Mintz Matthew L
George Washington University School of Medicine, Washington, DC, USA.
J Fam Pract. 2016 Dec;65(12 Suppl).
The aim of this supplement is to discuss the important role of the kidney in glucose homeostasis. It produces glucose via gluconeogenesis, it filters glucose from the blood, and reabsorbs the filtered glucose in the proximal tubule, mainly via the sodium-glucose cotransporter-2 (SGLT-2). SGLT-2 is paradoxically upregulated in individuals with type 2 diabetes (T2D), which results in increased glucose reabsorption and hyperglycemia. This core defect in the pathophysiology of T2D provides the rationale for the use of SGLT-2 inhibitors to increase urinary glucose excretion and reduce hyperglycemia in an insulin-independent manner. Benefits of SGLT-2 inhibitor use in patients with T2D, in addition to improved glycemic control, include modest weight loss, decreased systolic blood pressure, reduced serum uric acid, and reduced risk of cardiovascular events. Common adverse events are urinary tract infection and genital mycotic infections. The risk of hypoglycemia is low with SGLT-2 inhibitors, particularly when they are given as monotherapy.
本增刊的目的是讨论肾脏在葡萄糖稳态中的重要作用。它通过糖异生作用产生葡萄糖，从血液中过滤葡萄糖，并主要通过钠-葡萄糖协同转运蛋白2（SGLT-2）在近端小管中重吸收过滤后的葡萄糖。矛盾的是，SGLT-2在2型糖尿病（T2D）患者中上调，这导致葡萄糖重吸收增加和高血糖。T2D病理生理学中的这一核心缺陷为使用SGLT-2抑制剂以非胰岛素依赖方式增加尿糖排泄和降低高血糖提供了理论依据。SGLT-2抑制剂用于T2D患者的益处，除了改善血糖控制外，还包括适度体重减轻、收缩压降低、血清尿酸降低以及心血管事件风险降低。常见的不良事件是尿路感染和生殖器真菌感染。使用SGLT-2抑制剂时低血糖风险较低，尤其是单药治疗时。
