Minneapolis VA Center for Care Delivery and Outcomes Research, Minneapolis, Minn; Associate Professor of Medicine, University of Minnesota, Minneapolis.
Am J Med. 2020 Feb;133(2):182-185. doi: 10.1016/j.amjmed.2019.08.013. Epub 2019 Sep 5.
Sodium-glucose cotransporter 2 (SGLT2) inhibitors are a novel class of medications that reduce plasma glucose concentrations through an insulin-independent mechanism of increased urinary glucose excretion, with concomitant natriuresis and diuresis. Clinical outcomes trials with SGLT2 inhibitors revealed a cardioprotective benefit among patients with diabetes mellitus, with a consistent reduction in hospitalization for heart failure. As such, the 2018 updated US and European treatment guidelines for diabetes mellitus incorporated SGLT2 inhibitors as second-line glucose-lowering agents after metformin. Although well tolerated, there are known adverse effects with SGLT2 inhibitors that require clinical monitoring, such as genital mycotic infections, diabetic ketoacidosis, volume depletion particularly in the setting of concomitant diuretic use, and lower limb amputations with canagliflozin. Ongoing clinical trials will uncover the potential benefit of SGLT2 inhibitors in patients with prevalent heart failure with or without diabetes mellitus.
钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂是一类新型药物，通过增加尿葡萄糖排泄的非胰岛素依赖机制降低血浆葡萄糖浓度，同时伴有利钠和利尿作用。SGLT2 抑制剂的临床结局试验显示，在糖尿病患者中具有心脏保护益处，心力衰竭住院率持续降低。因此，2018 年更新的美国和欧洲糖尿病治疗指南将 SGLT2 抑制剂作为二甲双胍后的二线降糖药物。尽管 SGLT2 抑制剂具有良好的耐受性，但已知存在需要临床监测的不良反应，例如生殖器霉菌感染、糖尿病酮症酸中毒、容量不足，特别是在合并使用利尿剂时，以及卡格列净引起的下肢截肢。正在进行的临床试验将揭示 SGLT2 抑制剂在伴或不伴糖尿病的常见心力衰竭患者中的潜在益处。
