Antidiabetische Therapie und Gewichtskontrolle

Zusammenfassung

Mehr als 90 Prozent der Menschen mit Typ-2-Diabetes sind übergewichtig und adipös. Hieraus ergibt sich der Rat zu einer Lebensstilmodifikation mit energiereduzierter Ernährung und vermehrter körperlicher Bewegung, um über eine Gewichtsreduktion die Stoffwechsellage günstig zu beeinflussen. Gelingt das nicht, ist eine antidiabetische Pharmakotherapie erforderlich. Leider führen etliche der dabei verordneten Präparate zu einer signifikanten Gewichtszunahme. Dieses gilt für Sulfonylharnstoffe, Glinide, Glitazone und insbesondere auch Insulin. Andere Präparate, wie Metformin, Acarbose, DPP-4-Hemmer oder Inkretin-Mimetika haben einen eher günstigen Effekt auf das Körpergewicht und können zum Teil sogar eine Gewichtsabnahme begünstigen. Mehr als bisher sollte die Entwicklung des Körpergewichts in Planung und Auswahl antidiabetischer Therapiestrategien einbezogen werden.

Summary

More than 90 % of all type 2 diabetic patients are overweight or obese. Therefore, advice for lifestyle modification with a hypocaloric diet and increased physical activity is given to these patients in order to improve metabolism via a moderate weight loss. If this strategy does not succeed, an antidiabetic pharmacotherapy is needed. Unfortunately, numerous antidiabetic compounds result in significant weight gain, for which a variety of different mechanisms can be identified. Weight gain is a side effect of treatment with sulfonylureas, rapid-acting insulin secretagogues (glinides), glitazones and especially insulin. In contrast, metformin, acarbose, DPP-4-inhibitors and incretin mimetics have a more favourable effect on body weight and can even promote weight loss. The effect on body weight should more than before be included in the design of the individual antidiabetic treatment strategy

Schlüsselwörter

Adipositas - Typ-2-Diabetes - Gewichtszunahme - Metformin - Insulin

Keywords

Obesity - diabetes type 2 - weight gain - metformin - insulin

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