TY  - JOUR
AB  - Die medikamentöse Therapie ist Bestandteil eines umfassenden, 
      leitliniengerechten Behandlungskonzepts für Menschen mit Adipositas. 
      Grundlage der Adipositastherapie ist zunächst eine konservative 
      multimodale Basistherapie, bestehend aus energiereduzierter Ernährung, 
      Erhöhung der körperlichen Aktivität und Verhaltensänderungen. Wenn mit 
      diesen Maßnahmen individuelle Therapieziele nicht erreicht werden, 
      können Medikamente die Basistherapie unterstützen. Konzeptionell soll 
      mit Medikamenten nicht nur eine Gewichtsreduktion und -stabilisierung 
      des reduzierten Gewichts erreicht, sondern die chronische 
      Multisystemerkrankung Adipositas langfristig besser behandelt werden. 
      Die in den letzten Jahren eingeführten inkretinbasierten 
      Pharmakotherapien Liraglutid, Semaglutid und Tirzepatid haben neben 
      ausgeprägten gewichtsreduzierenden auch günstige kardiometabolische 
      Effekte. Dazu zählen Verbesserungen in Adipositasbegleiterkrankungen wie
       Typ-2-Diabetes, Hypertonie, Fettlebererkrankungen, dem obstruktiven 
      Schlafapnoesyndrom, kardiovaskulären Risikofaktoren, der chronischen 
      Nierenerkrankung und anderen. Demgegenüber stehen meist milde bis 
      moderate gastrointestinale Nebenwirkungen dieser Substanzen. Mit der 
      Markteinführung von Setmelanotid steht erstmals eine Substanz zur 
      Behandlung von seltenen, monogenetischen Adipositasformen zur Verfügung.
       Zusätzlich befinden sich zahlreiche inkretinbasierte Wirkstoffe und 
      neue Substanzklassen in fortgeschrittenen Phasen der klinischen 
      Entwicklung. Aufgrund ihres günstigen Wirkungs- und 
      Nebenwirkungsprofils, aber auch im Hinblick auf die positiven 
      kardiometabolischen Effekte haben die neuen Medikamente das Potenzial, 
      den Stellenwert der Adipositaspharmakotherapie in Deutschland deutlich 
      zu erhöhen.
AU  - Blüher, M.
C1  - 74196
C2  - 57365
CY  - Heidelbergerplatz 3, Berlin, Germany
SP  - 475–484
TI  - Medikamentöse Adipositastherapie in Deutschland.
JO  - Innere Med.
VL  - 66
IS  - 5
PB  - Springer Medizin Verlag Gmbh
PY  - 2025
SN  - 2731-7080
ER  - 

TY  - JOUR
AB  - Obesity represents an immense challenge for patients and physicians due to its numerous comorbidities and complications. For a long time, safe and effective pharmacological treatment remained wishful thinking. Bariatric surgery was considered the only option for sustained weight loss; however, with the advent of incretin-based treatment, initially introduced as a highly effective component of anti-diabetic treatment, research began to focus on the complex gastroenteropancreatic endocrine system, including central hunger and satiety regulation. This shift was driven by the discovery of a remarkable side effect: placebo-controlled weight reduction. Subsequent groundbreaking pharmacological developments based on long-acting peptides, the administration of which could be reduced from twice daily in earlier forms of treatment to once weekly, now enables significant weight reduction of over 20%, with a tolerable safety profile. This article provides an illustrative overview of the corresponding associations and highlights this milestone in obesity treatment.
AU  - Freibothe, I.*
AU  - Müller, T.D.
C1  - 74057
C2  - 57317
CY  - Heidelbergerplatz 3, Berlin, Germany
SP  - 461-466
TI  - Inkretine als Grundlage der Adipositastherapie.
JO  - Innere Med.
VL  - 66
IS  - 5
PB  - Springer Medizin Verlag Gmbh
PY  - 2025
SN  - 2731-7080
ER  - 

TY  - JOUR
AB  - The term prediabetes describes a fasting blood glucose level that is elevated but not yet in the diabetic range, a blood glucose level that is elevated after 120 min in a standard 75‑g oral glucose tolerance test, or both. The American Diabetes Association definition also includes glycated hemoglobin A (HbA1c). The incidence of prediabetes is rapidly increasing. Progression from normal glucose tolerance to diabetes is a continuous process. Insulin resistance and insulin secretory dysfunction, the simultaneous presence of which characterizes manifest diabetes, are already present in the prediabetic stage. Prediabetes is associated with an increased risk of diabetes; however, by no means all people with prediabetes go on to develop diabetes. Nevertheless, the identification of an increased risk of diabetes is still relevant insofar as it requires the adoption of diabetes prevention measures. Structured lifestyle intervention has been shown to be the most effective strategy for treating prediabetes. To increase its efficiency, it should, as far as possible, be made exclusively available to those people on whom it is most likely to confer a benefit. This would make it necessary to stratify people with prediabetes according to their risk profile. In a population of people at increased risk of diabetes (Tübingen Diabetes Family Study), a cluster analysis was performed, resulting in six clusters/subgroups. Within these, three high-risk subgroups were identified: Two of these risk groups show predominant insulin secretory dysfunction or predominant insulin resistance and high diabetes and cardiovascular risk. The third group shows a high risk of nephropathy and high mortality, but a comparatively lower diabetes risk. In general, prediabetes cannot yet be treated in a targeted pathophysiologically oriented manner. The new classification of prediabetes—based on pathophysiology—is now opening up new avenues for diabetes prevention. Current and future studies should confirm the assumption that the effectiveness of established, or not yet established, preventive measures depends on the respective subgroup.
AU  - Kantartzis, K.
AU  - Fritsche, A.
AU  - Birkenfeld, A.L.
C1  - 68349
C2  - 53632
CY  - Heidelbergerplatz 3, Berlin, Germany
SP  - 636-641
TI  - Prädiabetes als therapeutische Herausforderung in der Inneren Medizin.
JO  - Innere Med.
VL  - 64
IS  - 7
PB  - Springer Medizin
PY  - 2023
SN  - 2731-7080
ER  - 

TY  - JOUR
AB  - Obesity is a chronically progressing disease that represents a major challenge for affected patients, health care professionals and society, since it is highly prevalent and associated with several comorbidities. The treatment of obesity aims at body weight reduction, reducing the burden of comorbidities and weight maintenance after weight loss. To achieve these goals, a conservative treatment strategy is recommended that consists of an energy-reduced diet, increased physical activity and behavioral modifications. If individual treatment targets cannot be achieved by basic treatment, stepwise therapy intensification should be initiated including short-term very low calorie diets, pharmacotherapy or bariatric surgery. However, these treatment approaches differ with respect to average weight loss and other outcomes. There is still a large gap between the efficacy of conservative strategies and "metabolic" surgery that cannot be filled by current pharmacotherapies. However, recent advances in the development of anti-obesity medications could change the positioning of pharmacotherapies in obesity management. Here we discuss whether next-generation pharmacotherapies have the potential to become an alternative to obesity surgery in the future.
AU  - Müller, T.D.
AU  - Blüher, M.
C1  - 67845
C2  - 54323
CY  - Heidelbergerplatz 3, Berlin, Germany
SP  - 629-635
TI  - Adipositastherapie – werden Pharmakotherapien die Alternative zur metabolischen Chirurgie sein?
JO  - Innere Med.
VL  - 64
IS  - 7
PB  - Springer Medizin Verlag Gmbh
PY  - 2023
SN  - 2731-7080
ER  -