Lu Henri, Lu Hortense, Kosinski Christophe, Wojtusciszyn Anne, Zanchi Anne, Carron Pierre-Nicolas, Müller Martin, Meyer Philippe, Martin Jehan, Muller Olivier, Hullin Roger
Service of Cardiology, Cardiovascular Department, Lausanne University Hospital, 1011 Lausanne, Switzerland.
Emergency Department, Saint-Joseph Hospital, 75014 Paris, France.
J Clin Med. 2021 May 10;10(9):2036. doi: 10.3390/jcm10092036.
Canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin belong to a class of antidiabetic treatments referred to as sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors, or SGLT2is). SGLT2is are currently indicated in North America and in Europe in type 2 diabetes mellitus, especially in patients with cardiovascular (CV) disease, high CV risk, heart failure, or renal disease. In Europe, dapagliflozin is also approved as an adjunct to insulin in patients with type 1 diabetes mellitus. New data provide evidence for benefits in heart failure with reduced ejection fraction and chronic kidney disease, including in patients without diabetes. The use of SGLT2is is expected to increase, suggesting that a growing number of patients will present to the emergency departments with these drugs. Most common adverse events are easily treatable, including mild genitourinary infections and conditions related to volume depletion. However, attention must be paid to some potentially serious adverse events, such as hypoglycemia (when combined with insulin or insulin secretagogues), lower limb ischemia, and diabetic ketoacidosis. We provide an up-to-date practical guide highlighting important elements on the adverse effects of SGLT2is and their handling in some frequently encountered clinical situations such as acute heart failure and decompensated diabetes.
卡格列净、达格列净、恩格列净和依鲁格列净属于一类抗糖尿病药物，称为钠-葡萄糖协同转运蛋白2抑制剂（SGLT2抑制剂，或SGLT2i）。目前，SGLT2i在北美和欧洲被用于治疗2型糖尿病，尤其是患有心血管（CV）疾病、高CV风险、心力衰竭或肾脏疾病的患者。在欧洲，达格列净还被批准作为1型糖尿病患者胰岛素治疗的辅助药物。新数据表明，SGLT2i对射血分数降低的心力衰竭和慢性肾脏病有益，包括对无糖尿病的患者。预计SGLT2i的使用将会增加，这意味着越来越多服用这些药物的患者将前往急诊科就诊。最常见的不良事件易于治疗，包括轻度泌尿生殖系统感染和与血容量减少相关的情况。然而，必须注意一些潜在的严重不良事件，如低血糖（与胰岛素或胰岛素促泌剂合用时）、下肢缺血和糖尿病酮症酸中毒。我们提供了一份最新实用指南，重点介绍了SGLT2i的不良反应及其在一些常见临床情况（如急性心力衰竭和失代偿性糖尿病）中的处理要点。
