Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan.
Department of Endocrinology, Diabetes and Metabolism, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan; Tokyo Kyosai Hospital, 2-3-8 Nakameguro, Meguro-ku, Tokyo 153-8934, Japan.
J Diabetes Complications. 2022 Jul;36(7):108225. doi: 10.1016/j.jdiacomp.2022.108225. Epub 2022 Jun 2.
Although the difference in HbA reduction between sodium-glucose cotransporter 2 (SGLT2) inhibitors and other oral glucose-lowering agents is relatively small, SGLT2 inhibitors exhibit beneficial cardiorenal protection. This study was based on the hypothesis that changes of HbA in patients treated with SGLT2 inhibitors may not accurately reflect an improved glycemic profile.
Two studies were conducted: 1) a retrospective cohort study of 3039 patients administered with either an SGLT2 or a dipeptidyl peptidase-4 (DPP4) inhibitor for 12 months comparing the changes in glycated albumin (GA) and HbA levels and 2) a pilot study of 10 patients whose glycemic dynamics were evaluated using flash glucose monitoring at baseline and 2 months after treatment with an SGLT2 inhibitor.
SGLT2 inhibitors reduced GA more markedly than HbA in both studies. DPP4 inhibitors decreased both GA and HbA to a comparable degree. The mean glucose levels and glycemic standard deviation were significantly reduced after treatment with an SGLT2 inhibitor, in concordance with GA decline, although the lowering of HbA was marginal.
Changes in HbA levels underestimated the glucose-lowering effect and the diminished glycemic fluctuation induced by SGLT2 inhibitors. Thus, the distinct biomarker roles of GA and HbA should be reevaluated.
尽管钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂与其他口服降糖药在 HbA 降低方面的差异相对较小，但 SGLT2 抑制剂具有有益的心肾保护作用。本研究基于以下假设：接受 SGLT2 抑制剂治疗的患者 HbA 的变化可能无法准确反映血糖谱的改善。
进行了两项研究：1）对接受 SGLT2 或二肽基肽酶-4（DPP4）抑制剂治疗 12 个月的 3039 例患者进行回顾性队列研究，比较糖化白蛋白（GA）和 HbA 水平的变化；2）对 10 例患者进行试点研究，使用瞬态血糖监测在基线和 SGLT2 抑制剂治疗 2 个月后评估其血糖动力学。
在两项研究中，SGLT2 抑制剂降低 GA 的幅度明显大于 HbA。DPP4 抑制剂同样降低 GA 和 HbA。SGLT2 抑制剂治疗后，平均血糖水平和血糖标准差显著降低，与 GA 下降一致，尽管 HbA 略有降低。
HbA 水平的变化低估了 SGLT2 抑制剂的降糖作用和降低的血糖波动。因此，应该重新评估 GA 和 HbA 的不同生物标志物作用。
