2型糖尿病中胰高血糖素样肽-1受体激动剂的综述：聚焦于每周一次给药制剂的作用机制
A review of GLP-1 receptor agonists in type 2 diabetes: A focus on the mechanism of action of once-weekly agents.
作者信息
Cornell Susan
机构信息
Chicago College of Pharmacy, Midwestern University, Downers Grove, IL, USA.
出版信息
J Clin Pharm Ther. 2020 Sep;45 Suppl 1(Suppl 1):17-27. doi: 10.1111/jcpt.13230.
WHAT IS KNOWN AND OBJECTIVE
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are one of the preferred approved treatment options for people with type 2 diabetes (T2D) and inadequate glycaemic control. The objective of this review is to provide a general clinical overview of the similarities and differences in the mechanisms of action (MoA) of the once-weekly GLP-1 RA class of medications, highlighting the role of pharmacists in providing optimal medication management, education and care for people with diabetes.
METHODS
This is a narrative review of the published literature regarding the MoA of the currently available once-weekly GLP-1 RAs in T2D.
RESULTS AND DISCUSSION
GLP-1 RAs have an established efficacy and safety profile. Their benefits derive from their blood glucose-lowering effects, which include pancreatic beta-cell-mediated glucose-dependent insulin secretion and suppressed glucagon release, and their ability to slow gastric emptying and promote satiety. GLP-1 RAs may also exert beneficial effects on multiple organ systems in which GLP-1 receptors are present, including the cardiovascular and renal systems. Differences between individual GLP-1 RAs with regard to their molecular size, structure and duration of action (short or longer acting) have led to differing pharmacodynamics and clinical effects such as degree of glycaemic control, weight loss abilities, cardiovascular effects and tolerability profiles.
WHAT IS NEW AND CONCLUSION
From the literature, this appears to be the first review of the evidence base supporting the MoA of once-weekly GLP-1 RAs in T2D aimed at pharmacists, with a particular emphasis on the expanding role of pharmacists in team-based diabetes management. As a class, GLP-1 RAs are an effective treatment option for people with T2D, shown to achieve multi-factorial clinical benefits. The results suggest that when selecting or advising about treatments, pharmacists should consider how the different once-weekly GLP-1 RAs and their MoA affect clinical outcomes in order to ensure optimal treatment for individuals.
已知信息与目标
胰高血糖素样肽-1受体激动剂（GLP-1 RAs）是2型糖尿病（T2D）患者且血糖控制不佳时首选的获批治疗方案之一。本综述的目的是对每周一次的GLP-1 RA类药物作用机制（MoA）的异同进行全面临床概述，强调药师在为糖尿病患者提供最佳药物管理、教育和护理方面的作用。
方法
这是一篇关于目前可用的每周一次GLP-1 RAs在T2D中MoA的已发表文献的叙述性综述。
结果与讨论
GLP-1 RAs具有既定的疗效和安全性。它们的益处源于其降血糖作用，包括胰腺β细胞介导的葡萄糖依赖性胰岛素分泌和胰高血糖素释放受抑制，以及它们减缓胃排空和促进饱腹感的能力。GLP-1 RAs还可能对存在GLP-1受体的多个器官系统产生有益影响，包括心血管和肾脏系统。各个GLP-1 RAs在分子大小、结构和作用持续时间（短效或长效）方面的差异导致了不同的药效学和临床效果，如血糖控制程度、减肥能力、心血管影响和耐受性。
新内容与结论
从文献来看，这似乎是第一篇针对药师的、支持每周一次GLP-1 RAs在T2D中MoA的证据综述，特别强调了药师在基于团队的糖尿病管理中不断扩大的作用。作为一类药物，GLP-1 RAs是T2D患者的有效治疗选择，已显示可实现多方面的临床益处。结果表明，在选择治疗方法或提供建议时，药师应考虑不同的每周一次GLP-1 RAs及其MoA如何影响临床结果，以确保为个体提供最佳治疗。
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