Glucose-lowering therapy in type 2 diabetes. New hope after the EMPA-REG outcome trial
Abstract
Prevention of cardiovascular morbidity and mortality remains the key factor in the treatment of type 2 diabetes (T2DM). In the early phase of T2DM, multifactorial intervention is mandatory and glucose levels should be near normal, in particular in younger patients presenting with the highest cardiovascular risk. Anti-diabetic drugs without any risk for hypoglycaemia should be preferred in order to reduce clinical inertia and increase the long-term adherence to the treatment. In patients already presenting with cardiovascular disease, the best outcome may be expected with the triple oral therapy of metformin, pioglitazone, and empagliflozin, although a controlled prospective study versus insulin therapy is needed to confirm the expectation.
Die Verhinderung kardiovaskulärer Ereignisse und des kardiovaskulären Todes bleiben die Schlüsselfaktoren bei der Behandlung des Typ-2-Diabetes mellitus. In der Frühphase des Diabetes ist eine multifaktorielle Intervention notwendig und der Blutzuckerspiegel sollte annähernd normal sein, besonders bei jungen Patienten mit hohem kardiovaskulären Risiko. Antidiabetika ohne Hypoglykämierisiko sollten bevorzugt warden, um klinische Untätigkeit zu reduzieren und die Langzeitadhärenz der Therapie zu erhöhen. Bei Patienten mit bereits vorhandener kardiovaskulärer Erkrankung wird die beste Wirkung mit einer oralen Tripeltherapie aus Metformin, Pioglitazone und Empagliflozin erwartet, wiewohl eine kontrollierte prospektive Studie mit diesen drei…
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