Institute of Medical Science, University of Toronto.
Faculty of Medicine, University of Toronto.
Curr Opin Cardiol. 2018 Nov;33(6):676-682. doi: 10.1097/HCO.0000000000000561.
To address common concerns regarding sodium-glucose cotransporter 2 (SGLT2) inhibitor use for patients with type 2 diabetes mellitus (T2DM) in cardiovascular practice.
SGLT2 inhibitors provide glycemic control and improve cardiovascular and renal endpoints in T2DM. Cardiovascular outcome trials have demonstrated sustained cardiovascular, heart failure and renal benefits independent of glycemic control, which persist down to an eGFR of 30 ml/min/1.73 m. SGLT2 inhibitors can be safely administered alongside common diuretics, and routine monitoring of renal function is advised at initiation of therapy, particularly for patients on loop diuretics. Mild initial reductions in eGFR are expected, usually stabilizing over time. The most common adverse effect noted with SGLT2 inhibitors is genital mycotic infections, primarily in women. Less common, but concerning effects associated with canagliflozin include increased risk of fractures and lower limb amputations, particularly in patients with previous amputation history. Overall, SGLT2 inhibitors are well tolerated and effective adjuncts to diabetic treatment, for which the benefits seem to outweigh the risks.
The care of patients with T2DM requires an interdisciplinary team approach, within which the role of cardiologists is expanding. SGLT2 inhibitors are an encouraging treatment option for achieving glycemic control, whilst also improving cardiovascular and renal outcomes.
解决在心血管疾病实践中，2 型糖尿病（T2DM）患者使用钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂的常见问题。
SGLT2 抑制剂可控制血糖，改善 T2DM 的心血管和肾脏结局。心血管结局试验显示，SGLT2 抑制剂具有持续的心血管、心力衰竭和肾脏获益，独立于血糖控制，甚至在 eGFR 低至 30ml/min/1.73m 时仍持续存在。SGLT2 抑制剂可与常用利尿剂安全合用，建议在开始治疗时监测肾功能，特别是对于使用袢利尿剂的患者。预计最初会出现 eGFR 轻度下降，通常会随时间稳定。SGLT2 抑制剂最常见的不良反应是生殖器真菌感染，主要发生在女性。坎格列净相关的不太常见但令人担忧的影响包括骨折和下肢截肢风险增加，特别是对于有既往截肢史的患者。总体而言，SGLT2 抑制剂耐受性良好，是糖尿病治疗的有效辅助手段，其益处似乎超过了风险。
T2DM 患者的治疗需要多学科团队的方法，其中心脏病专家的角色正在扩大。SGLT2 抑制剂是一种有前途的治疗选择，可控制血糖，同时改善心血管和肾脏结局。
