Baruah Manash Pratim, Makkar B M, Ghatnatti Vikrant B, Mandal Kaushik
Department of Endocrinology, Excel Centre, Guwahati, Assam, India.
Dr. Makkar's Diabetes and Obesity Centre, New Delhi, India.
Indian J Endocrinol Metab. 2019 Jan-Feb;23(1):140-149. doi: 10.4103/ijem.IJEM_160_17.
Type 2 diabetes mellitus (T2DM) is a family of metabolic disorders characterized by hyperglycemia as a consequence of abnormalities in insulin secretion and insulin sensitivity. It affects hundreds of millions of people worldwide and leads to increased morbidity, compromised quality of life, higher mortality sodium glucose co-transporter 2 (SGLT2) inhibitors, a new class of oral antidiabetic drugs, have garnered considerable attention in the recent past and are considered potential first-line candidates for the management of T2DM. This review outlines the evidence-based therapeutic efficacy, safety, limitations, and advantages of SGLT2 inhibitors in the management of T2DM. SGLT2 inhibitors work by preventing the kidneys from reabsorbing glucose back into the blood, leading to increase in excretion of glucose through urine, thereby lowering hyperglycemia. Treatment with SGLT2 inhibitors improves A1C levels, reduces blood pressure and body weight, and is overall well tolerated by patients with T2DM. However, additional data on long-term cardiovascular safety are still needed. Characteristic adverse events include mild genital - urinary tract infection more commonly seen in women than in men, but serious infection is uncommon. Their use should be exercised with extra caution in patients suffering from renal impairment. Further, advancing to dual/triple combinational therapies with SGLT2 inhibitors and existing oral antidiabetic options may prove to be a breakthrough in the management of T2DM.
2型糖尿病(T2DM)是一类代谢紊乱疾病,其特征为因胰岛素分泌异常和胰岛素敏感性异常而导致高血糖。它影响着全球数亿人,导致发病率增加、生活质量受损、死亡率上升。钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂是一类新型口服抗糖尿病药物,最近受到了广泛关注,被认为是治疗T2DM的潜在一线候选药物。本综述概述了SGLT2抑制剂在治疗T2DM方面基于证据的治疗效果、安全性、局限性和优势。SGLT2抑制剂的作用机制是阻止肾脏将葡萄糖重新吸收回血液中,导致葡萄糖通过尿液排泄增加,从而降低高血糖。使用SGLT2抑制剂进行治疗可改善糖化血红蛋白(A1C)水平、降低血压和体重,并且T2DM患者总体耐受性良好。然而,仍需要更多关于长期心血管安全性的数据。其特征性不良事件包括轻度泌尿生殖道感染,女性比男性更常见,但严重感染并不常见。对于肾功能受损的患者,应格外谨慎使用。此外,将SGLT2抑制剂与现有的口服抗糖尿病药物推进到双联/三联联合治疗可能会成为T2DM治疗的一个突破。