Therapeutische Optionen bei Typ 1-Diabetes

Zusammenfassung

Therapie der Wahl ist bei Patienten mit Typ 1-Diabetes eine Insulintherapie mit Nachahmung der physiologischen Insulinsekretion mit dem Basis-Bolus Prinzip. Dieses wird entweder mit der intensivierten konventionellen Insulintherapie oder Insulinpumpentherapie umgesetzt (ICT bzw. CSII). Ziel ist das Erreichen normnaher Blutzuckerwerte. Neue Insulinanaloga unterstützen das Erreichen dieses Ziels, eine gute Schulung des Patienten bildet die Basis der Behandlung. Gegenüber der konventionellen Therapie mit Mischinsulin (CT) konnte in der DCCT-Studie für die ICT eine Reduktion der diabetischen Folgeerkrankungen beobachtet werden. In der Zukunft werden auch präventive Strategien bei Manifestation mit dem Ziel des Erhaltes der C-Peptid-Reserve an Bedeutung gewinnen, da hierdurch die Folgeerkrankungen verringert werden können.

Summary

The treatment aim in type 1 diabetes is to mimic the physiological insulin release by multiple injection therapy. Therefore, intensified conventional or insulin pump therapy with multiple insulin injections is used (ICT or CSII). These therapies aim to reach near normal blood glucose levels. New insulin analogues and structured patient education improved the therapeutic results. The DCCT showed a significant reduction of microvascular complications through ICT in comparison to conventional therapy (CT) with two injections of premixed insulin. It has been shown that preserving the beta cell reserve reduces complications of type 1 diabetes. Therefore, in future C-peptid preserving therapies will probably be important.

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