Neue Entwicklungen in der Therapie des Diabetes mellitus Typ 2

Die rasante Entwicklung der Diabetesforschung hat viele neue Medikamente und Therapiestrategien auf den Weg gebracht, die das Potenzial haben, auch unabhängig von einer Diabeteserkrankung wirksam zu sein. So gibt es neue Erkenntnisse zu SGLT-2-Inhibitoren bei Herz- und chronischer Niereninsuffizienz. Auch die Weiterentwicklung inkretinbasierter Medikamente und duale GIP/GLP-1-Rezeptoragonisten sind vielversprechend.

Abstract

Diabetes mellitus has become a widespread disease worldwide. In recent years, there has been a rapid development of therapeutic options in the field of diabetology. Many new drugs and therapeutic strategies are now available or will be available in the near future, which have the potential to significantly improve the care of patients even if they do not have diabetes. In this article, we would like to present the latest therapeutic options and possible further applications. The article focuses, among other things, on the new findings of SGLT-2-inhibitors in cardiac and chronic renal failure and the further development of incretin-based drugs toward dual GIP/GLP-1-receptor agonists. Once-weekly insulin and the selective mineralocorticoid receptor antagonist finerenone will also be presented.

Schlüsselwörter

Diabetes mellitus Typ 2 - GLP-1- Rezeptoragonisten - SGLT-2-Inhibitoren - Insulin Icodec - Finerenon

Key words

type 2 diabetes mellitus - GLP-1 receptor agonist - SGLT-2-inhibitors - insulin icodec - finerenone

Publication History

Article published online:
11 May 2022

• Literatur

• 1 International Diabetes Federation IDF Diabetes Atlas. 9. Aufl.. Brüssel: IDF; 2019
• 2 Jacobs E, Hoyer A, Brinks R. et al. Burden of Mortality Attributable to Diagnosed Diabetes: A Nationwide Analysis Based on Claims Data From 65 Million People in Germany. Diabetes Care 2017; 40: 1703-1709 DOI: 10.2337/dc-17-0954.
• 3 Deutsche Diabetes Gesellschaft (DDG). Deutscher Gesundheitsbericht Diabetes. Berlin: DDG; 2021
• 4 Nichols GA, Gullion CM, Koro CE. et al. The incidence of congestive heart failure in type 2 diabetes: an update. Diabetes Care 2004; 27: 1879-1884 DOI: 10.2337/diacare.27.8.1879.
• 5 Go AS, Chertow GM, Fan D. et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351: 1296-1305 DOI: 10.1056/ NEJMoa041031.
• 6 Weckmann G, Stracke S, Chenot J. DEGAM S3-Leitlinie Nr. 22: Versorgung von Patienten mit chronischer nicht-dialysepflichtiger Nierenerkrankung in der Hausarztpraxis. AWMF-Register-Nr. 053-048. Stand: 2019
• 7 Wiviott S, Raz I, Bonaca MP. et al. Dapagliflozin and Cardiovascular outcomes in Type 2 Diabetes. N Engl J Med 2019; 380: 347-357 DOI: 10.1056/ NEJMc1902837.
• 8 Wanner C, Inzucchi SE, Lachin JM. et al. Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes. N Engl J Med 2016; 375: 323-334
• 9 Cannon CP, Pratley R, Dagogo-Jack S. et al. Cardiovascular Outcomes with Ertugliflozin in Type 2 Diabetes. N Engl J Med 2020; 383 (15) 1425-1435 DOI: 10.1056/NEJMoa2004967.
• 10 McMurray JJV, Solomon SD, Inzucchi SE. et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med 2019; 381: 1995-2008 DOI: 10.1056/ NEJMoa1911303.
• 11 Packer M, Anker SD, Butler J. et al. Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. N Engl J Med 2020; 383: 1413-1424 DOI: 10.1056/ NEJMoa2022190.
• 12 Anker SD, Butler J, Filippatos G. et al. Empagliflozin in Heart Failure with a Preserved Ejection Fraction. N Engl J Med 2021; 385: 1451-1461 DOI: 10.1056/NEJMoa2107038.
• 13 Heerspink HJ, Stefánsson BV, Correa-Rotter R. et al. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med 2019; 383: 1436-1446 DOI: 10.1056/ NEJMoa2024816.
• 14 Marso SP, Daniels GH, Brown-Frandsen K. et al. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2016; 375: 311-322 DOI: 10.1056/ NEJMoa1603827.
• 15 Gerstein GC, Colhoun HM, Dagenais GR. et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet 2019; 394: 121-130 DOI: 10.1016/ S0140-6736(19)31149-3.
• 16 Marso SP, Bain SC, Consoli A. et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med 2016; 375: 1834-1844 DOI: 10.1056/ NEJMoa1607141.
• 17 Pratley RE, Aroda VR, Lingvay I. et al. Semaglutide versus dulaglutide once weekly in patients with type 2 diabetes (SUSTAIN 7): a randomised, open-label, phase 3b trial. Lancet Diabetes Endocrinol 2018; 6 (04) 275-286 DOI: 10.1016/S2213-8587(18)30024-X.
• 18 Lingvay I, Bauer R, Baker-Knight J. et al An indirect treatment comparison of semaglutide 2.0 mg versus dulaglutide 3.0 mg and 4.5 mg using multi-level network meta-regression. J Clin Endocrinol Metab 2021; DOI: 10.1210/clinem/dgab905. . Online ahead of print
• 19 EMA. Rybelsus® Summary of Product Characteristics. Im Internet (Stand: 03.02.2022): https://www.ema.europa.eu/en/documents/product-information/rybelsus-epar-product-information_en.pdf
• 20 Eliaschewitz FG, Canani LH. Advances in GLP-1 treatment: focus on oral semaglutide. Diabetol Metab Syndr 2021; 13 (01) 99 DOI: 10.1186/s13098-021-00713-9.
• 21 Wilding JPH, Batterham RL, Calanna S. et al. Once-weekly Semaglutide in adults with oberweight or obesity. N Engl J Med 2021; 384: 989-1002 DOI: 10.1056/NEJMoa2032183.
• 22 Frias PJ, Davies MJ, Rosenstock J. et al. Tirzepatide versus semaglutide once weekly in patients with type 2 diabetes. N Engl J Med 2021; 385 (06) 503-515 DOI: 10.1056/NEJMoa2107519.
• 23 Lingvay I, Buse JB, Franek E. et al. A randomized, open-label Comparison of once-weekly Insulin Icodec Titration Strategies versus once-daily Insulin glargine U100. Diabetes Care 2021; 44 (07) 1595-1603 DOI: 10.2337/dc20-2878.
• 24 Bakris GL, Agarwal R, Anker SD. et al. Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes. N Engl J Med 2020; 383 (23) 2219-2229 DOI: 10.1056/ NEJMoa2025845.
• 25 Pitt B, Filippatos G, Agarwal R. et al. Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes. N Engl J Med 2021; 385: 2252-2263 DOI: 10.1056/NEJMoa2110956.
• 26 Harger A, Stemmer K, Tschöp MH. et al. Incretin-based co- and tri-agonists: Innovative pholypharmacology for the treatment of obesity and diabetes. Internist (Berl) 2019; 60 (09) 895-902 DOI: 10.1007/s00108-019-0649-9.
• 27 Ärztliche Zentrum für Qualität in der Medizin. Nationale Versorgunsleitlinie Typ-2-Diabetes, Leitlinienreport. 2. Aufl. AWMF-Register-Nr. nvl-001. Stand: 2021
• 28 Landgraf R, Aberle J, Birkenfeld AL. et al. Therapie des Typ-2-Diabetes. Diabetologie und Stoffwechsel 2021; 16 (Suppl. 02) S168-S206