Diabetes aktuell 2015; 13(06): 265-276
DOI: 10.1055/s-0041-107335
Schwerpunkt
© Georg Thieme Verlag Stuttgart · New York

Optionen zur Intensivierung einer Basalinsulintherapie bei Menschen mit Typ-2-Diabetes – Stellenwert der GLP-1-Rezeptoragonisten in der Kombinationstherapie

Options for Intensifying a Basal Insulin Therapy in Humans with Type 2 Diabetes – Significance of GLP-1 receptor agonists in combination therapy
B Gallwitz
1   Universitätsklinikum Tübingen, Medizinische Klinik IV, Tübingen
,
S Matthaei
2   Diabetes-Zentrum Quakenbrück, Fachabteilung für Diabetologie, Endokrinologie und Stoffwechsel am Christlichen Krankenhaus Quakenbrück, Quakenbrück
› Author Affiliations
Further Information

Publication History

Publication Date:
11 November 2015 (online)

Bei Menschen mit Typ-2-Diabetes, die eine mit Basalinsulin unterstützte orale Therapie (BOT) erhalten, entsteht häufig die Notwendigkeit zur weiteren Intensivierung der Therapie. In derartigen Situationen sind Glucagon-like-peptide-1-Rezeptoragonisten (GLP-1-RA) wegen ihrer sich ergänzenden Eigenschaften zu Insulin besonders gut für die Kombinationstherapie geeignet.

In der Gesamtschau von 10 randomisierten kontrollierten Studien wurden mit GLP-1-RA und kurz wirksamen Insulinen mindestens gleich gute HbA1c-Reduktionen erreicht. Einzelne Studien zeigen für GLP-1-RA Vorteile hinsichtlich einer um ca. 0,5–1,5mmol/l stärkeren Reduktion des Nüchternblutzuckers, weniger Hypoglykämien, einer deutlich günstigeren Gewichtsentwicklung, einer Reduktion des systolischen Blutdrucks um ca. 4–5mmHg. Dagegen können mit kurz wirksamen Insulinanaloga postprandiale Blutzuckerwerte gezielter beeinflusst und zur Förderung der Therapieadhärenz und -persistenz unerwünschte gastrointestinale Ereignisse zu Therapiebeginn vermieden werden. GLP-1-RA können die Therapieadhärenz im Vergleich zu kurz wirksamen Insulinanaloga verbessern durch Körpergewichtsreduktionen, weniger Hypoglykämien, eine geringe Komplexität der Behandlung und eine höhere Therapiezufriedenheit. Bei bestimmten Patienten mit Typ-2-Diabetes konnte im Verlauf die Insulindosis reduziert oder Insulin abgesetzt werden.

People with type 2 diabetes receiving a basal insulin therapy in combination with oral antidiabetic drugs (BOT) often develop the need for further intensification of treatment. In such situations, Glucagon-like peptide-1 receptor agonists (GLP-1-RA) are particularly suited for a combination treatment because their properties are complementary supportive to insulin.

GLP-1 RA and short-acting insulins achieved at least equivalent HbA1c reductions in the review of ten randomised controlled trials. Individual trials showed advantages for GLP-1 RA in terms of an approx. 0.5–1.5mmol/l greater reduction of fasting blood glucose, less episodes of hypoglycaemia, a clearly more favourable weight development, a reduction of systolic blood pressure by approx. 4–5mmHg. On the other hand, short-acting insulin analogues are able to affect postprandial blood glucose values more specifically and to avoid adverse gastrointestinal events at the start of treatment if compared to GLP-1 RA which helps to promote treatment adherence and persistence. GLP-1 RA can help to improve treatment adherence compared with short-acting insulin analogues by body weight reduction, less episodes of hypoglycaemia, a lower complexity of treatment as well as a higher treatment satisfaction. Specific patients with type 2 diabetes were able to reduce the insulin dose or discontinue insulin completely in the course of treatment.

 
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