieressourcen gegenüber. Ergebnisse Als Therapeutika stehen Metformin und Thiazolidindione zur Verfügung. Über Orlistat kann die Resorption von Fettsäuren und damit einer der wichtigsten Einflussfaktoren bei der Entwicklung der Insulinresistenz vermindert werden. Seit Neuestem bieten außerdem Modulatoren des Endocannabinoid- sowie des Inkretinsystems vielversprechende Ansätze zur Behandlung der Insulinresistenz. Schlussfolgerung Obgleich inzwischen vielfältige Medikamente zur Verbesserung der Insulinsensitivität zur Verfügung stehen, müssen zukünftige Studien zeigen, inwiefern diese besonders langfristig einen Vorteil gegenüber traditionellen Ansätzen darstellen.

Abstract

Background Insulin resistance is defined as diminished response of peripheral tissue towards insulin. If pancreatic β-cells cannot compensate this condition by means of an increase in insulin secretion, diabetes mellitus type 2 may develop. Furthermore, insulin resistance itself is a risk factor for cardiovascular complications. Gold standard for the assessment of insulin sensitivity is the euglycemic-hyperinsulinemic glucose clamp, which does not play a role in clinical routine, though. AIM This review provides an overview of pharmacological strategies in the treatment of insulin resistance and compares them to conventional therapy resources. Results Metformin and thiazolidinediones are able to improve insulin sensitivity. In addition, Orlistat decreases enteral resorption of fatty acids and through this mechanism influences insulin resistance. Lately, modulators of the endocannabinoid as well as incretin system have been developed and appear as promising new classes of antidiabetic agents. Conclusion Although several pharmacological agents have been developed to improve insulin sensitivity, future studies will have to evaluate their role in comparison to traditional therapy resources, especially as long-term effects are concerned.

Schlüsselwörter

Insulinresistenz - Diagnose - Therapie - Insulinsensitivität - Inkretine

Key words

insulin resistance - diagnosis - therapy - insulin sensitizer - incretins

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