Typ-2-Diabetes - Update 2018

The most important advances in the diagnosis and therapy of type 2 diabetes (T2D) are presented. In patients who first present with the clinical picture of T2D, the prognosis and thus the required intensity of therapy can be estimated on the basis of biomarkers. Biomarkers also allow the evaluation of the probability of MODY (maturity onset diabetes of the young) in a 3-step procedure. In outcome trials, cardio- and renoprotective efficiency was shown for treatment with the GLP1-receptor agonists (GLP1aEuroRA [GLPaEuro1: glucagon-like peptide 1]) liraglutide and semaglutide as well as with the SGLT2 (sodium dependent glucose transporter 2) inhibitors empagliflozin and canagliflozin. New positively evaluated options in the treatment of T2D include, among others, triple therapy with the oral antidiabetic drugs metformin, DPP4 inhibitors (DPP: dipeptidylpeptidase) and SGLT2 inhibitors that exert additive effects without increasing the risk for hypoglycemic events. The combination of basal insulin with a DPP4 inhibitor is as efficient for the metabolic control in periperal hospital wards as the more complex treatment with intensive insulin therapy. If the diabetes is inadequately controlled under metformin and a DPP4 inhibitor, treatment with the GLP1-RA dulaglutide is able to effectively reduce the HbA1c (hemoglobin type A(1c)) value without increasing the risk for hypoglycemic events. When the diabetes is inadequately controlled under metformin with or without a sulfonylurea drug, combination with semaglutid is more effective and safer than the addition of insulin glargine.