Download PDF
Kardiologie up2date 2014; 10(04): 267-277
DOI: 10.1055/s-0034-1391238
Koronare Herzerkrankung und Atherosklerose
© Georg Thieme Verlag KG Stuttgart · New York

Orale Antidiabetika bei herzkranken Patienten

Baptist Gallwitz
Further Information

Publication History

Publication Date:
21 January 2015 (online)

Also available at
    Permissions and Reprints All articles of this category

Abstract

This article gives an overview on the treatment of patients with type 2 diabetes and heart diseases with oral antidiabetic agents. The stepwise treatment algorithm according to the guidelines for type 2 diabetes therapy is highlighted and the various groups of antidiabetic agents are introduced. Their indication and value in heart disease is discussed. Along these lines, the prevention of hypoglycaemia is an important treatment goal in patients with heart disease. Additional relevant concomit-ant diseases, planned invasive procedures as well as acute impairment of renal- and hepatic function have to be considered as well. Adverse events associated with oral antidiabetic drugs on the cardiovascular system should be avoided. A transient insulin therapy is therefore indicated in many patients with diabetes and acute phases of heart disease, especially in a hospital inpatient setting.

Kernaussagen

  • Ein vorrangiges Therapieziel der Diabetesbehandlung herzkranker Patienten liegt in der strikten Vermeidung von Hypoglykämien.

  • Bei der Auswahl der medikamentösen Therapieformen müssen auch relevante Begleiterkrankungen, anstehende invasive Eingriffe sowie akute Einschränkungen der Nieren- und Leberfunktion berücksichtigt werden.

  • Eine passagere Insulintherapie stellt bei vielen Patienten mit Diabetes und Akutphasen ihrer Herzerkrankung vor allem im Krankenhaus ein probates Mittel zur Blutzuckereinstellung dar.

 

  • Literatur

  • 1 American DiabetesAssociation. Standards of medical care in diabetes 2014. Diabetes Care 2014; 37 : 14-80
    CrossrefPubMedSearch in Google Scholar
  • 2 Inzucchi SE, Bergenstal RM, Buse JB et al. Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 2012; 55: 1577-1596
    CrossrefPubMedSearch in Google Scholar
  • 3 Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale Versorgungsleitlinie Therapie des Typ-2-Diabetes – Langfassung, 1. Auflage. Version 1.2013. Im Internet: http://www.versorgungsleitlinien.de/themen/diabetes2/dm2_Therapie (letzter Zugriff: 1.10.2014)
    PubMed
  • 4 UKPDS. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998; 352: 854-865
    CrossrefPubMedSearch in Google Scholar
  • 5 Breuer TG, Meier JJ. Inpatient treatment of type 2 diabetes. Dtsch Arztebl Int 2012; 109: 466-474
    PubMedSearch in Google Scholar
  • 6 Stumvoll M, Häring HU, Matthaei S. Metformin. Endocr Res 2007; 32: 39-57
    CrossrefPubMedSearch in Google Scholar
  • 7 Rote-Liste-Service-GmbH. Fachinformationsverzeichnis Deutschland. Im Internet: http://www.fachinfo.de (letzter Zugriff: 1.10.2014)
    PubMed
  • 8 Lipska KJ, Bailey CJ, Inzucchi SE. Use of metformin in the setting of mild-to-moderate renal insufficiency. Diabetes Care 2011; 34: 1431-1447
    CrossrefPubMedSearch in Google Scholar
  • 9 Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale Versorgungsleitlinie Nierenerkrankungen bei Diabetes im Erwachsenenalter – Kurzfassung Version 1.3.2011. Im Internet: http://www.deutsche-diabetes-gesellschaft.de/fileadmin/Redakteur/Leitlinien/Evidenzbasierte_Leitlinien/nvl-dm-nephro-kurz.pdf (letzter Zugriff: 1.10.2014)
    PubMed
  • 10 Zander JF, Risse A. Perioperative Behandlung und Einstellung des Diabetes mellitus. Orthopäde 2009; 38: 818-827
    CrossrefPubMedSearch in Google Scholar
  • 11 Deutsche Diabetes-Gesellschaft. Praxisempfehlungen Diabetesbehandlung im Krankenhaus. Diabetologie 2015; in press
    PubMedSearch in Google Scholar
  • 12 Senior PA. Type 2 diabetes, metformin and lactic acidosis-defining the risk and promoting safe practice. Diabet Med 2012; 29: 161-163
    CrossrefPubMedSearch in Google Scholar
  • 13 Eurich DT, Majumdar SR, McAlister FA et al. Improved clinical outcomes associated with metformin in patients with diabetes and heart failure. Diabetes Care 2005; 28: 2345-2351
    CrossrefPubMedSearch in Google Scholar
  • 14 McGill JB. Pharmacotherapy in type 2 diabetes: a functional schema for drug classification. Curr Diabetes Rev 2012; 8: 257-267
    CrossrefPubMedSearch in Google Scholar
  • 15 Bannister CA, Holden SE, Jenkins-Jones S et al. Can people with type 2 diabetes live longer than those without? A comparison of mortality in people initiated with metformin or sulphonylurea monotherapy and matched, non-diabetic controls. . Diabetes Obes Metab 2014;
    PubMedSearch in Google Scholar
  • 16 Schernthaner G. Diabetes and Cardiovascular Disease: Is intensive glucose control beneficial or deadly? Lessons from ACCORD, ADVANCE, VADT, UKPDS, PROactive, and NICE-SUGAR. . Wien Med Wochenschr 2010; 160: 8-19
    CrossrefPubMedSearch in Google Scholar
  • 17 Bell DS. Do sulfonylurea drugs increase the risk of cardiac events?. CMAJ 2006; 174: 185-186
    CrossrefPubMedSearch in Google Scholar
  • 18 Meier JJ, Gallwitz B, Schmidt WE et al. Is impairment of ischaemic preconditioning by sulfonylurea drugs clinically important?. Heart 2004; 90: 9-12
    CrossrefPubMedSearch in Google Scholar
  • 19 Siegel E, Schröder F, Kunder J et al. Medikamente. In: Siegel E, Schröder F, Kunder J, Dreyer M, (Hrsg.). Diabetes mellitus XXS pocket. Grünwald: Börm Bruckmeier; 2011: 93-116
    Search in Google Scholar
  • 20 Bennett WL, Maruthur NM, Singh S et al. Comparative effectiveness and safety of medications for type 2 diabetes: an update including new drugs and 2-drug combinations. Ann Intern Med 2011; 154: 602-613
    CrossrefPubMedSearch in Google Scholar
  • 21 Gallwitz B. Small molecule dipeptidylpeptidase IV inhibitors under investigation for diabetes mellitus therapy. Expert Opin Investig Drugs 2011; 20: 723-732
    CrossrefPubMedSearch in Google Scholar
  • 22 Scirica BM, Bhatt DL, Braunwald E et al. SAVOR-TIMI 53 Steering Committee and Investigators. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med 2013; 369: 1317-1326
    CrossrefPubMedSearch in Google Scholar
  • 23 White WB, Cannon CP, Heller SR et al. EXAMINE Investigators. Alogliptin after acute coronary syndrome in patients with type 2 diabetes. . N Engl J Med 2013; 369: 1327-1335
    CrossrefPubMedSearch in Google Scholar
  • 24 Scirica BM, Braunwald E, Raz I et al. for the SAVOR-TIMI 53 Steering Committee and Investigators. Heart Failure, Saxagliptin and Diabetes Mellitus: Observations from the SAVOR – TIMI 53 Randomized Trial. Circulation 2014; pii: CIRCULATIONAHA.114.010389
    PubMedSearch in Google Scholar
  • 25 Rosenstock J, Marx N, Kahn SE et al. Cardiovascular outcome trials in type 2 diabetes and the sulphonylurea controversy: rationale for the active-comparator CAROLINA trial. Diab Vasc Dis Res 2013; 10: 289-301
    CrossrefPubMedSearch in Google Scholar
  • 26 Nauck MA. Update on developments with SGLT2 inhibitors in the management of type 2 diabetes. Drug Des Devel Ther 2014; 8: 1335-1380
    PubMedSearch in Google Scholar
  • 27 Clement S, Braithwaite SS, Magee MF et al. American Diabetes Association Diabetes in Hospitals Writing Committee. Management of diabetes and hyperglycemia in hospitals. Diabetes Care 2004; 27: 553-591
    PubMedSearch in Google Scholar