降糖药物对心肺适能的影响。
Effects of glucose-lowering agents on cardiorespiratory fitness.
作者信息
Hamasaki Hidetaka
机构信息
Endocrinology and Metabolism, Internal Medicine, Hamasaki Clinic, Kagoshima 890-0046, Japan.
出版信息
World J Diabetes. 2018 Dec 15;9(12):230-238. doi: 10.4239/wjd.v9.i12.230.
Exercise therapy is essential for the management of type 2 diabetes (T2D). However, patients with T2D show lower physical activity and reduced cardiorespiratory fitness than healthy individuals. It would be ideal for clinicians to co-prescribe glucose-lowering agents that improve cardiorespiratory fitness or exercise capacity in conjunction with exercise therapy. Metformin does not improve cardiorespiratory fitness and may attenuate any beneficial effect of exercise in patients with T2D. In contrast, thiazolidinediones appear to improve cardiorespiratory fitness in patients with T2D. Although evidence is limited, sodium-glucose cotransporter 2 (SGLT2) inhibitors may improve cardiorespiratory fitness in patients with heart failure, and the effect of glucagon-like peptide-1 (GLP-1) receptor agonists on cardiorespiratory fitness is controversial. Recent clinical trials have shown that both SGLT2 inhibitors and GLP-1 receptor agonists exert a favorable effect on cardiovascular disease. It becomes more important to choose drugs that have beneficial effects on the cardiovascular system beyond glucose-lowering effects. Further studies are warranted to determine an ideal glucose-lowering agent combined with exercise therapy for the treatment of T2D.
运动疗法对于2型糖尿病（T2D）的管理至关重要。然而，与健康个体相比，T2D患者的身体活动水平较低，心肺适能也有所下降。对于临床医生而言，理想的做法是在进行运动疗法的同时，联合开具能够改善心肺适能或运动能力的降糖药物。二甲双胍并不能改善心肺适能，且可能会削弱运动对T2D患者的任何有益作用。相比之下，噻唑烷二酮类药物似乎可以改善T2D患者的心肺适能。尽管证据有限，但钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂可能会改善心力衰竭患者的心肺适能，而胰高血糖素样肽-1（GLP-1）受体激动剂对心肺适能的影响存在争议。最近的临床试验表明，SGLT2抑制剂和GLP-1受体激动剂对心血管疾病均有有利影响。选择除降糖作用外还对心血管系统有有益作用的药物变得更加重要。有必要进行进一步研究，以确定与运动疗法联合用于治疗T2D的理想降糖药物。
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