Der Diabetes mellitus zählt hierzulande inzwischen zu den führenden chronischen Volkskrankheiten.
Aufgrund der weiterhin steigenden Diabetesprävalenz in Deutschland und der Welt ergeben
sich besondere volkswirtschaftliche und gesundheitspolitische Ansprüche an die Optimierung
der Diabetestherapie. Die frühzeitige und optimale Stoffwechseleinstellung führt zu
einer Reduktion der diabetischen makro- und mikrovaskulären Folgeschäden und somit
auch zu einer Reduktion der dauerhaften Behandlungskosten. Die Deutsche Diabetesgesellschaft
empfiehlt beim Typ-2-Diabetes das Vorgehen nach einem Stufenschema, das zunächst eine
Lebensstiländerung, und nach Versagen dieser Maßnahme eine medikamentöse Therapie
und/oder eine Insulintherapie vorsieht. Als Standardtherapie des Diabetes mellitus
Typ 1 haben sich die Intensivierte konventionelle Insulintherapie (ICT) beziehungsweise
ihre Varianten (z.B. Insulinpumpentherapie-CSII) durchgesetzt. Im vorliegenden Beitrag
werden die einzelnen oralen Antidiabetika und die verschiedenen Insuline in ihrer
Wirkung, ihren Nebenwirkungen und Kontraindikationen vorgestellt sowie einzelne Therapiestrategien
erläutert.
Diabetes mellitus is by now one of the principal chronic national diseases. Due to
the continually growing prevalence of diabetes mellitus in Germany and also on a world
wide scale there is an increasing demand for optimizing the treatment of this disease
both from the viewpoint of national economy and health policy. Early and optimal metabolic
stabilisation reduces the macrovascular and microvascular consequences and hence also
permanent treatment expenses. The German Diabetes Association recommends in case of
type 2 diabetes to proceed by stages: first of all, the patient must change his mode
of life; if this first step fails, pharmacotherapy must be initiated and/or insulin
treatment. In case of type 1 diabetes the standard treatment is now Intensified Conventional
Insulin.Therapy (ICT) or one of its variations (eg CSII = using continuous insulin
infusion pumps). The following contribution introduces the individual oral antidiabetics
and the various insulin types, their effects, side effects and contraindications and
discusses and explains individual therapeutic strategies.
Key words
Type 1 diabetes - type 2 diabetes - non-pharmacological measures - HbA1c
- oral antidiabetics - insulin - non-insulinotropic substances
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Korrespondenz
Dr. med. Antje Preisler
Diabetes Zentrum Mergentheim
Theodor-Klotzbücher-Straße 12
97980 Bad Mergentheim
Fax: 07931/594-111
