Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France.
Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Paris, France.
Cardiovasc Diabetol. 2021 May 13;20(1):107. doi: 10.1186/s12933-021-01301-x.
In a recent meta-analysis of randomized controlled trials of sodium glucose co-transporter 2 inhibitors (SGLT2i) in patients with diabetes, Lin and colleagues showed a positive association between SGLT2i-induced blood pressure and weight reduction and the risk of lower limb events. These results support the potential mechanism of a volume depletion effect of SGLT2i to explain the increase risk of amputation observed with this pharmacological class. Since the first result of the CANVAS trial raised a concern regarding the risk of amputation with SGLT2i, this hypothesis emerged from studies showing a higher incidence of amputations in patients with diabetes using diuretics. Furthermore, recent data found that copeptin, a surrogate marker of hydration status was also associated with lower limb outcomes. In conclusion, this assumption of diuretic-induced hypovolemia explanation highlights the fact that medications that induce a contraction of plasma volume, both traditional and novel agents with a diuretic mode of action should be introduced cautiously in patients with diabetes at high risk of diabetic foot events.
在最近一项对糖尿病患者中钠-葡萄糖协同转运蛋白 2 抑制剂 (SGLT2i) 的随机对照试验的荟萃分析中，Lin 及其同事表明 SGLT2i 引起的血压和体重减轻与下肢事件风险之间存在正相关。这些结果支持 SGLT2i 引起的容量耗竭效应的潜在机制，以解释观察到的这种药理学类别的截肢风险增加。自 CANVAS 试验的第一个结果引起了对 SGLT2i 截肢风险的关注以来，这一假设源于研究表明，使用利尿剂的糖尿病患者截肢的发生率更高。此外，最近的数据发现， copeptin（一种水合状态的替代标志物）也与下肢结局相关。总之，利尿剂引起的血容量不足的假设解释强调了这样一个事实，即诱导血浆体积收缩的药物，包括传统和新型具有利尿剂作用模式的药物，应谨慎引入糖尿病高危足事件的患者中。
