肾脏和 SGLT2 抑制剂在 2 型糖尿病中的作用。

The Role of the Kidney and SGLT2 Inhibitors in Type 2 Diabetes.

机构信息

Department of Medicine, Section of Endocrinology and Metabolism, University of Manitoba, St. Boniface Hospital, Winnipeg, Manitoba, Canada.

Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Division of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada.

出版信息

Can J Diabetes. 2015 Dec;39 Suppl 5:S167-75. doi: 10.1016/j.jcjd.2015.09.001.

Abstract

Effective glycemic control reduces the risk for diabetes-related complications. However, the majority of patients with type 2 diabetes still do not achieve glycemic targets. Beyond metformin therapy, current practice guidelines for the management of type 2 diabetes recommend individualized treatment based on patient and agent characteristics. The sodium glucose cotransporter type 2 (SGLT2) inhibitors represent a novel treatment strategy, independent of impaired beta-cell function and insulin resistance. SGLT2 inhibitors decrease renal glucose reabsorption, thereby increasing urinary glucose excretion with subsequent reduction in plasma glucose levels and glycosylated hemoglobin concentrations. Current evidence suggests that they are effective as monotherapy or as add-ons to metformin either alone, or in combination with other oral glucose-lowering agents or insulin. They are generally well tolerated, though rates of lower urinary tract and genital mycotic infections are slightly increased. The advantages of this class include modest reductions in body weight and blood pressure, and low risk for hypoglycemia. Long-term safety data and results of ongoing cardiovascular outcome studies are awaited so we can fully understand the role that SGLT2 inhibitors will play in the comprehensive management of type 2 diabetes.

摘要

有效的血糖控制可降低与糖尿病相关并发症的风险。然而,大多数 2 型糖尿病患者仍未达到血糖目标。除了二甲双胍治疗外,2 型糖尿病管理的现行实践指南还建议根据患者和药物特点进行个体化治疗。钠-葡萄糖共转运蛋白 2(SGLT2)抑制剂是一种新的治疗策略,不依赖于受损的β细胞功能和胰岛素抵抗。SGLT2 抑制剂可减少肾脏对葡萄糖的重吸收,从而增加尿糖排泄,进而降低血糖水平和糖化血红蛋白浓度。目前的证据表明,它们可作为单药治疗或与二甲双胍联合治疗,无论是单独使用,还是与其他口服降糖药物或胰岛素联合使用,均有效。它们通常具有良好的耐受性,尽管下尿路感染和生殖器真菌感染的发生率略有增加。该类药物的优点包括体重和血压适度降低,以及低血糖风险低。需要等待长期安全性数据和正在进行的心血管结局研究结果,以便我们充分了解 SGLT2 抑制剂在 2 型糖尿病综合管理中的作用。

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