J Clin Invest. 2021 Jan 19;131(2). doi: 10.1172/JCI142243.
Diabetes mellitus is a major public health problem, affecting about 10% of the population. Pharmacotherapy aims to protect against microvascular complications, including blindness, end-stage kidney disease, and amputations. Landmark clinical trials have demonstrated that intensive glycemic control slows progression of microvascular complications (retinopathy, nephropathy, and neuropathy). Long-term follow-up has demonstrated that intensive glycemic control also decreases risk of macrovascular disease, albeit rigorous evidence of macrovascular benefit did not emerge for over a decade. The US FDA's recent requirement for dedicated cardiovascular outcome trials ushered in a golden age for understanding the clinical profiles of new type 2 diabetes drugs. Some clinical trials with sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP1) receptor agonists reported data demonstrating cardiovascular benefit (decreased risk of major adverse cardiovascular events and hospitalization for heart failure) and slower progression of diabetic kidney disease. This Review discusses current guidelines for use of the 12 classes of drugs approved to promote glycemic control in patients with type 2 diabetes. The Review also anticipates future developments with potential to improve the standard of care: availability of generic dipeptidylpeptidase-4 (DPP4) inhibitors and SGLT2 inhibitors; precision medicine to identify the best drugs for individual patients; and new therapies to protect against chronic complications of diabetes.
糖尿病是一个主要的公共卫生问题，影响了大约 10%的人口。药物治疗旨在预防微血管并发症，包括失明、终末期肾病和截肢。具有里程碑意义的临床试验表明，强化血糖控制可减缓微血管并发症（视网膜病变、肾病和神经病变）的进展。长期随访表明，强化血糖控制也降低了大血管疾病的风险，尽管严格的大血管获益证据在十多年后才出现。美国 FDA 最近要求进行专门的心血管结局试验，这迎来了一个理解新型 2 型糖尿病药物临床特征的黄金时代。一些钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂和胰高血糖素样肽 1（GLP1）受体激动剂的临床试验报告了数据，表明具有心血管获益（主要不良心血管事件和心力衰竭住院风险降低）和糖尿病肾病进展减缓。这篇综述讨论了目前用于促进 2 型糖尿病患者血糖控制的 12 类批准药物的使用指南。该综述还预测了未来可能改善护理标准的发展：二肽基肽酶-4（DPP4）抑制剂和 SGLT2 抑制剂的仿制药；用于确定个体患者最佳药物的精准医学；以及预防糖尿病慢性并发症的新疗法。
