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Die Auswirkungen Eines Vom Apotheker Durchgeführten

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Die Auswirkungen Eines Vom Apotheker Durchgeführten Die Auswirkungen eines vom Apotheker durchgeführten Medikationsassessments und der anschließenden Einleitung daraus resultierender Maßnahmen auf die Versorgungssituation von Typ-2-Diabetikern Dissertation zur Erlangung des Doktorgrades der Naturwissenschaften (Dr. rer. nat.) dem Fachbereich Pharmazie der Philipps-Universität Marburg vorgelegt von Anne-Kathrin Treutle aus Sinsheim Marburg/Lahn 2015 Erstgutachter: Professor Dr. Hartmut Morck Zweitgutachter: Professor Dr. Carsten Culmsee Eingereicht am 15.5.2015 Tag der mündlichen Prüfung am 6.7.2015 Hochschulkennziffer: 1180 Meiner Familie Inhaltsverzeichnis Inhaltsverzeichnis Inhaltsverzeichnis………………………………………………………………………………………………………………………… i 1. Einleitung ............................................................................................................................. 1 1.1. Hypothese ............................................................................................................................... 2 1.2. Das Krankheitsbild Diabetes mellitus Typ 2 ............................................................................ 2 1.2.1. Definition ......................................................................................................................... 2 1.2.2. Abgrenzung zu anderen Diabetes-Typen ........................................................................ 2 1.2.3. Manifestationsfördernde Faktoren ................................................................................. 5 1.2.4. Prävalenz und Inzidenz .................................................................................................... 6 1.3. Diagnostik und Therapie des Typ-2-Diabetes.......................................................................... 8 1.3.1. Diagnostik ........................................................................................................................ 8 1.3.2. Therapie ......................................................................................................................... 10 1.3.2.1. Orale Therapieformen ............................................................................................... 11 1.3.2.2. Injektabile Therapieformen ....................................................................................... 22 1.4. Übersicht zur Versorgungssituation von Typ-2-Diabetikern in Deutschland ........................ 28 1.4.1. Ziele und Maßnahmen .................................................................................................. 28 1.4.2. Paradigmenwechsel in der Therapie von Typ-2-Diabetikern ........................................ 29 1.5. Gesetzlicher Rahmen und politische Diskussion ................................................................... 31 1.6. Begleit- und Folgeerkrankungen ........................................................................................... 33 1.6.1. Relevante Interaktionen ................................................................................................ 36 1.7. Fragestellung ......................................................................................................................... 39 2. Aufgaben und Ziele ............................................................................................................. 39 2.1. These ..................................................................................................................................... 40 2.2. Einleitende Literaturrecherche ............................................................................................. 40 2.3. Thematischer Schwerpunkt ................................................................................................... 43 2.3.1. Kardiovaskuläre Erkrankungen ...................................................................................... 43 2.3.2. Risikofaktoren ................................................................................................................ 44 2.3.3. Risikoprognose für kardiovaskuläre Erkrankungen ....................................................... 47 2.3.4. Relevante Studien ......................................................................................................... 48 2.3.5. Leitlinien ........................................................................................................................ 53 2.4. Datenerhebung in Apotheken ............................................................................................... 55 2.5. Datenerfassung ..................................................................................................................... 55 2.5.1. Patientenbezogene Daten ............................................................................................. 55 2.5.2. Arzneimittelbezogene Daten ......................................................................................... 56 2.5.2.1. IMS-Klassifizierung................................................................................................. 56 i Inhaltsverzeichnis 2.5.2.2. ATC-Klassifizierung ................................................................................................ 57 2.6. Die Rolle des Apothekers ...................................................................................................... 79 3. Material und Methoden ...................................................................................................... 80 3.1. Datenquelle ........................................................................................................................... 80 3.2. Patientenauswahl .................................................................................................................. 80 3.3. Datenerfassung ..................................................................................................................... 80 3.3.1. Warenwirtschaftssystem und EDV für Apotheken ........................................................ 80 3.3.2. Listenerzeugung und -definition ................................................................................... 81 3.3.3. Datenfilter ..................................................................................................................... 84 3.3.4. Basisdatei ....................................................................................................................... 85 3.4. Mess- und Auswerteverfahren/ Statistik .............................................................................. 87 4. Analyse des Versorgungsalltags von Typ-2-Diabetikern ........................................................ 90 4.1. Allgemeines ........................................................................................................................... 90 4.2. Patientenstammdaten ........................................................................................................... 91 4.2.1. Geschlechter- und Altersverteilung............................................................................... 91 4.2.2. Typ-2-Diabetiker im Altenheim ..................................................................................... 99 4.2.3. Vergleich behandelnder Ärzte (Hausarzt/ Diabetologe) ............................................. 101 4.3. Medikationsassessment ...................................................................................................... 103 4.3.1. Definition ..................................................................................................................... 103 4.3.2. Antidiabetika ............................................................................................................... 104 4.3.2.1. Übersicht antidiabetischer Therapieformen ....................................................... 104 4.3.2.2. Insuline ................................................................................................................ 108 4.3.2.3. Orale Antidiabetika .............................................................................................. 109 4.3.2.4. Kombinationen Insulin und orale Antidiabetika .................................................. 112 4.3.2.5. Therapieumstellungen......................................................................................... 115 4.3.2.6. Antidiabetika differenziert nach Geschlecht ....................................................... 124 4.3.2.7. Antidiabetika differenziert nach Alter ................................................................. 126 4.3.2.8. Vergleich der verordneten Medikation Hausarzt/ Diabetologe ......................... 131 4.3.2.9. Vergleich antidiabetischer Therapieformen Altenheim/ Nicht-Altenheim ......... 135 4.3.2.10. Neuere antidiabetische Therapieoptionen ......................................................... 138 4.3.2.11. Typ-2-Diabetiker mit erhöhtem Hypoglykämierisiko .......................................... 141 4.3.3. Abgleich der erfassten Therapieformen mit der NVL ................................................. 143 4.3.4. Komedikation .............................................................................................................. 156 4.3.4.1. Übersicht Koarzneimittelgruppen ....................................................................... 156 4.3.4.2. Koarzneimittelgruppen differenziert nach Geschlecht ....................................... 158 ii Inhaltsverzeichnis 4.3.4.3. Koarzneimittelgruppen differenziert nach Alter ................................................. 161 4.3.4.4. Vergleich der Komedikation Altenheim/ Nicht-Altenheim ................................
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