El Mouhayyar Christopher, Riachy Ruba, Khalil Abir Bou, Eid Asaad, Azar Sami
Department of Anatomy, Cell Biology and Physiology, American University of Beirut, Beirut, Lebanon.
Diabetes Program, American University of Beirut-Medical Center, Beirut, Lebanon.
Int J Endocrinol. 2020 Feb 29;2020:1762164. doi: 10.1155/2020/1762164. eCollection 2020.
The prevalence of diabetes and its associated complications is increasing throughout the decades. Promising diabetes medications were introduced to the market including GLP-1 agonists, DPP-4 inhibitors, and SGLT2 inhibitors aiming to target these complications. The literature lacks sufficient data regarding these new medications and their influence on nephropathy, retinopathy, and neuropathy. This review expands on the major results of effects of the 3 drug classes on microvascular complications. In our review, both SGLT2 inhibitors and GLP-1 agonists appear to have promising nephroprotective outcomes at this stage, with less promising outcomes seen with DPP-4 inhibitors. Moreover, the retinoprotective outcomes of both SGLT2 inhibitors and DPP-4 inhibitors were only tested on mice, while those of GLP-1 agonists were assessed in few trials. In addition, the results of both GLP-1 agonists and DPP-4 inhibitors showed discrepancies in these studies. On the contrary, conclusions regarding the effect of these medications on neuroprotective outcomes cannot be drawn at the time due to the lack of clinical trials targeting these complications. Hence, a clearer picture of the microvascular outcomes will manifest over time with the release of multiple upcoming clinical trials.
几十年来，糖尿病及其相关并发症的患病率一直在上升。包括胰高血糖素样肽-1（GLP-1）受体激动剂、二肽基肽酶-4（DPP-4）抑制剂和钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂在内的有前景的糖尿病药物被引入市场，旨在针对这些并发症。文献中缺乏关于这些新药及其对肾病、视网膜病变和神经病变影响的充分数据。本综述详细阐述了这三类药物对微血管并发症影响的主要结果。在我们的综述中，目前SGLT2抑制剂和GLP-1受体激动剂似乎都有有前景的肾脏保护效果，而DPP-4抑制剂的效果则不太理想。此外，SGLT2抑制剂和DPP-4抑制剂的视网膜保护效果仅在小鼠身上进行了测试，而GLP-1受体激动剂的视网膜保护效果仅在少数试验中进行了评估。此外，GLP-1受体激动剂和DPP-4抑制剂在这些研究中的结果存在差异。相反，由于缺乏针对这些并发症的临床试验，目前无法得出这些药物对神经保护效果的结论。因此，随着多个即将开展的临床试验结果的公布，微血管结局的情况将随着时间的推移而更加清晰。
