Busch Robert S, Kane Michael P
a Albany Medical Center Division of Community Endocrinology , Albany , NY , USA.
b Department of Pharmacy Practice , Albany College of Pharmacy and Health Sciences , Albany , NY , USA.
Postgrad Med. 2017 Sep;129(7):686-697. doi: 10.1080/00325481.2017.1342509. Epub 2017 Jun 28.
Among persons with type 2 diabetes (t2d), the development of glucose intolerance involves dysfunction in several organs and tissues, including the muscle, liver, pancreas, kidney, gastrointestinal tract, adipose tissue, and brain. individuals with t2d typically have a number of comorbidities, including hypertension, hyperlipidemia, and being overweight or obese, and are, consequently, at high cardiovascular risk. guidelines recommend a comprehensive care strategy that includes treatment of diabetes-related complications and comorbidities beyond those related to hyperglycemia. use of glucose-lowering therapies with complementary activities that address multiple facets of the disease may improve long-term outcomes for patients with t2d. two recent drug classes developed for use in t2d, glucagon-like peptide-1 receptor agonists (glp-1ras) and sodium glucose cotransporter 2 (sglt2) inhibitors, have been shown in clinical trials to have beneficial effects on glycemic control, body weight, cardiovascular risk factors, and (for liraglutide, semaglutide, and empagliflozin) cardiovascular outcomes, while having an acceptable safety profile. between them, these drug classes directly or indirectly affect many of the organs and tissues involved in the pathogenesis of t2d, and their beneficial effects on glycemic- and cardiovascular-related parameters are likely to be complementary and potentially additive. in the largest clinical trial of a glp-1ra and an sglt2 inhibitor in combination (duration-8), patients with t2d (n = 685) who received exenatide plus dapagliflozin added to their treatment regimen for 28 weeks had significantly greater reductions from baseline in glycated hemoglobin, body weight, and systolic blood pressure compared with patients who received either drug as monotherapy. this review summarizes the complementary aspects of these drug classes and presents the available data among patients receiving dual therapy with a glp-1ra and an sglt2 inhibitor.
在2型糖尿病（T2D）患者中，葡萄糖耐量异常的发生涉及多个器官和组织的功能障碍，包括肌肉、肝脏、胰腺、肾脏、胃肠道、脂肪组织和大脑。T2D患者通常有多种合并症，包括高血压、高脂血症以及超重或肥胖，因此心血管风险很高。指南推荐一种综合治疗策略，包括治疗与糖尿病相关的并发症以及除高血糖相关并发症之外的合并症。使用具有互补作用、能解决该疾病多个方面问题的降糖疗法，可能会改善T2D患者的长期预后。最近开发用于治疗T2D的两类药物，即胰高血糖素样肽-1受体激动剂（GLP-1RAs）和钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂，在临床试验中已显示出对血糖控制、体重、心血管危险因素以及（对于利拉鲁肽、司美格鲁肽和恩格列净）心血管结局有有益影响，同时具有可接受的安全性。这两类药物之间直接或间接影响参与T2D发病机制的许多器官和组织，它们对血糖和心血管相关参数的有益作用可能具有互补性且可能相加。在一项GLP-1RA和SGLT2抑制剂联合使用的最大规模临床试验（持续时间8年）中，接受艾塞那肽加达格列净并添加到其治疗方案中28周的T2D患者（n = 685），与接受单一药物治疗的患者相比，糖化血红蛋白、体重和收缩压从基线的降低幅度显著更大。本综述总结了这两类药物的互补方面，并展示了接受GLP-1RA和SGLT2抑制剂联合治疗患者的现有数据。
