Ito Daisuke, Ikuma-Suwa Emi, Inoue Kazuyuki, Kaneko Kimie, Yanagisawa Morifumi, Inukai Kouichi, Noda Mitsuhiko, Shimada Akira
Department of Endocrinology and Diabetes, Saitama Medical University, Saitama, Japan; Department of Internal Medicine, Ogawa Red Cross Hospital, Saitama, Japan.
Department of Endocrinology and Diabetes, Saitama Medical University, Saitama, Japan.
J Clin Med Res. 2017 Feb;9(2):154-162. doi: 10.14740/jocmr2875w. Epub 2016 Dec 31.
Sodium-glucose cotransporter 2 (SGLT2) inhibitors are novel agents used to treat type 2 diabetic patients. We investigated the efficacy of the SGLT2 inhibitor ipragliflozin on diabetic nephropathy in Japanese patients with type 2 diabetes.
A 50 mg dose of ipragliflozin was administered for 24 weeks to 50 patients with type 2 diabetes who were concomitantly managed with diet and exercise therapy alone or antidiabetic medications other than SGLT2 inhibitors.
At the end of the 24-week ipragliflozin treatment, significant decreases in mean glycated hemoglobin (HbA1c) (1.0±1.2%) and body weight (2.7 ± 2.5 kg) were observed; in addition, median urinary albumin-to-creatinine ratio (UACR) significantly decreased from 15.5 (8.0 - 85.7) to 12.9 (7.4 - 36.3) mg/gCr. Sub-analysis by renal function at baseline revealed that median UACR in patients with estimated glomerular filtration rate (eGFR) ≥ 90 mL/min/1.73 m decreased significantly from 12.3 (7.5 - 89.6) to 10.6 (5.8 - 27.3) mg/gCr. Furthermore, mean eGFR decreased significantly from 102.4 ± 8.6 to 93.6 ± 10.5 mL/min/1.73 m in these patients. In contrast, UACR and eGFR did not change significantly in patients with eGFR < 90. In addition, analysis of the relationship between the amount of change in UACR and blood pressure at 24 weeks revealed a significant positive correlation between UACR and SBP values, independently of the presence of diabetic nephropathy.
Our results indicate that ipragliflozin may facilitate HbA1c control and body weight reduction. Furthermore, our results also raise the possibility that ipragliflozin significantly reduces urinary albumin levels and improves glomerular hyperfiltration in a subset of patients with type 2 diabetes.
钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂是用于治疗2型糖尿病患者的新型药物。我们研究了SGLT2抑制剂依帕列净对日本2型糖尿病患者糖尿病肾病的疗效。
对50例2型糖尿病患者给予50mg依帕列净治疗24周，这些患者仅接受饮食和运动疗法或接受除SGLT2抑制剂以外的抗糖尿病药物联合治疗。
在24周依帕列净治疗结束时，观察到糖化血红蛋白（HbA1c）均值显著下降（1.0±1.2%），体重显著下降（2.7±2.5kg）；此外，尿白蛋白与肌酐比值（UACR）中位数从15.5（8.0 - 85.7）显著降至12.9（7.4 - 36.3）mg/gCr。根据基线肾功能进行的亚组分析显示，估算肾小球滤过率（eGFR）≥90 mL/min/1.73 m²的患者UACR中位数从12.3（7.5 - 89.6）显著降至10.6（5.8 - 27.3）mg/gCr。此外，这些患者的平均eGFR从102.4±8.6显著降至93.6±10.5 mL/min/1.73 m²。相比之下，eGFR<90的患者UACR和eGFR没有显著变化。此外，对24周时UACR变化量与血压之间关系的分析显示，UACR与收缩压值之间存在显著正相关，与糖尿病肾病的存在无关。
我们的结果表明依帕列净可能有助于控制HbA1c和减轻体重。此外，我们的结果还提出了依帕列净可显著降低一部分2型糖尿病患者尿白蛋白水平并改善肾小球高滤过的可能性。
