Inkretin-basierte Therapie: ein ergänzender Therapieansatz bei Patienten mit Typ-1-Diabetes?

Zusammenfassung

Menschen mit Typ-1-Diabetes (T1 D) leiden unter einem absoluten Insulinmangel, resultierend aus einem chronischen Autoimmunangriff auf pankreatische β-Zellen. Zudem liegt eine Dysregulation der sekretorischen Aktivität von Glucagon in pankreatischen α-Zellen vor. Trotz der zwingenden, intensivierten Insulintherapie ist die Kontrolle des Blutzuckers bei T1 D oft unzureichend und birgt ein Hypoglykämierisiko für die Patienten. Als fester Bestandteil der Therapie des Typ-2-Diabetes (T2 D) etablierten sich in den letzten Jahren Inkretin-basierte Wirkstoffe, die GLP-1 Rezeptor-Agonisten (GLP-1 RA) und Dipeptidyl-Peptidase-IV(DPP-IV)-Hemmer. Untersuchungen lassen nun auch auf einen positiven therapeutischen Nutzen bei der Behandlung von Patienten mit T1 D schließen. So deuten bisherige Studien darauf hin, dass der durch GLP-1 RA hervorgerufene glykämische Effekt bei T1 D durch eine Hemmung der sekretorischen Aktivität der α-Zellen und durch den inhibitorischen Effekt auf die Nährstoffaufnahme verursacht wird.

Abstract

People suffering from type 1 diabetes (T1 D) show absolute insulin deficiency due to a chronic autoimmune attack on pancreatic β-cells. In addition glucagon secretion in pancreatic α cells is dysregulated. Although treatment of T1 D demands intensified insulin therapy, control of blood glucose is often insufficient and patients are frequently at risk of hypoglycemia. In type 2 diabetes T2 D incretin-based substances, GLP-1 receptor agonists (GLP-1 RA) and dipeptidyl-peptidase-IV(DDP-IV)-inhibitors play an important therapeutic role. Current results from clinical trials with this class of drugs indicate a potential therapeutic benefit also for patients with T1 D. Recent findings indicate that the glycoregulatory effect of GLP-1 RA in T1 D results from inhibition of α cell secretory activity, as well as suppression of caloric uptake.

Schlüsselwörter

Typ-1-Diabetes - Inkretin - GLP-1 Rezeptor-Agonisten - Dipeptidyl-Peptidase-IV-Inhibitor

Key words

type 1 diabetes - incretin - GLP-1 receptor agonist - dipeptidyl-peptidase-IV-inhibitor

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