John Mathew, Gopinath Deepa, Jagesh Rejitha
Department of Endocrinology and Diabetes, Providence Endocrine and Diabetes Specialty Centre, Thiruvananthapuram, Kerala, India.
Indian J Endocrinol Metab. 2016 Jan-Feb;20(1):22-31. doi: 10.4103/2230-8210.172268.
The treatment of type 2 diabetes is a challenging problem. Most subjects with type 2 diabetes have progression of beta cell failure necessitating the addition of multiple antidiabetic agents and eventually use of insulin. Intensification of insulin leads to weight gain and increased risk of hypoglycemia. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a class of antihyperglycemic agents which act by blocking the SGLT2 in the proximal tubule of the kidney. They have potential benefits in terms of weight loss and reduction of blood pressure in addition to improvements in glycemic control. Further, one of the SGLT2 inhibitors, empagliflozin has proven benefits in reducing adverse cardiovascular (CV) outcomes in a CV outcome trial. Adding SGLT2 inhibitors to insulin in subjects with type 2 diabetes produced favorable effects on glycemic control without the weight gain and hypoglycemic risks associated with insulin therapy. The general risks of increased genital mycotic infections, urinary tract infections, volume, and osmosis-related adverse effects in these subjects were similar to the pooled data of individual SGLT2 inhibitors. There are subsets of subjects with type 2 diabetes who may have insulin deficiency, beta cell autoimmunity, or is prone to diabetic ketoacidosis. In these subjects, SGLT2 inhibitors should be used with caution to prevent the rare risks of ketoacidosis.
2型糖尿病的治疗是一个具有挑战性的问题。大多数2型糖尿病患者存在β细胞功能衰竭的进展,这使得有必要添加多种抗糖尿病药物,并最终使用胰岛素。强化胰岛素治疗会导致体重增加和低血糖风险增加。钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂是一类降糖药物,其作用机制是阻断肾脏近端小管中的SGLT2。除了改善血糖控制外,它们在减轻体重和降低血压方面具有潜在益处。此外,在一项心血管结局试验中,一种SGLT2抑制剂恩格列净已被证明在降低不良心血管(CV)结局方面具有益处。在2型糖尿病患者中,将SGLT2抑制剂添加到胰岛素治疗中,对血糖控制产生了有利影响,且没有胰岛素治疗相关的体重增加和低血糖风险。这些患者中生殖器真菌感染、尿路感染、容量和渗透相关不良反应增加的总体风险与单个SGLT2抑制剂的汇总数据相似。有一部分2型糖尿病患者可能存在胰岛素缺乏、β细胞自身免疫或易患糖尿病酮症酸中毒。在这些患者中,应谨慎使用SGLT2抑制剂,以预防罕见的酮症酸中毒风险。