Desouza Cyrus V, Gupta Namita, Patel Anery
Omaha Veterans Affairs Medical Center, Omaha, Nebraska; Department of Internal Medicine, Division of Diabetes, Endocrine, and Metabolism, University of Nebraska Medical Center, Omaha, Nebraska.
Department of Internal Medicine, Division of Diabetes, Endocrine, and Metabolism, University of Nebraska Medical Center, Omaha, Nebraska.
Clin Ther. 2015 Jun 1;37(6):1178-94. doi: 10.1016/j.clinthera.2015.02.016. Epub 2015 Mar 7.
Within the past decade, many new classes of drugs have received approval from the US Food and Drug Administration for treatment of type 2 diabetes mellitus, including glucagon-like peptide-1agonists, dipeptidyl peptidase-4 inhibitors, and the sodium-glucose cotransporter-2 inhibitors. Many trials have been performed, and several more are currently ongoing to evaluate these drugs. This review addresses the broad therapeutic and pleiotropic effects of these drugs. The review also discusses the role of these drugs in the treatment paradigm for type 2 diabetes and identifies patients who would be suitable candidates for treatment with these drugs.
In this comprehensive evidence-based review, the following databases were searched from 1990 to the present: PubMed/MEDLINE, Scopus, CINAHL, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Portal, and the American Diabetes Association and European Association for the Study of Diabetes abstract databases. Randomized clinical trials (RCTs) were only included for the main therapeutic and cardiovascular (CV) effects of these drug classes. For pleiotropic effects, RCTs were included unless no RCTs exist, in which case other studies as specified in the detailed Methods section were included.
All 3 drug classes are effective in lowering hemoglobin A1c between 0.4% and 1.4%, depending on the drug class and population selected. These drug classes have beneficial effects on CV risk factors, such as weight, lipids, and blood pressure, in addition to lowering blood glucose levels. The CV tolerability of some drugs has been evaluated and found to be neutral; however, most trials are currently ongoing to assess CV tolerability. There are no concrete guidelines to determine where these drugs fit in the diabetes management paradigm, and there are ongoing trials to determine the best combination drug with metformin.
These 3 drug classes will potentially increase the armamentarium against hyperglycemia. However, the specific combinations with other antidiabetic drugs and populations that will best benefit from these drugs are still being tested. Future research is also being conducted on the use of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors in patients with type 1 diabetes.
在过去十年中，许多新型药物已获得美国食品药品监督管理局批准用于治疗2型糖尿病，包括胰高血糖素样肽-1激动剂、二肽基肽酶-4抑制剂和钠-葡萄糖协同转运蛋白-2抑制剂。已经进行了许多试验，目前还有几项试验正在进行以评估这些药物。本综述阐述了这些药物广泛的治疗作用和多效性作用。该综述还讨论了这些药物在2型糖尿病治疗模式中的作用，并确定了适合使用这些药物进行治疗的患者。
在这项全面的循证综述中，检索了1990年至今的以下数据库：PubMed/MEDLINE、Scopus、CINAHL、ClinicalTrials.gov、世界卫生组织国际临床试验注册平台以及美国糖尿病协会和欧洲糖尿病研究协会的摘要数据库。随机临床试验（RCT）仅纳入用于这些药物类别主要治疗作用和心血管（CV）作用的研究。对于多效性作用，纳入RCT，除非不存在RCT，在这种情况下纳入详细方法部分中指定的其他研究。
所有这3类药物在降低糖化血红蛋白方面都有效，降低幅度在0.4%至1.4%之间，具体取决于所选药物类别和人群。除了降低血糖水平外，这些药物类别对心血管危险因素，如体重、血脂和血压，也有有益作用。已对一些药物的心血管耐受性进行了评估，发现其为中性；然而，目前大多数试验正在进行以评估心血管耐受性。尚无具体指南来确定这些药物在糖尿病管理模式中的位置，并且正在进行试验以确定与二甲双胍的最佳联合用药。
这3类药物可能会增加对抗高血糖的手段。然而，与其他抗糖尿病药物的具体联合用药以及最能从这些药物中获益的人群仍在测试中。未来还将对1型糖尿病患者使用胰高血糖素样肽-1受体激动剂和钠-葡萄糖协同转运蛋白-2抑制剂进行研究。
