Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
Diabetes Metab J. 2020 Feb;44(1):11-32. doi: 10.4093/dmj.2019.0208.
The prevalence of obesity in Asia is of epidemic proportions, with an estimated 1 billion overweight/obese individuals in the region. The majority of patients with type 2 diabetes mellitus (T2DM) are overweight/obese, which increases the risk of cardiorenal outcomes in these patients; hence, sustained reductions in body weight and visceral adiposity are important management goals. However, most of the glucose-lowering therapies such as insulin, sulfonylureas, glinides, and thiazolidinediones induce weight gain, which makes the management of overweight/obese T2DM patients challenging. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are the only oral glucose-lowering agents that have been shown to reduce body weight and visceral adiposity. In addition, SGLT-2 inhibitors therapy reduces ectopic fat deposition and improves adipose tissue function and weight-related quality of life. In this article, we aim to consolidate the existing literature on the effects of SGLT-2 inhibitors in Asian patients with T2DM and to produce clinical recommendations on their use in overweight or obese patients with T2DM. Recommendations from international and regional guidelines, as well as published data from clinical trials in Asian populations and cardiovascular outcomes trials are reviewed. Based on the available data, SGLT-2 inhibitors represent an evidence-based therapeutic option for the management of overweight/obese patients with T2DM.
亚洲地区的肥胖患病率呈流行趋势，据估计该地区有 10 亿超重/肥胖人群。大多数 2 型糖尿病（T2DM）患者超重/肥胖，这增加了这些患者心肾结局的风险；因此，持续降低体重和内脏脂肪是重要的管理目标。然而，大多数降血糖药物，如胰岛素、磺酰脲类、格列奈类和噻唑烷二酮类，都会导致体重增加，这使得超重/肥胖的 T2DM 患者的管理具有挑战性。钠-葡萄糖共转运蛋白-2（SGLT-2）抑制剂是唯一被证明可以减轻体重和内脏脂肪的口服降糖药物。此外，SGLT-2 抑制剂治疗还可以减少异位脂肪沉积，改善脂肪组织功能和与体重相关的生活质量。本文旨在总结 SGLT-2 抑制剂在亚洲 T2DM 患者中的现有文献，并就其在超重或肥胖 T2DM 患者中的应用提出临床建议。我们回顾了国际和地区指南的推荐意见、以及来自亚洲人群临床试验和心血管结局试验的已发表数据。基于现有数据，SGLT-2 抑制剂是超重/肥胖 T2DM 患者管理的一种基于证据的治疗选择。
