Stellenwert der Insulinanaloga bei der Therapie von Menschen mit Typ-2-Diabetes

Zusammenfassung

Die Beurteilung des Stellenwertes der verschiedenen Insuline bei Typ 2 Diabetes mellitus ist für den Behandlungsalltag von grundlegender Bedeutung. Im Vergleich zu Humaninsulin fluten kurz wirksame Insulinanaloga schneller an und haben eine höhere Peakwirkung sowie eine kürzere Wirkdauer. Lang wirksame Insulinanaloga haben ein flacheres Wirkprofil und eine längere Wirkdauer als NPH-Insulin. In der Folge ermöglichen Insulinanaloga im Allgemeinen eine verbesserte glykämische Kontrolle. Außerdem sind Unterschiede im Bereich der Praktikabilität von Bedeutung (Spritz-Ess-Abstand und Zwischenmahlzeiten bei kurz wirksamen Insulinen sowie Durchmischen der Suspension und Anzahl der Injektionen bei lang wirksamen Insulinen). Die Konsequenzen für die klinische Praxis werden unterschiedlich beurteilt wie ein Verordnungsanteil von ca. 50 % für die Insulinanaloga in Deutschland im Vergleich zu ca. 90 % in bestimmten anderen europäischen Ländern zeigt. Das Fortbestehen von offenen Fragen ist im Wesentlichen auf das Fehlen von aussagekräftigen Langzeitstudien zu diabetesbezogenen Komplikationen zurückzuführen.

Abstract

Assessment of the significance of the different insulins used in type 2 diabetes mellitus is of fundamental importance for routine treatment. Compared with human insulin, rapid acting insulin analogues have a faster uptake and a higher peak effect as well as a shorter duration of action. Long acting insulin analogues have a flatter action profile and a longer duration of action than NPH insulin. Consequently, insulin analogues generally allow an improved glycaemic control to be achieved. Moreover, differences relating to practical aspects are of importance (snacks and interval between injection and meals in the case of short acting insulin as well as mixing of suspensions and number of injections in the case of long acting insulins). The consequences for clinical practice are seen differently by countries as shown by a prescription rate of 50 % for insulin analogues in Germany compared with approximately 90 % in certain other European countries. One of the main reasons why questions remain is the lack of meaningful long-term studies on diabetes-related complications.

Schlüsselwörter

Diabetes - Humaninsulin - Insulinanaloga - HbA_1c - Hypoglykämien - Körpergewicht

Keywords

diabetes - human insulin - insulin analogues - HbA_1c - hypoglycemia - body weight

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