Scripps Clinic, La Jolla, California, USA.
J Diabetes. 2015 Jul;7(4):448-61. doi: 10.1111/1753-0407.12278. Epub 2015 May 18.
In the treatment of type 2 diabetes mellitus (T2DM), a relatively new class of oral agents inhibits sodium-glucose cotransporter 2 (SGLT2), reducing reabsorption of filtered glucose and increasing urinary glucose excretion. Numerous SGLT2 inhibitors have been approved for the treatment of T2DM in adults, most recently empagliflozin, which was approved in Europe and the US in 2014. The Phase 3 program has enrolled >14,000 patients and has assessed the efficacy and safety of empagliflozin as monotherapy and in combination. These studies have demonstrated improvements in glycemic control, and modest reductions in body weight and blood pressure. Empagliflozin was generally well tolerated, with no increased risk of hypoglycemia versus placebo as monotherapy or as add-on therapy, except when given with sulfonylurea. The studies showed an increased risk of urinary tract and genital infections with empagliflozin, although most infections were mild to moderate in intensity. Furthermore, small (but clinically insignificant) increases in hematocrit and lipid levels have been observed for empagliflozin. Due to the mode of action of empagliflozin, care should be exercised when treating patients at risk of volume depletion. The risks and benefits must be weighed for each patient, but the data reviewed herein show promise for empagliflozin as a treatment for patients with T2DM.
在 2 型糖尿病(T2DM)的治疗中,一类相对较新的口服药物抑制钠-葡萄糖协同转运蛋白 2(SGLT2),减少滤过葡萄糖的重吸收并增加尿葡萄糖排泄。许多 SGLT2 抑制剂已被批准用于成人 T2DM 的治疗,最近的是恩格列净,它于 2014 年在欧洲和美国获得批准。该 3 期项目已纳入超过 14000 名患者,并评估了恩格列净作为单药治疗和联合治疗的疗效和安全性。这些研究表明,恩格列净可改善血糖控制,适度降低体重和血压。恩格列净总体耐受性良好,与安慰剂相比,作为单药或联合治疗时,低血糖风险没有增加,除了与磺脲类药物联合使用时。研究表明,恩格列净会增加尿路感染和生殖道感染的风险,尽管大多数感染的严重程度为轻度至中度。此外,还观察到恩格列净的血细胞比容和血脂水平略有升高(但临床意义不大)。由于恩格列净的作用机制,在治疗有容量不足风险的患者时应谨慎。必须权衡每位患者的风险和获益,但本文综述的数据显示,恩格列净有望成为 T2DM 患者的治疗选择。