Scheen A J, Paquot N
Service de Diabétologie, Nutrition et Maladies métaboliques et Unité de Pharmacologie clinique, CHU Liège, Belgique.
) Service de Diabétologie, Nutrition et Maladies métaboliques, CHU Liège, Belgique.
Rev Med Liege. 2020 May;75(5-6):392-398.
Type 2 diabetes is a complex disease with an increasing prevalence and a huge morbidity and premature mortality, essentially due to cardiovascular and renal complications. Classical glucose-lowering agents (metformin, sulphonylureas) exert little protective effects on these complications so that emphasis has been put on a multifactorial management targeting all risk factors. Gliptins offer the advantage of an excellent tolerance profile, with no hypoglycaemia or weight gain, but have not shown any specific cardiovascular or renal protection. Over the last decade, new antidiabetic medications (glucagon-like peptide-1 receptor agonists and gliflozins) have demonstrated a cardiovascular and renal protection, independently of glucose control. These data of evidence-based medicine have revolutionized the therapeutic approach of patients with type 2 diabetes who are at high risk of atherosclerotic cardiovascular disease, heart failure and progressive renal disease. Unexpectedly, the protective effect of gliflozins is currently investigated in patients with heart failure or renal disease, in the absence of diabetes.
2型糖尿病是一种复杂的疾病，其患病率不断上升，发病率和过早死亡率极高，主要归因于心血管和肾脏并发症。传统的降糖药物（二甲双胍、磺脲类药物）对这些并发症几乎没有保护作用，因此重点已放在针对所有风险因素的多因素管理上。格列汀类药物具有耐受性良好的优势，不会导致低血糖或体重增加，但尚未显示出任何特定的心血管或肾脏保护作用。在过去十年中，新型抗糖尿病药物（胰高血糖素样肽-1受体激动剂和钠-葡萄糖协同转运蛋白2抑制剂）已证明具有心血管和肾脏保护作用，且独立于血糖控制。这些循证医学数据彻底改变了患有动脉粥样硬化性心血管疾病、心力衰竭和进行性肾脏疾病高风险的2型糖尿病患者的治疗方法。出乎意料的是，目前正在没有糖尿病的心力衰竭或肾脏疾病患者中研究钠-葡萄糖协同转运蛋白2抑制剂的保护作用。
