Avranas Konstantinos, Imprialos Konstantinos, Stavropoulos Konstantinos, Lales Georgios, Manafis Alexandos, Skalkou Anastasia, Kihm Lars
Department of Internal Medicine I, Clinic for Endocrinology, Metabolism and Clinical Chemistry, University of Heidelberg, Germany.
Second Propedeutic Department of Internal Medicine, Hippokration Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Cardiovasc Hematol Disord Drug Targets. 2018;18(2):94-103. doi: 10.2174/1871529X18666180206160838.
The treatment of diabetes remains challenging over the decades, even after the introduction of numerous novel drugs of different classes. Most patients with type 2 diabetes require a combination of multiple agents and eventually the use of insulin. The newest antidiabetic drugs, possibly with the most pleiotropic actions after metformin are the sodium-glucose cotransporter 2 (SGLT-2) inhibitors (SGLT-2i). This class has a unique mechanism inhibiting the glucose reabsorption in the proximal tubule of the kidney.
The purpose of this review is to critically discuss the beneficial effect of SGLT-2i on glycemic control as monotherapy or in combination with other hypoglycemic agents.
A systematic review of randomised clinical trials on SGLT-2i vs placebo, other glucoselowering drugs or insulin was performed, and studies assessing glycemic control, mainly expressed through glycated hemoglobin and fasting plasma glucose levels (FPG) were included in the review. Electronic and manual searches on MEDLINE, EMBASE and Cochrane Library were performed.
In our review, we mainly focused on dapagliflozin, empaglifozin and canagliflozin. All agents exhibited a sufficient reduction of HbA1c as well as FPG.
SGLT-2i are a reliable second-line therapy of T2DM, since they can be combined safely with metformin, sulfonylures, incretin mimetics, insulin as well as in triple combinations. In many studies, they were prioritised as monotherapy with satisfying effects regarding HbA1c and FPG level reductions.
几十年来，即使引入了众多不同类型的新型药物，糖尿病的治疗仍然具有挑战性。大多数2型糖尿病患者需要多种药物联合使用，最终还需使用胰岛素。最新的抗糖尿病药物，可能是继二甲双胍之后具有最多效作用的药物，是钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂（SGLT-2i）。这类药物具有独特的机制，可抑制肾脏近端小管中的葡萄糖重吸收。
本综述的目的是批判性地讨论SGLT-2i作为单一疗法或与其他降糖药物联合使用对血糖控制的有益作用。
对SGLT-2i与安慰剂、其他降糖药物或胰岛素的随机临床试验进行了系统综述，纳入了评估血糖控制的研究，主要通过糖化血红蛋白和空腹血糖水平（FPG）来表示。在MEDLINE、EMBASE和Cochrane图书馆进行了电子和手动检索。
在我们的综述中，我们主要关注达格列净、恩格列净和卡格列净。所有药物均使糖化血红蛋白以及空腹血糖有足够程度的降低。
SGLT-2i是2型糖尿病可靠的二线治疗药物，因为它们可以安全地与二甲双胍、磺脲类药物、肠促胰岛素类似物、胰岛素联合使用，也可进行三联联合使用。在许多研究中，它们被优先作为单一疗法，在降低糖化血红蛋白和空腹血糖水平方面具有令人满意的效果。
