Center for Endocrine and Metabolic Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy.
University of Genoa and IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Int J Cardiol. 2022 Mar 15;351:66-70. doi: 10.1016/j.ijcard.2021.12.050. Epub 2022 Jan 1.
Sodium-glucose cotransporter-2 inhibitors (SGLT-2i), initially studied and approved for the treatment of diabetes, are now becoming a promising class of agents to treat heart failure (HF) and chronic kidney disease (CKD), even in patients without diabetes. While the potential benefits in several diseases (usually treated by different medical specialties) is amplifying the interest in these drugs, their use in frail patients with multiple pathologies and on polypharmacy can be complex, requiring a composite multidisciplinary approach. Following a brief overview of the evidence supporting the benefits of SGLT-2i in patients with HF or CKD, we herein provide guidance for prescribing SGLT-2i in daily practice using a multidisciplinary approach. A shared treatment algorithm is presented for initiating an SGLT-2i in patients already being treated for diabetes and HF. Tools to prevent hypoglycemia, blood pressure drop, genital infections, euglycemic diabetic ketoacidosis and eGFR dip are also provided. It is hoped that this practical, multidisciplinary guidance for initiating SGLT-2i in patients with HF and/or CKD, whatever therapy they are currently on, can help to offer SGLT-2i to the largest population of patients possible to provide the most therapeutic benefit.
钠-葡萄糖共转运蛋白 2 抑制剂（SGLT-2i）最初是为治疗糖尿病而研究和批准的，现在正在成为治疗心力衰竭（HF）和慢性肾脏病（CKD）的一类有前途的药物，即使在没有糖尿病的患者中也是如此。虽然在几种疾病（通常由不同的医学专业治疗）中具有潜在的益处，这增加了人们对这些药物的兴趣，但在患有多种疾病和多种药物治疗的脆弱患者中使用这些药物可能很复杂，需要采用综合的多学科方法。在简要概述了 SGLT-2i 在 HF 或 CKD 患者中的益处的证据后，我们在此使用多学科方法为日常实践中的 SGLT-2i 处方提供指导。为已经接受糖尿病和 HF 治疗的患者启动 SGLT-2i 治疗提出了一个共享的治疗方案。还提供了预防低血糖、血压下降、生殖器感染、血糖正常的糖尿病酮症酸中毒和 eGFR 下降的工具。希望本实用的、多学科的 HF 和/或 CKD 患者 SGLT-2i 起始治疗指南，无论他们目前接受何种治疗，都能帮助尽可能多的患者使用 SGLT-2i，从而获得最大的治疗益处。
