Florentin Matilda, Kostapanos Michael S, Papazafiropoulou Athanasia K
Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina 45221, Greece.
Lipid Clinic, Department of General Medicine, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge CB2 0QQ, United Kingdom.
World J Diabetes. 2022 Feb 15;13(2):85-96. doi: 10.4239/wjd.v13.i2.85.
The last few years important changes have occurred in the field of diabetes treatment. The priority in the therapy of patients with diabetes is not glycemic control per se rather an overall management of risk factors, while individualization of glycemic target is suggested. Furthermore, regulatory authorities now require evidence of cardiovascular (CV) safety in order to approve new antidiabetic agents. The most novel drug classes, , sodium-glucose transporter 2 inhibitors (SGLT2-i) and some glucagon-like peptide-1 receptor agonists (GLP-1 RA), have been demonstrated to reduce major adverse CV events and, thus, have a prominent position in the therapeutic algorithm of hyperglycemia. In this context, the role of previously used hypoglycemic agents, including dipeptidyl peptidase 4 (DPP-4) inhibitors, has been modified. DPP-4 inhibitors have a favorable safety profile, do not cause hypoglycemia or weight gain and do not require dose uptitration. Furthermore, they can be administered in patients with chronic kidney disease after dose modification and elderly patients with diabetes. Still, though, they have been undermined to a third line therapeutic choice as they have not been shown to reduce CV events as is the case with SGLT2-i and GLP-1 RA. Overall, DPP-4 inhibitors appear to have a place in the management of patients with diabetes as a safe class of oral glucose lowering agents with great experience in their use.
在过去几年里,糖尿病治疗领域发生了重大变化。糖尿病患者治疗的重点并非单纯的血糖控制,而是危险因素的全面管理,同时建议血糖目标个体化。此外,监管机构现在要求提供心血管(CV)安全性证据,以便批准新的抗糖尿病药物。最新型的药物类别,即钠-葡萄糖协同转运蛋白2抑制剂(SGLT2-i)和一些胰高血糖素样肽-1受体激动剂(GLP-1 RA),已被证明可减少主要不良心血管事件,因此在高血糖治疗方案中占据突出地位。在这种背景下,包括二肽基肽酶4(DPP-4)抑制剂在内的先前使用的降糖药物的作用已发生改变。DPP-4抑制剂具有良好的安全性,不会引起低血糖或体重增加,也不需要增加剂量。此外,在调整剂量后,它们可用于慢性肾脏病患者和老年糖尿病患者。尽管如此,由于它们未像SGLT2-i和GLP-1 RA那样被证明可减少心血管事件,它们已沦为三线治疗选择。总体而言,作为一类安全的口服降糖药物且使用经验丰富,DPP-4抑制剂在糖尿病患者管理中似乎占有一席之地。