Rasul Sazan, Geist Barbara Katharina, Brath Helmut, Baltzer Pascal, Sundar Lalith Kumar Shiyam, Pichler Verena, Mitterhauser Markus, Kautzky-Willer Alexandra, Hacker Marcus
Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria.
Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
BMJ Open Diabetes Res Care. 2020 Mar;8(1). doi: 10.1136/bmjdrc-2019-001135.
Inhibitors of sodium-glucose linked transporter-2 (SGLT2i) are enhancing glucose excretion in the proximal renal tubules, and thus are increasingly used to lower blood glucose levels in patients with type 2 diabetes mellitus (T2DM). The glucose analog 2-deoxy-2-(F) fluoro-D-glucose (FDG) can be used to quantify renal function in vivo, and due to an affinity for SGLT2 could also provide information about SGLT2 transporter function. Our objectives in this study were, therefore, to assess the impact of SGLT2i on renal function parameters in patients with T2DM and identify predictive parameters of long-term response to SGLT2i using dynamic FDG positron emission tomography (PET)/MRI.
PET FDG renal function measures such as mean transit time (MTT) and general renal performance (GRP) together with glomerular filtration rate (GFR) were determined in 20 patients with T2DM before (T2DM) and 2 weeks after initiation of therapy with SGLT2i (T2DM). Additionally, dynamic FDG PET data of 24 healthy subjects were used as controls.
MTT in T2DM was significantly higher than in healthy controls (5.7 min vs 4.3 min, p=0.012) and significantly decreased to 4.4 min in T2DM (p=0.004). GRP of T2DM was higher than of T2DM (5.2 vs 4.7, p=0.02) and higher but not significantly than of healthy individuals (5.2 vs 5.1, p=0.34). Expectedly, GFR of healthy participants was significantly higher than of T2DM and T2DM (122 vs 92 and 86 mL/min/1.73 m², respectively; p<0.001). The higher the GRP value in kidneys of T2DM, the lower was the glycated hemoglobin level 3 months after therapy initiation.
MTT and GRP values of patients with T2DM shifted significantly toward values of healthy control 2 weeks after therapy with SGLT2i begins. GRP in T2DM was associated with better long-term glycemic response 3 months after initiation of therapy.
NCT03557138.
钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）可增强近端肾小管对葡萄糖的排泄，因此越来越多地用于降低2型糖尿病（T2DM）患者的血糖水平。葡萄糖类似物2-脱氧-2-（F）氟-D-葡萄糖（FDG）可用于体内定量肾功能，并且由于其对SGLT2的亲和力，还可提供有关SGLT2转运蛋白功能的信息。因此，我们在本研究中的目标是评估SGLT2i对T2DM患者肾功能参数的影响，并使用动态FDG正电子发射断层扫描（PET）/磁共振成像（MRI）确定对SGLT2i长期反应的预测参数。
在20例T2DM患者治疗前（T2DM）和开始使用SGLT2i治疗2周后（T2DM），测定PET FDG肾功能指标，如平均通过时间（MTT）和总体肾功能（GRP）以及肾小球滤过率（GFR）。此外，将24名健康受试者的动态FDG PET数据用作对照。
T2DM患者的MTT显著高于健康对照组（5.7分钟对4.3分钟，p = 0.012），在T2DM时显著降至4.4分钟（p = 0.004）。T2DM患者的GRP高于T2DM患者（5.2对4.7，p = 0.02），高于健康个体但无显著差异（5.2对5.1，p = 0.34）。不出所料，健康参与者的GFR显著高于T2DM患者和T2DM患者（分别为122对92和86 mL/min/1.73 m²；p<0.001）。T2DM患者肾脏中GRP值越高，治疗开始后3个月糖化血红蛋白水平越低。
T2DM患者在开始使用SGLT2i治疗2周后，MTT和GRP值显著向健康对照值转变。T2DM患者的GRP与治疗开始后3个月更好的长期血糖反应相关。
NCT03557138。
