Department of Endocrinology Diabetology Nutrition, Jean Verdier Hospital, APHP, Paris 13 University, CINFO, CRNH-IdF, Bondy, France.
Department of Endocrinology, Diabetes and Metabolic Diseases, Normandie Univ, UNIROUEN, Rouen University Hospital, Rouen, France.
Diabetes Res Clin Pract. 2020 Jan;159:107947. doi: 10.1016/j.diabres.2019.107947. Epub 2019 Nov 26.
The recent CVOTs which tested the new glucose-lowering drugs (GLD) show that in patients with type 2 diabetes mellitus (T2DM) it is now possible to reduce cardiovascular complications including ischemic events and hospitalization for heart failure, and mortality, and, to some extent, microvascular complications of diabetes, in particular renal outcomes. Additionally CVOTs provide major informations on safety and metabolic effects for long-term use of these drugs. The benefits with GLP-1 RAs are most likely derived through the reduction of atherosclerosis-related events while SGLT-2is seem mostly to reduce heart failure-related events. Specific mechanisms independent from glucose control are involved. Based on CVOTs results it is time, as stated in the new EASD-ADA and ESC/EASD guidelines, to take into consideration such opportunities in the decision-making process when treating T2DM patients, favoring the use of drugs that have shown clear cardiovascular and renal benefits. The treatment decisions require more expertise in the evaluation of cardiovascular and renal risk which becomes a major determinant for the choice of GLD treatment, the target for lipids, the adjustment of anti-hypertensive treatments and the prescription of aspirin. In this context it is essential that endocrinologists-diabetologists communicate more with cardiologists and nephrologists and with the primary care practitioners.
最近的心血管结局试验（CVOT）测试了新型降糖药物（GLD），结果表明，在 2 型糖尿病（T2DM）患者中，现在有可能减少心血管并发症，包括缺血事件和心力衰竭住院，以及死亡率，并在一定程度上减少糖尿病的微血管并发症，特别是肾脏结局。此外，CVOT 还提供了这些药物长期使用的安全性和代谢效应的重要信息。GLP-1RA 的益处可能主要源于减少与动脉粥样硬化相关的事件，而 SGLT-2is 似乎主要减少心力衰竭相关的事件。涉及到一些独立于血糖控制的特定机制。基于 CVOT 的结果，正如新的 EASD-ADA 和 ESC/EASD 指南所述，在治疗 T2DM 患者时，应考虑到这些机会，从而在决策过程中考虑到这些机会，优先选择具有明确心血管和肾脏获益的药物。治疗决策需要更多的专业知识来评估心血管和肾脏风险，这成为 GLD 治疗选择、血脂目标、抗高血压治疗调整和阿司匹林处方的主要决定因素。在这种情况下，内分泌学家-糖尿病学家与心脏病专家和肾病专家以及初级保健医生进行更多的沟通至关重要。
