Toronto General Hospital Research Institute, University Health Network, ON, Canada.
Division of Nephrology, Department of Medicine, University of Toronto, ON, Canada.
Endocrinol Metab (Seoul). 2021 Apr;36(2):256-269. doi: 10.3803/EnM.2021.987. Epub 2021 Apr 19.
Over the last 5 years there have been many new developments in the management of diabetic kidney disease. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) and sodium-glucose cotransporter-2 (SGLT2) inhibitors were initially used for glycemic control, but more recent studies have now shown that their benefits extend to cardiovascular and kidney outcomes. The recent addition of data on the novel mineralocorticoid receptor antagonist (MRA) gives us another approach to further decrease the residual risk of diabetic kidney disease progression. In this review we describe the mechanism of action, key studies, and possible adverse effects related to these three classes of medications. The management of type 2 diabetes now includes an increasing number of medications for the management of comorbidities in a patient population at significant risk of cardiovascular disease and progression of chronic kidney disease. It is from this perspective that we seek to outline the rationale for the sequential and/or combined use of SGLT2 inhibitors, GLP-1 RA and MRAs in patients with type 2 diabetes for heart and kidney protection.
在过去的 5 年中，糖尿病肾病的治疗有了许多新的进展。胰高血糖素样肽-1 受体激动剂（GLP-1RA）和钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂最初用于血糖控制，但最近的研究表明，它们的益处还扩展到了心血管和肾脏结局。最近关于新型盐皮质激素受体拮抗剂（MRA）的数据的加入，为我们提供了另一种方法来进一步降低糖尿病肾病进展的残余风险。在这篇综述中，我们描述了这三类药物的作用机制、关键研究和可能的不良反应。2 型糖尿病的管理现在包括越来越多的药物，用于治疗心血管疾病风险大且慢性肾脏病进展风险高的患者的合并症。正是从这个角度出发，我们试图概述 2 型糖尿病患者联合或序贯使用 SGLT2 抑制剂、GLP-1RA 和 MRA 的基本原理，以实现心脏和肾脏保护。
