Ogawa Susumu, Nako Kazuhiro, Ito Sadayoshi
Division of Nephrology, Endocrinology and Vascular Medicine Tohoku University Hospital Sendai Japan.
Division of Research in Student Support, Section of Clinical Medicine, Institute for Excellence in Higher Education Tohoku University Sendai Japan.
Endocrinol Diabetes Metab. 2018 Dec 1;2(1):e00044. doi: 10.1002/edm2.44. eCollection 2019 Jan.
The effects of sodium-glucose cotransporter 2 inhibitors (SGLT2Is) on fasting blood glucose concentration (FBG) in patients with unstable FBG despite undergoing intensive insulin therapy (IIT) remain unclear. This study aimed to identify the effects of SGLT2Is on unstable FBGs.
Thirty brittle diabetic patients with unstable FBGs despite undergoing IIT were included in the study. SGLT2Is were added and used in combination. We evaluated the data of the subjects in Evaluation 1 (immediately before using SGLT2Is) and evaluations 2, 3 and 4 (4, 24 and 48 weeks after starting concomitant therapy, respectively). FBGs were measured every day for a period of 28 days immediately before conducting Evaluations 1, 2, 3 and 4. The mean value of the 28 sets of FBG data (FBG mean) and their standard deviation (SD) values were established as each evaluation's FBGs. The changes in the mean values of the 30 subjects as well as their SD before and after concomitant therapy were evaluated.
The concomitant use of SGLT2Is helped reduce not only FBG mean but also SD. FBG max dropped, and the frequency of occurrence of hyperglycaemic FBG (>11.1 mmol/L) decreased. However, FBG min did not drop, and the frequency of occurrence of hypoglycaemic FBG (<3.9 mmol/L) increased. The frequency of occurrence of subjective hypoglycaemia decreased. The decrease in the SD of FBG was related to the decrease in subjective hypoglycaemia.
Concomitant use of SGLT2Is in patients with brittle diabetes appears to be useful in terms of improvement of FBG and fewer occurrences of hypoglycaemic events.
对于尽管接受了强化胰岛素治疗（IIT）但空腹血糖浓度（FBG）仍不稳定的患者，钠-葡萄糖协同转运蛋白2抑制剂（SGLT2Is）对其FBG的影响尚不清楚。本研究旨在确定SGLT2Is对不稳定FBG的影响。
本研究纳入了30例尽管接受了IIT但FBG仍不稳定的脆性糖尿病患者。添加并联合使用SGLT2Is。我们评估了评估1（使用SGLT2Is之前即刻）以及评估2、3和4（分别为开始联合治疗后4、24和48周）时受试者的数据。在进行评估1、2、3和4之前，连续28天每天测量FBG。将28组FBG数据的平均值（FBG均值）及其标准差（SD）值确定为每次评估的FBG。评估了30名受试者在联合治疗前后的均值变化及其SD。
联合使用SGLT2Is不仅有助于降低FBG均值，还能降低SD。FBG最大值下降，高血糖FBG（>11.1 mmol/L）的发生频率降低。然而，FBG最小值未下降，低血糖FBG（<3.9 mmol/L）的发生频率增加。主观低血糖的发生频率降低。FBG的SD降低与主观低血糖的减少有关。
在脆性糖尿病患者中联合使用SGLT2Is似乎有助于改善FBG，并减少低血糖事件的发生。
