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Update Typ-2-Diabetes

Update on type 2 diabetes

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Der Diabetologe Aims and scope

Zusammenfassung

Die wichtigsten neuen Erkenntnisse zur Diagnostik und Therapie des Typ-2-Diabetes 2019/2020 werden aufgezeigt. Eine erstmals 2018 von einer schwedischen Arbeitsgruppe postulierte Zuordnung von Patienten mit neu diagnostiziertem Diabetes im Erwachsenenalter zu 5 verschiedenen Clustern lässt sich auch auf andere Patientenkollektive übertragen. In der CAROLINA-Studie wurde die kardiovaskuläre Sicherheit des Sulfonylharnstoffs Glimepirid im direkten Vergleich zum DPP-4-Hemmer (DPP: Dipeptidylpeptidase) Linagliptin nachgewiesen. In der REWIND-Studie wurde die Überlegenheit des GLP-1-Rezeptoragonisten Dulaglutid im Hinblick auf den primären Endpunkt festgestellt, während in der PIONEER-6-Studie mit oralem Semaglutid kardiovaskuläre Sicherheit nachgewiesen wurde. Für den SGLT-2-Inhibitor (SGLT-2: „sodium dependent glucose transporter 2“) Canagliflozin wurde in der CREDENCE-Studie ein nephroprotektiver Effekt über ein breites Spektrum der eGFR (geschätzte glomeruläre Filtration) und unabhängig vom HbA1c (Glykohämoglobin Typ A1c) bei Studienbeginn gezeigt. Diese und weitere Studiendaten gingen in ein aktuelles Update des Konsensusreports von ADA („American Diabetes Association“) und EASD („European Association for the Study of Diabetes“) als aktuell wichtigster Leitlinie zur Therapie des Typ-2-Diabetes ein, welches wesentliche Änderungen für die Behandlung von Diabetespatienten mit atherosklerotischer kardiovaskulärer Erkrankung bzw. einem erhöhten Risiko hierfür sowie mit Herzinsuffizienz und/oder chronischer Nierenerkrankung beinhaltet.

Abstract

The most important advances in 2019/2020 in the diagnosis and therapy of type 2 diabetes (T2D) are discussed. Novel subgroups of patients with adult-onset diabetes first identified by a Swedish group in 2018 were verified in additional cohorts. Cardiovascular safety of the sulfonylurea compound glimepiride was demonstrated in the CAROLINA trial in direct comparison to the DPP4 (dipeptidylpeptidase 4) inhibitor linagliptin. In the REWIND trial, the GLP‑1 (glucagon-like peptide 1) receptor agonist dulaglutide was shown to reduce the primary cardiovascular endpoint significantly, thereby being superior compared to placebo. In the PIONEER‑6 trial, oral semaglutide demonstrated cardiovascular safety compared to placebo. In the CREDENCE trial, a beneficial effect of the SGLT2 (sodium dependent glucose transporter 2) inhibitor canagliflozin for the primary endpoint and kidney function was shown over a broad spectrum of eGFRs (estimated glomerular filtration rates) and independent of HbA1c (glycohemoglobin type A1c) at baseline. These and other study data had a marked impact on an update of the ADA (American Diabetes Association) and EASD (European Association for the Study of Diabetes) consensus report, which is currently our most important clinical guideline for the therapy of type 2 diabetes. Important changes compared to the previous version were made for diabetes patients with atherosclerotic cardiovascular disease or high cardiovascular risk as well as heart failure and/or chronic kidney disease.

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Abb. 1

Abbreviations

95 %-KI:

95 %-Konfidenzintervall

ADA:

„American Diabetes Association“

ASCVD:

Atherosklerotische kardiovaskuläre Erkrankung

BMI:

Body-Mass-Index

CKD:

„Chronic kidney disease“ (chronische Nierenerkrankung)

DDD:

„Defined daily dose“

EASD:

„European Association for the Study of Diabetes“

eGFR:

Geschätzte („estimated“) glomeruläre Filtrationsrate

GAD :

Glutamatdekarboxylase

GKV:

Gesetzliche Krankenversicherung

GLP‑1:

„Glucagon-like peptide 1“ (glukagonähnliches Peptid 1)

GLP-1-RA:

GLP-1-Rezeptoragonist

HbA1c :

Glykohämoglobin Typ A1c

HER2:

Humaner epidermaler Wachstumsfaktorrezeptor 2

HFrEF:

„Heart failure with reduced ejection fraction“ (Herzinsuffizienz mit reduzierter Ejektionsfraktion)

HOMA2:

„Updated homeostasis model assessment“

HOMA2‑B:

HOMA2 für Betazellfunktion

HOMA2-IR:

HOMA2 für Insulinresistenz

HR:

„Hazard ratio“

KHK:

Koronare Herzkrankheit

LDL:

„Low density lipoprotein“

MACE:

„Major adverse cardiac events“

MARD:

„Mild age-related diabetes“

MOD:

„Mild obesity-related diabetes“

NVL:

Nationale Versorgungsleitlinie

NNT:

„Number needed to treat“

PCSK9:

Proproteinkonvertase Subtilisin/Kexin Typ 9

PI3:

Phosphoinositid‑3

PI3K:

Phosphoinositid-3-Kinase

PIK3CA :

Gen für die Phosphatidylinositol‑4,5‑Bisphosphat-3-Kinase-katalytische Untereinheit alpha

SAID:

„Severe autoimmune diabetes“

SIDD:

„Severe insulin-deficient diabetes“

SIRD:

„Severe insulin-resistant diabetes“

TSH :

Thyroidstimulierendes Hormon

Literatur

  1. Ahlqvist E et al (2018) Clustering of adult-onset diabetes into novel subgroups guides therapy and improves prediction of outcome. Lancet Diabetes Endocrinol 6:361–369

    Article  PubMed  Google Scholar 

  2. Zou X et al (2019) Novel subgroups of patients with adult-onset diabetes in Chinese and US populations. Lancet Diabetes Endocrinol 7:9–11

    Article  PubMed  Google Scholar 

  3. Zaharia OP et al (2019) Risk of diabetes-associated diseases in subgroups of patients with recent-onset diabetes: a 5-year follow-up study. Lancet Diabetes Endocrinol 7:684–694

    Article  PubMed  Google Scholar 

  4. Dennis JM et al (2019) Disease progression and treatment response in data-driven subgroups of type 2 diabetes compared with models based on simple clinical features: an analysis using clinical trial data. Lancet Diabetes Endocrinol 7:442–451

    Article  PubMed  PubMed Central  Google Scholar 

  5. Sattar N et al (2019) Age at diagnosis of type 2 diabetes mellitus and associations with cardiovascular and mortality risks. Circulation 139:2228–2237

    Article  PubMed  Google Scholar 

  6. André F et al (2019) Alpelisib for PIK3CA-mutated, hormone receptor-positive advanced breast cancer. N Engl J Med 380:1929–1940

    Article  PubMed  Google Scholar 

  7. Freichel M, Mengel K (2019) Antidiabetika. In: Schwabe U et al (Hrsg) Arzneiverordnungs-Report 2019. Springer, Berlin, S 471–490

    Chapter  Google Scholar 

  8. Reaven PD et al (2019) Intensive glucose control in patients with type 2 diabetes – 15 year follow-up. N Engl J Med 380:2215–2224

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Tseng CH (2019) Metformin reduces risk of benign goiter in patients with type 2 diabetes mellitus. Eur J Endocrinol 180:365–372

    Article  CAS  PubMed  Google Scholar 

  10. Dos Santos PB et al (2019) Effects of metformin on TSH levels and benign nodular goiter volume in patients without insulin resistance or iodine insufficiency. Front Endocrinol 10:465. https://doi.org/10.3389/fendo.2019.00465

    Article  Google Scholar 

  11. He X et al (2019) Role of metformin in the treatment of patients with thyroid nodules and insulin resistance: a systematic review and meta-analysis. Thyroid 29:359–367

    Article  CAS  PubMed  Google Scholar 

  12. Rosenstock J et al (2019) Effect of linagliptin vs placebo on major cardiovascular events in adults with type 2 diabetes and high cardiovascular and renal risk. The CARMELINA randomized clinical trial. JAMA 321:69–79

    Article  CAS  PubMed  Google Scholar 

  13. Rosenstock J et al (2019) Effect of linagliptin vs glimepiride on major adverse cardiovascular outcomes in patients with type 2 diabetes: the CAROLINA randomized clinical trial. JAMA. https://doi.org/10.1001/jama.2019.13772

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gerstein HC et al (2019) Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet 394:121–130

    Article  CAS  PubMed  Google Scholar 

  15. Gerstein HC et al (2019) Dulaglutide and renal outcomes in type 2 diabetes: an exploratory analysis of the REWIND randomized, placebo-controlled trial. Lancet 394:131–138

    Article  CAS  PubMed  Google Scholar 

  16. Gerstein HC et al (2020) The effect of dulaglutide on stroke: an exploratory analysis of the REWIND trial. Lancet Diabetes Endocrinol 8:106–114

    Article  CAS  PubMed  Google Scholar 

  17. Lingvay I et al (2019) Efficacy and safety of once-weekly semaglutide versus daily canagliflozin as add-on to metformin in patients with type 2 diabetes (SUSTAIN 8): a double-blind, phase 3b, randomized controlled trial. Lancet Diabetes Endocrinol 7:834–844

    Article  CAS  PubMed  Google Scholar 

  18. Husain M et al (2019) Oral semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med 381:841–851

    Article  CAS  PubMed  Google Scholar 

  19. Mosenzon O et al (2019) Effects of dapagliflozin on development and progression of kidney disease in patients with type 2 diabetes: an analysis from the DECLARE-TIMI 58 randomised trial. Lancet Diabetes Endocroinol 380:2295–2306

    Google Scholar 

  20. Perkovic V et al (2019) Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med 380:2295–2306

    Article  CAS  PubMed  Google Scholar 

  21. Cannon CP et al (2020) Evaluating the effects of canagliflozin on cardiovascular and renal events in patients with type 2 diabetes and chronic kidney disease according to baseline HbA1c, including those with HbA1c <7 %: results from the CREDENCE trial. Circulation 141:407–410

    Article  PubMed  Google Scholar 

  22. Mahaffey KW et al (2019) Canagliflozin and cardiovascular and renal outcomes in type 2 diabetes mellitus and chronic kidney disease in primary and secondary cardiovascular prevention groups. Circulation 140:739–750

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Matthews DR et al (2019) Glycaemic durability of an early combination therapy with vildagliptin and metformin versus sequential metformin monotherapy in newly diagnosed type 2 diabetes (VERIFY): a 5-year, multicenter, randomized, double-blind trial. Lancet 394:1519–1529

    Article  CAS  PubMed  Google Scholar 

  24. Neugebauer R et al (2020) Comparison of mortality and major cardiovascular events among adults with type 2 diabetes using human vs analogue insulins. JAMA Netw Open 3:e1918554. https://doi.org/10.1001/jamanetworkopen.2019.18554

    Article  PubMed  PubMed Central  Google Scholar 

  25. Davies MJ et al (2018) Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 41:2669–2701

    Article  PubMed  PubMed Central  Google Scholar 

  26. Davies MJ et al (2018) Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 61:2461–2498

    Article  PubMed  Google Scholar 

  27. Buse JB et al (2020) 2019 update to: Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 43:487–493

    Article  PubMed  Google Scholar 

  28. Buse JB et al (2020) 2019 update to: Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia 63:221–228

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Medizinische Klinik IV, Hochtaunus-Kliniken gGmbH, Zeppelinstraße 20, 61352, Bad Homburg v. d. H., Deutschland

    Andreas Hamann

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Correspondence to Andreas Hamann.

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Interessenkonflikt

A. Hamann erklärt, dass er sich bei der Erstellung des Beitrages nicht von wirtschaftlichen Interessen leiten ließ. Er legt die folgenden potenziellen Interessenkonflikte offen: Boehringer Ingelheim, MSD (klinische Studien); Boehringer Ingelheim, Cheplapharm, Kassenärztliche Vereinigung Hessen, Lilly, MSD, Novo Nordisk, Sanofi (Vortragstätigkeit); Amgen, Boehringer Ingelheim, Cheplapharm, Kassenärztliche Vereinigung Hessen, Lilly, MSD, Novartis, Novo Nordisk, Sanofi (Beratertätigkeit); Novo Nordisk (Aktienbesitz).

Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Hamann, A. Update Typ-2-Diabetes. Diabetologe 16, 446–460 (2020). https://doi.org/10.1007/s11428-020-00627-6

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