3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases, Zabrze, Poland.
Endokrynol Pol. 2021;72(2):163-170. doi: 10.5603/EP.a2021.0033.
Diabetes mellitus is a major, global problem. Among the numerous complications of diabetes, there is increasing concern over the coexisting heart failure. Metformin is the most frequently used oral antidiabetic drug that is considered to be safe and effective in the management of type 2 diabetes mellitus. Since the publication of the UK Prospective Diabetes Study, it has been suggested that metformin might improve cardiovascular prognoses. Results from available studies have shown that metformin therapy in patients with type 2 diabetes mellitus and heart failure was associated with improved clinical outcomes when compared with other oral antidiabetic agents, insulin, or lifestyle management. However, there have been no randomized controlled trials evaluating the influence of metformin use on clinical outcomes in patients with type 2 diabetes mellitus and heart failure. New evidence from large cardiovascular outcome trials that showed a reduction in heart failure hospitalization for SGLT2 inhibitors caused changes in recommendations on the management of hyperglycaemia. Currently, the European Society of Cardiology recommends sodium-glucose co-transporter 2 inhibitors in patients with type 2 diabetes mellitus and heart failure or at high risk for heart failure, as a first choice in drug naïve patients, or as a second drug if the patient is already on metformin. The aim of our study is to review the current state of knowledge about the position of metformin in the treatment of patients with type 2 diabetes mellitus and heart failure.
糖尿病是一个全球性的重大问题。在糖尿病的众多并发症中，人们越来越关注同时存在的心力衰竭。二甲双胍是最常被使用的口服降糖药物，被认为在 2 型糖尿病的治疗中是安全且有效的。自英国前瞻性糖尿病研究发表以来，人们一直认为二甲双胍可能改善心血管预后。现有研究结果表明，与其他口服降糖药物、胰岛素或生活方式管理相比，二甲双胍治疗 2 型糖尿病合并心力衰竭的患者可改善临床结局。然而，目前还没有随机对照试验评估二甲双胍的使用对 2 型糖尿病合并心力衰竭患者的临床结局的影响。来自大型心血管结局试验的新证据表明，SGLT2 抑制剂可减少心力衰竭住院，这导致了对高血糖管理建议的改变。目前，欧洲心脏病学会建议将钠-葡萄糖共转运蛋白 2 抑制剂用于 2 型糖尿病合并心力衰竭或心力衰竭高危患者，作为初治患者的首选药物，或作为已使用二甲双胍的患者的二线药物。我们的研究旨在回顾关于二甲双胍在治疗 2 型糖尿病合并心力衰竭患者中的地位的现有知识状况。
