Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK; Diabetes Research Centre, University of Leicester, UK.
Department of Clinical & Experimental Medicine, Section of Diabetes & Metabolic Diseases, University of Pisa, Pisa, Italy.
Metabolism. 2020 Jun;107:154242. doi: 10.1016/j.metabol.2020.154242. Epub 2020 Apr 18.
In recent years guidelines for the treatment of type 2 diabetes (T2DM) have evolved substantially. Initially limited to a few glucose lowering agents, early guidelines predicated strict glycemic control as a main goal in the attempt to reduce the risk of long-term diabetic complications. Nowadays, guidelines are not limited to such a goal but include cardiovascular (and renal) protection. This rapid evolution was made possible by the introduction of new glucose lowering agents, which have been extensively tested in randomized clinical studies including large cardiovascular outcome trials (CVOTs). In this review we will specifically consider the use of incretin-based medications in T2DM as recommended in the recent ADA/EASD consensus, and other international guidelines, with special consideration of their glucose-lowering efficacy, their cardiovascular (and renal) benefit, their effect on body weight and risk of hypoglycemia, as well as the economic implications for their use.
近年来，2 型糖尿病（T2DM）的治疗指南发生了重大变化。最初仅限于少数几种降血糖药物，早期的指南将严格的血糖控制作为主要目标，试图降低长期糖尿病并发症的风险。如今，指南不仅限于这样的目标，还包括心血管（和肾脏）保护。这种快速发展得益于新型降血糖药物的推出，这些药物在包括大型心血管结局试验（CVOTs）在内的随机临床试验中得到了广泛测试。在本综述中，我们将特别考虑最近的 ADA/EASD 共识以及其他国际指南中推荐的基于肠促胰岛素的药物在 T2DM 中的应用，特别考虑它们的降糖效果、心血管（和肾脏）获益、对体重和低血糖风险的影响，以及使用这些药物的经济意义。
