Skip to main content

06.12.2024 | Mini-Review

Regulation of glucose metabolism by incretins: implications for treatment of type 2 diabetes

verfasst von: Rie Saito, Norio Harada

Erschienen in: Diabetology International

Einloggen, um Zugang zu erhalten

Abstract

Gastrointestinal hormones that potentiate insulin secretion from pancreatic β-cells are called incretins. Glucose-dependent insulinotropic polypeptide/gastric inhibitory polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) are the major incretins. Incretin-mediated stimulation of insulin secretion (incretin effect) plays an important role in lowering postprandial blood-glucose levels. Incretin effect is reduced under diabetic condition. Several mechanisms have been reported for the reduction of incretin effect. Incretin-related drugs are used worldwide for the treatment of type 2 diabetes. In addition, several new incretin-related drugs have been developed and are expected to be available in clinical practice.
Literatur
1.
Zurück zum Zitat Yamane S, Harada N, Hamasaki A, Muraoka A, Joo E, Suzuki K, Nasteska D, Tanaka D, Ogura M, Harashima S, Inagaki N. Effects of glucose and meal ingestion on incretin secretion in Japanese subjects with normal glucose tolerance. J Diabetes Investig. 2012;20:80–5.CrossRef Yamane S, Harada N, Hamasaki A, Muraoka A, Joo E, Suzuki K, Nasteska D, Tanaka D, Ogura M, Harashima S, Inagaki N. Effects of glucose and meal ingestion on incretin secretion in Japanese subjects with normal glucose tolerance. J Diabetes Investig. 2012;20:80–5.CrossRef
2.
Zurück zum Zitat Kendall DM, Cuddihy RM, Bergenstal RM. Clinical application of incretin-based therapy: therapeutic potential, patient selection and clinical use. Am J Med. 2009;122:S37–50.CrossRefPubMed Kendall DM, Cuddihy RM, Bergenstal RM. Clinical application of incretin-based therapy: therapeutic potential, patient selection and clinical use. Am J Med. 2009;122:S37–50.CrossRefPubMed
3.
Zurück zum Zitat Fukushima M, Suzuki H, Seino Y. Insulin secretion capacity in the development from normal glucose tolerance to type 2 diabetes. Diabetes Res Clin Pract. 2006;66S:S37–43. Fukushima M, Suzuki H, Seino Y. Insulin secretion capacity in the development from normal glucose tolerance to type 2 diabetes. Diabetes Res Clin Pract. 2006;66S:S37–43.
4.
Zurück zum Zitat Pankow JS, Kwan DK, Duncan BB, Schmidt MI, Couper DJ, Golden S, Ballantyne CM. Cardiometabolic risk in impaired fasting glucose and impaired glucose tolerance: the Atherosclerosis Risk in Communities Study. Diabetes Care. 2007;30:325–31.CrossRefPubMed Pankow JS, Kwan DK, Duncan BB, Schmidt MI, Couper DJ, Golden S, Ballantyne CM. Cardiometabolic risk in impaired fasting glucose and impaired glucose tolerance: the Atherosclerosis Risk in Communities Study. Diabetes Care. 2007;30:325–31.CrossRefPubMed
5.
Zurück zum Zitat Kondo Y, Harada N, Sozu T, Hamasaki A, Yamane S, Muraoka A, Harada T, Shibue K, Nasteska D, Joo E, Sasaki K, Inagaki N. A hospital-based cross-sectional study to develop an estimation formula for 2-h post-challenge plasma glucose for screening impaired glucose tolerance. Diabetes Res Clin Pract. 2013;101:218–25.CrossRefPubMed Kondo Y, Harada N, Sozu T, Hamasaki A, Yamane S, Muraoka A, Harada T, Shibue K, Nasteska D, Joo E, Sasaki K, Inagaki N. A hospital-based cross-sectional study to develop an estimation formula for 2-h post-challenge plasma glucose for screening impaired glucose tolerance. Diabetes Res Clin Pract. 2013;101:218–25.CrossRefPubMed
6.
Zurück zum Zitat Nauck M, Stöckmann F, Ebert R, Creutzfeldt W. Reduced incretin effect in type 2 (non-insulin-dependent) diabetes. Diabetologia. 1986;29:46–52.CrossRefPubMed Nauck M, Stöckmann F, Ebert R, Creutzfeldt W. Reduced incretin effect in type 2 (non-insulin-dependent) diabetes. Diabetologia. 1986;29:46–52.CrossRefPubMed
7.
Zurück zum Zitat Hatoko T, Harada N, Tokumoto S, Yamane S, Ikeguchi-Ogura E, Kato T, Yasuda T, Tatsuoka H, Shimazu-Kuwahara S, Yabe D, Hayashi Y, Inagaki N. An analysis of intestinal morphology and incretin-producing cells using tissue optical clearing and 3-D imaging. Sci Rep. 2022;12:17530.CrossRefPubMedPubMedCentral Hatoko T, Harada N, Tokumoto S, Yamane S, Ikeguchi-Ogura E, Kato T, Yasuda T, Tatsuoka H, Shimazu-Kuwahara S, Yabe D, Hayashi Y, Inagaki N. An analysis of intestinal morphology and incretin-producing cells using tissue optical clearing and 3-D imaging. Sci Rep. 2022;12:17530.CrossRefPubMedPubMedCentral
8.
Zurück zum Zitat Smith EP, An Z, Wagner C, Lewis AG, Cohen EB, Li B, Mahbod P, Sandoval D, Perez-Tilve D, Tamarina N, Philipson LH, Stoffers DA, Seeley RJ, D’Alessio DA. The role of β cell glucagon-like peptide-1 signaling in glucose regulation and response to diabetes drugs. Cell Metab. 2014;19:1050–7.CrossRefPubMedPubMedCentral Smith EP, An Z, Wagner C, Lewis AG, Cohen EB, Li B, Mahbod P, Sandoval D, Perez-Tilve D, Tamarina N, Philipson LH, Stoffers DA, Seeley RJ, D’Alessio DA. The role of β cell glucagon-like peptide-1 signaling in glucose regulation and response to diabetes drugs. Cell Metab. 2014;19:1050–7.CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Seino S, Sugawara K, Yokoi N, Takahashi H. β-cell signalling and insulin secretagogues: a path for improved diabetes therapy. Diabetes Obes Metab. 2017;19:22–9.CrossRefPubMed Seino S, Sugawara K, Yokoi N, Takahashi H. β-cell signalling and insulin secretagogues: a path for improved diabetes therapy. Diabetes Obes Metab. 2017;19:22–9.CrossRefPubMed
10.
Zurück zum Zitat Hamasaki A, Harada N, Muraoka A, Yamane S, Joo E, Suzuki K, Inagaki N. The integrated incretin effect is reduced by both glucose intolerance and obesity in Japanese subjects. Front Endocrinol (Lausanne). 2024;15:1301352.CrossRefPubMed Hamasaki A, Harada N, Muraoka A, Yamane S, Joo E, Suzuki K, Inagaki N. The integrated incretin effect is reduced by both glucose intolerance and obesity in Japanese subjects. Front Endocrinol (Lausanne). 2024;15:1301352.CrossRefPubMed
11.
Zurück zum Zitat Oh TJ, Kim MY, Shin JY, Lee JC, Kim S, Park KS, Cho YM. The incretin effect in Korean subjects with normal glucose tolerance or type 2 diabetes. Clin Endocrinol (Oxf). 2014;80:221–7.CrossRefPubMed Oh TJ, Kim MY, Shin JY, Lee JC, Kim S, Park KS, Cho YM. The incretin effect in Korean subjects with normal glucose tolerance or type 2 diabetes. Clin Endocrinol (Oxf). 2014;80:221–7.CrossRefPubMed
12.
Zurück zum Zitat Vollmer K, Holst JJ, Baller B, Ellrichmann M, Nauck MA, Schmidt WE, Meier JJ. Predictors of incretin concentrations in subjects with normal, impaired, and diabetic glucose tolerance. Diabetes. 2008;57:678–87.CrossRefPubMed Vollmer K, Holst JJ, Baller B, Ellrichmann M, Nauck MA, Schmidt WE, Meier JJ. Predictors of incretin concentrations in subjects with normal, impaired, and diabetic glucose tolerance. Diabetes. 2008;57:678–87.CrossRefPubMed
13.
Zurück zum Zitat Harada N, Hamasaki A, Yamane S, Muraoka A, Joo E, Fujita K, Inagaki N. Plasma gastric inhibitory polypeptide and glucagon-like peptide-1 levels after glucose loading are associated with different factors in Japanese subjects. J Diabetes Investig. 2011;2:193–9.CrossRefPubMed Harada N, Hamasaki A, Yamane S, Muraoka A, Joo E, Fujita K, Inagaki N. Plasma gastric inhibitory polypeptide and glucagon-like peptide-1 levels after glucose loading are associated with different factors in Japanese subjects. J Diabetes Investig. 2011;2:193–9.CrossRefPubMed
14.
Zurück zum Zitat Toft-Nielsen MB, Damholt MB, Madsbad S, Hilsted LM, Hughes TE, Michelsen BK, Holst JJ. Determinants of the impaired secretion of glucagon-like peptide-1 in type 2 diabetic patients. J Clin Endocrinol Metab. 2001;86:3717–23.CrossRefPubMed Toft-Nielsen MB, Damholt MB, Madsbad S, Hilsted LM, Hughes TE, Michelsen BK, Holst JJ. Determinants of the impaired secretion of glucagon-like peptide-1 in type 2 diabetic patients. J Clin Endocrinol Metab. 2001;86:3717–23.CrossRefPubMed
15.
Zurück zum Zitat Calanna S, Christensen M, Holst JJ, Laferrère B, Gluud LL, Vilsbøll T, Knop FK. Secretion of glucagon-like peptide-1 in patients with type 2 diabetes mellitus: systematic review and meta-analyses of clinical studies. Diabetologia. 2013;56:965–72.CrossRefPubMedPubMedCentral Calanna S, Christensen M, Holst JJ, Laferrère B, Gluud LL, Vilsbøll T, Knop FK. Secretion of glucagon-like peptide-1 in patients with type 2 diabetes mellitus: systematic review and meta-analyses of clinical studies. Diabetologia. 2013;56:965–72.CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Calanna S, Christensen M, Holst JJ, Laferrère B, Gluud LL, Vilsbøll T, Knop FK. Secretion of glucose-dependent insulinotropic polypeptide in patients with type 2 diabetes: systematic review and meta-analysis of clinical studies. Diabetes Care. 2013;36:3346–52.CrossRefPubMedPubMedCentral Calanna S, Christensen M, Holst JJ, Laferrère B, Gluud LL, Vilsbøll T, Knop FK. Secretion of glucose-dependent insulinotropic polypeptide in patients with type 2 diabetes: systematic review and meta-analysis of clinical studies. Diabetes Care. 2013;36:3346–52.CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Xu G, Kaneto H, Laybutt DR, Duvivier-Kali VF, Trivedi N, Suzuma K, King GL, Weir GC, Bonner-Weir S. Downregulation of GLP-1 and GIP receptor expression by hyperglycemia: possible contribution to impaired incretin effects in diabetes. Diabetes. 2017;56:1551–8.CrossRef Xu G, Kaneto H, Laybutt DR, Duvivier-Kali VF, Trivedi N, Suzuma K, King GL, Weir GC, Bonner-Weir S. Downregulation of GLP-1 and GIP receptor expression by hyperglycemia: possible contribution to impaired incretin effects in diabetes. Diabetes. 2017;56:1551–8.CrossRef
18.
Zurück zum Zitat Oduori OS, Murao N, Shimomura K, Takahashi H, Zhang Q, Dou H, Sakai S, Minami K, Chanclon B, Guida C, Kothegala L, Tolö J, Maejima Y, Yokoi N, Minami Y, Miki T, Rorsman P, Seino S. Gs/Gq signaling switch in β cells defines incretin effectiveness in diabetes. J Clin Investig. 2020;130:6639–55.CrossRefPubMedPubMedCentral Oduori OS, Murao N, Shimomura K, Takahashi H, Zhang Q, Dou H, Sakai S, Minami K, Chanclon B, Guida C, Kothegala L, Tolö J, Maejima Y, Yokoi N, Minami Y, Miki T, Rorsman P, Seino S. Gs/Gq signaling switch in β cells defines incretin effectiveness in diabetes. J Clin Investig. 2020;130:6639–55.CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Meier JJ, Nauck MA. Is the diminished incretin effect in type 2 diabetes just an epi-phenomenon of impaired beta-cell function? Diabetes. 2010;59:1117–25.CrossRefPubMedPubMedCentral Meier JJ, Nauck MA. Is the diminished incretin effect in type 2 diabetes just an epi-phenomenon of impaired beta-cell function? Diabetes. 2010;59:1117–25.CrossRefPubMedPubMedCentral
20.
Zurück zum Zitat Højberg PV, Vilsbøll T, Rabøl R, Knop FK, Bache M, Krarup T, Holst JJ, Madsbad S. Four weeks of near-normalisation of blood glucose improves the insulin response to glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide in patients with type 2 diabetes. Diabetologia. 2009;52:199–207.CrossRefPubMed Højberg PV, Vilsbøll T, Rabøl R, Knop FK, Bache M, Krarup T, Holst JJ, Madsbad S. Four weeks of near-normalisation of blood glucose improves the insulin response to glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide in patients with type 2 diabetes. Diabetologia. 2009;52:199–207.CrossRefPubMed
21.
Zurück zum Zitat Drucker DJ, Sherman SI, Gorelick FS, Bergenstal RM, Sherwin RS, Buse JB. Incretin-based therapies for the treatment of type 2 diabetes: evaluation of the risks and benefits. Diabetes Care. 2010;33:428–33.CrossRefPubMedPubMedCentral Drucker DJ, Sherman SI, Gorelick FS, Bergenstal RM, Sherwin RS, Buse JB. Incretin-based therapies for the treatment of type 2 diabetes: evaluation of the risks and benefits. Diabetes Care. 2010;33:428–33.CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat DeFronzo RA, Okerson T, Viswanathan P, Guan X, Holcombe JH, MacConell L. Effects of exenatide versus sitagliptin on postprandial glucose, insulin and glucagon secretion, gastric emptying, and caloric intake: a randomized, cross-over study. Curr Med Res Opin. 2008;24:2943–52.CrossRefPubMed DeFronzo RA, Okerson T, Viswanathan P, Guan X, Holcombe JH, MacConell L. Effects of exenatide versus sitagliptin on postprandial glucose, insulin and glucagon secretion, gastric emptying, and caloric intake: a randomized, cross-over study. Curr Med Res Opin. 2008;24:2943–52.CrossRefPubMed
23.
Zurück zum Zitat Davies MJ, Aroda VR, Collins BS, Gabbay RA, Green J, Maruthur NM, Rosas SE, Del Prato S, Mathieu C, Mingrone G, Rossing P, Tankova T, Tsapas A, Buse JB. Management of hyperglycemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2022;65:1925–66.CrossRefPubMedPubMedCentral Davies MJ, Aroda VR, Collins BS, Gabbay RA, Green J, Maruthur NM, Rosas SE, Del Prato S, Mathieu C, Mingrone G, Rossing P, Tankova T, Tsapas A, Buse JB. Management of hyperglycemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2022;65:1925–66.CrossRefPubMedPubMedCentral
24.
Zurück zum Zitat Bouchi R, Kondo T, Ohta Y, Goto A, Tanaka D, Satoh H, Yabe D, Nishimura R, Harada N, Kamiya H, Suzuki R, Yamauchi T, JDS Committee on Consensus Statement Development. A consensus statement from the Japan Diabetes Society (JDS): a proposed algorithm for pharmacotherapy in people with type 2 diabetes-2nd edition (English version). Diabetol Int. 2024;15:327–45.CrossRefPubMed Bouchi R, Kondo T, Ohta Y, Goto A, Tanaka D, Satoh H, Yabe D, Nishimura R, Harada N, Kamiya H, Suzuki R, Yamauchi T, JDS Committee on Consensus Statement Development. A consensus statement from the Japan Diabetes Society (JDS): a proposed algorithm for pharmacotherapy in people with type 2 diabetes-2nd edition (English version). Diabetol Int. 2024;15:327–45.CrossRefPubMed
25.
Zurück zum Zitat Sun B, Willard FS, Feng D, Alsina-Fernandez J, Chen Q, Vieth M, Ho JD, Showalter AD, Stutsman C, Ding L, Suter TM, Dunbar JD, Carpenter JW, Mohammed FA, Aihara E, Brown RA, Bueno AB, Emmerson PJ, Moyers JS, Kobilka TS, Coghlan MP, Kobilka BK, Sloop KW. Structural determinants of dual incretin receptor agonism by tirzepatide. Proc Natl Acad Sci U S A. 2022;119: e2116506119.CrossRefPubMedPubMedCentral Sun B, Willard FS, Feng D, Alsina-Fernandez J, Chen Q, Vieth M, Ho JD, Showalter AD, Stutsman C, Ding L, Suter TM, Dunbar JD, Carpenter JW, Mohammed FA, Aihara E, Brown RA, Bueno AB, Emmerson PJ, Moyers JS, Kobilka TS, Coghlan MP, Kobilka BK, Sloop KW. Structural determinants of dual incretin receptor agonism by tirzepatide. Proc Natl Acad Sci U S A. 2022;119: e2116506119.CrossRefPubMedPubMedCentral
26.
Zurück zum Zitat Coskun T, Sloop KW, Loghin C, Alsina-Fernandez J, Urva S, Bokvist KB, Cui X, Briere DA, Cabrera O, Roell WC, Kuchibhotla U, Moyers JS, Benson CT, Gimeno RE, D’Alessio DA, Haupt A. LY3298176, a novel dual GIP and GLP-1 receptor agonist for the treatment of type 2 diabetes mellitus: from discovery to clinical proof of concept. Mol Metab. 2018;18:3–14.CrossRefPubMedPubMedCentral Coskun T, Sloop KW, Loghin C, Alsina-Fernandez J, Urva S, Bokvist KB, Cui X, Briere DA, Cabrera O, Roell WC, Kuchibhotla U, Moyers JS, Benson CT, Gimeno RE, D’Alessio DA, Haupt A. LY3298176, a novel dual GIP and GLP-1 receptor agonist for the treatment of type 2 diabetes mellitus: from discovery to clinical proof of concept. Mol Metab. 2018;18:3–14.CrossRefPubMedPubMedCentral
27.
Zurück zum Zitat Willard FS, Douros JD, Gabe MB, Showalter AD, Wainscott DB, Suter TM, Capozzi ME, van der Velden WJ, Stutsman C, Cardona GR, Urva S, Emmerson PJ, Holst JJ, D’Alessio DA, Coghlan MP, Rosenkilde MM, Campbell JE, Sloop KW. Tirzepatide is an imbalanced and biased dual GIP and GLP-1 receptor agonist. JCI Insight. 2020;5: e140532.CrossRefPubMedPubMedCentral Willard FS, Douros JD, Gabe MB, Showalter AD, Wainscott DB, Suter TM, Capozzi ME, van der Velden WJ, Stutsman C, Cardona GR, Urva S, Emmerson PJ, Holst JJ, D’Alessio DA, Coghlan MP, Rosenkilde MM, Campbell JE, Sloop KW. Tirzepatide is an imbalanced and biased dual GIP and GLP-1 receptor agonist. JCI Insight. 2020;5: e140532.CrossRefPubMedPubMedCentral
28.
Zurück zum Zitat El K, Douros JD, Willard FS, Novikoff A, Sargsyan A, Perez-Tilve D, Wainscott DB, Yang B, Chen A, Wothe D, Coupland C, Tschöp MH, Finan B, D’Alessio DA, Sloop KW, Müller TD, Campbell JE. The incretin co-agonist tirzepatide requires GIPR for hormone secretion from human islets. Nat Metab. 2023;5:945–54.CrossRefPubMedPubMedCentral El K, Douros JD, Willard FS, Novikoff A, Sargsyan A, Perez-Tilve D, Wainscott DB, Yang B, Chen A, Wothe D, Coupland C, Tschöp MH, Finan B, D’Alessio DA, Sloop KW, Müller TD, Campbell JE. The incretin co-agonist tirzepatide requires GIPR for hormone secretion from human islets. Nat Metab. 2023;5:945–54.CrossRefPubMedPubMedCentral
29.
Zurück zum Zitat Locatelli JC, Costa JG, Haynes A, Naylor LH, Fegan PG, Yeap BB, Green DJ. Incretin-based weight loss pharmacotherapy: can resistance exercise optimize changes in body composition? Diabetes Care. 2024;30:dci230100. Locatelli JC, Costa JG, Haynes A, Naylor LH, Fegan PG, Yeap BB, Green DJ. Incretin-based weight loss pharmacotherapy: can resistance exercise optimize changes in body composition? Diabetes Care. 2024;30:dci230100.
30.
Zurück zum Zitat Kim YG, Hahn S, Oh TJ, Park KS, Cho YM. Differences in the HbA1c-lowering efficacy of glucagon-like peptide-1 analogues between Asians and non-Asians: a systematic review and meta-analysis. Diabetes Obes Metab. 2024;16:900–9.CrossRef Kim YG, Hahn S, Oh TJ, Park KS, Cho YM. Differences in the HbA1c-lowering efficacy of glucagon-like peptide-1 analogues between Asians and non-Asians: a systematic review and meta-analysis. Diabetes Obes Metab. 2024;16:900–9.CrossRef
31.
Zurück zum Zitat Kim YG, Hahn S, Oh TJ, Kwak SH, Park KS, Cho YM. Differences in the glucose-lowering efficacy of dipeptidyl peptidase-4 inhibitors between Asians and non-Asians: a systematic review and meta-analysis. Diabetologia. 2013;56:696–708.CrossRefPubMed Kim YG, Hahn S, Oh TJ, Kwak SH, Park KS, Cho YM. Differences in the glucose-lowering efficacy of dipeptidyl peptidase-4 inhibitors between Asians and non-Asians: a systematic review and meta-analysis. Diabetologia. 2013;56:696–708.CrossRefPubMed
Metadaten
Titel
Regulation of glucose metabolism by incretins: implications for treatment of type 2 diabetes
verfasst von
Rie Saito
Norio Harada
Publikationsdatum
06.12.2024
Verlag
Springer Nature Singapore
Erschienen in
Diabetology International
Print ISSN: 2190-1678
Elektronische ISSN: 2190-1686
DOI
https://doi.org/10.1007/s13340-024-00781-y

Kompaktes Leitlinien-Wissen Innere Medizin (Link öffnet in neuem Fenster)

Mit medbee Pocketcards schnell und sicher entscheiden.
Leitlinien-Wissen kostenlos und immer griffbereit auf ihrem Desktop, Handy oder Tablet.

Neu im Fachgebiet Innere Medizin

Verbände und Cremes gegen Dekubitus: „Wir wissen nicht, was sie bringen!“

Die Datenlage zur Wirksamkeit von Verbänden oder topischen Mitteln zur Prävention von Druckgeschwüren sei schlecht, so die Verfasser einer aktuellen Cochrane-Studie. Letztlich bleibe es unsicher, ob solche Maßnahmen den Betroffenen nutzen oder schaden.

Schützt das tägliche Glas Milch vor Darmkrebs?

Die Milch machts – sie bietet Frauen nach Daten einer großen Ernährungsanalyse den besten Darmkrebsschutz aller Lebensmittel, was am hohen Kalziumgehalt liegen dürfte. Am anderen Ende des Spektrums steht der Alkoholkonsum: Das Glas Wein am Abend ist eher ungünstig.

Vorsicht mit Glukokortikoiden bei Glomerulopathie

Auch niedrig dosierte Glukokortikoide zur Behandlung einer primären Glomerulopathie lassen offenbar die Infektionsgefahr steigen. In einer US-Studie hing das Risiko vor allem mit der kombinierten Anwendung von Immunsuppressiva zusammen.

KI-gestütztes Mammografiescreening überzeugt im Praxistest

Mit dem Einsatz künstlicher Intelligenz lässt sich die Detektionsrate im Mammografiescreening offenbar deutlich steigern. Mehr unnötige Zusatzuntersuchungen sind laut der Studie aus Deutschland nicht zu befürchten.

EKG Essentials: EKG befunden mit System (Link öffnet in neuem Fenster)

In diesem CME-Kurs können Sie Ihr Wissen zur EKG-Befundung anhand von zwölf Video-Tutorials auffrischen und 10 CME-Punkte sammeln.
Praxisnah, relevant und mit vielen Tipps & Tricks vom Profi.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.