Müller-Wieland Dirk, Schütt Katharina, Brandts Julia, Marx Nikolaus
Medizinische Klinik I, Universitätsklinikum RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
Herz. 2020 Aug;45(5):493-503. doi: 10.1007/s00059-020-04946-8.
A paradigm change in the treatment of type 2 diabetes has recently emerged due to the introduction of new oral antidiabetic agents. Cardiovascular endpoint studies confirmed the safety of dipeptidyl peptidase 4 (DPP-4) inhibitors and a cardiovascular protective effect for glucagon-like peptide 1 (GLP-1) receptor agonists and sodium-glucose linked transporter 2 (SGLT-2) inhibitors. Furthermore, SGLT‑2 inhibitors reduce the risk for heart failure and have a renoprotective effect. These studies led to changes in clinical recommendations and guidelines. In patients with high or very high cardiorenal risk, SGLT‑2 inhibitors or GLP‑1 receptor agonists are recommended for risk protection independent of HbA1c values, with existing or high risk for chronic heart failure SGLT‑2 inhibitors are the preferred choice. Therefore, the choice of antidiabetic treatment strategy is no longer determined by the level of glycosylated hemoglobin (HbA1c) alone but particularly by the cardiorenal risk of the individual patient.
由于新型口服抗糖尿病药物的引入，2型糖尿病的治疗模式最近发生了变化。心血管终点研究证实了二肽基肽酶4（DPP-4）抑制剂的安全性以及胰高血糖素样肽1（GLP-1）受体激动剂和钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂的心血管保护作用。此外，SGLT-2抑制剂可降低心力衰竭风险并具有肾脏保护作用。这些研究导致了临床建议和指南的改变。对于有高或非常高的心肾风险的患者，推荐使用SGLT-2抑制剂或GLP-1受体激动剂进行风险保护，而不考虑糖化血红蛋白（HbA1c）值；对于已有慢性心力衰竭或有高风险的患者，SGLT-2抑制剂是首选。因此，抗糖尿病治疗策略的选择不再仅由糖化血红蛋白（HbA1c）水平决定，尤其取决于个体患者的心肾风险。
