Personalisierte Diabetestherapie – Wo stehen wir heute?

Die personalisierte Medizin verfolgt das Ziel, individuelle Präventions- und Behandlungsstrategien anzuwenden, die speziell auf einen Patienten zugeschnitten sind. Grundlage dieses Konzepts ist die Identifikation von Genen und Biomarkern, die die Auswahl einer individualisierten Therapie ermöglichen. Der Typ-2-Diabetes mellitus ist eine sehr heterogene Erkrankung mit steigender Prävalenz. Sowohl für das Ansprechen auf eine Lebensstilintervention zur Prävention des Typ-2-Diabetes als auch für den Erfolg einer Therapie des Typ-2-Diabetes konnten Assoziationen mit genetischen Faktoren identifiziert werden. Genpolymorphismen, die einen Einfluss auf den Therapieerfolg haben, wurden beispielsweise bereits für die Behandlung mit Sulfonylharnstoffen, Biguaniden, Thiazolidinedionen und ACE (angiotensin converting enzyme)-Hemmern beschrieben. Um das langfristige Ziel der personalisierten Medizin, die Inzidenz des Typ-2-Diabetes durch erfolgreiche Prävention zu senken und die Patienten mit Typ-2-Diabetes optimal zu therapieren, erreichen zu können, ist jedoch noch eine intensive Grundlagen- und klinische Forschung notwendig. Auch müssen infrastrukturelle, personelle, ethische und finanzielle Barrieren überwunden werden, um eine individualisierte Medizin erfolgreich umzusetzen. Erste Erkenntnisse weisen darauf hin, dass eine Personalisierung einen großen Stellenwert in der Prävention und der Therapie des Typ-2-Diabetes erhalten könnte.

Personalized medicine aims to individualize prevention and treatment options. The concept is based on the identification of genes and biomarkers which allow choosing an individualized therapy. Type 2 diabetes mellitus (T2DM) is a very heterogeneous disease with an increasing prevalence. Associations were identified between genetic factors and the response to lifestyle interventions that aim to prevent T2DM as well as between genetic factors and the response to drug treatment. Gene polymorphisms that influence the treatment response were found for example for the treatment with sulfonylurea, biguanides, thiazolidinediones, and ACE (angiotensin converting enzyme)-inhibitors. Intense basic and clinical research is needed in order to reach the longitudinal aim of personalized medicine that comprises a reduction of the incidence of T2DM by successful diabetes prevention as well as an optimal therapy of the disease. In addition, personal, infrastructural, ethical and financial barriers need to be overcome for an implementation of an individualized medicine. Based on the initial findings, a personalization of the prevention and the therapy of T2DM could become increasingly important.

Key words

Type 2 diabetes mellitus - individualized therapy - gene polymorphism - lifestyle intervention

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