Aberer Felix, Pieber Thomas R, Eckstein Max L, Sourij Harald, Moser Othmar
Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria.
Division of Exercise Physiology and Metabolism, Institute of Sport Science, University of Bayreuth, 95447 Bayreuth, Germany.
Pharmaceutics. 2022 May 31;14(6):1180. doi: 10.3390/pharmaceutics14061180.
In Type 1 diabetes (T1D), according to the most recent guidelines, the everyday glucose-lowering treatment is still restricted to the use of subcutaneous insulin, while multiple therapeutic options exist for Type 2 diabetes (T2D). For this narrative review we unsystematically screened PubMed and Embase to identify clinical trials which investigated glucose-lowering agents as an adjunct to insulin treatment in people with T1D. Published studies up to March 2022 were included. We discuss the safety and efficacy in modifying cardiovascular risk factors for each drug, the current status of research, and provide a clinical perspective. For several adjunct agents, in T1D, the scientific evidence demonstrates improvements in HbA1c, reductions in the risk of hypoglycemia, and achievements of lower insulin requirements, as well as positive effects on cardiovascular risk factors, such as blood lipids, blood pressure, and weight. As the prevalence of obesity, the major driver for double diabetes, is rising, weight and cardiovascular risk factor management is becoming increasingly important in people with T1D. Adjunct glucose-lowering agents, intended to be used in T2D, bear the potential to beneficially impact on cardiovascular risk factors when investigated in the T1D population and are suggested to be more extensively considered as potentially disease-modifying drugs in the future and should be investigated for hard cardiovascular endpoints.
根据最新指南，在1型糖尿病（T1D）中，日常降糖治疗仍局限于皮下注射胰岛素的使用，而2型糖尿病（T2D）则有多种治疗选择。在本叙述性综述中，我们对PubMed和Embase进行了非系统性筛查，以确定在T1D患者中研究降糖药物作为胰岛素治疗辅助手段的临床试验。纳入了截至2022年3月发表的研究。我们讨论了每种药物在改善心血管危险因素方面的安全性和有效性、研究现状，并提供了临床观点。对于几种辅助药物，在T1D中，科学证据表明糖化血红蛋白（HbA1c）有所改善、低血糖风险降低、胰岛素需求量减少，以及对血脂、血压和体重等心血管危险因素有积极影响。由于肥胖（双重糖尿病的主要驱动因素）的患病率正在上升，体重和心血管危险因素管理在T1D患者中变得越来越重要。旨在用于T2D的辅助降糖药物，在T1D人群中进行研究时，有可能对心血管危险因素产生有益影响，并建议在未来更广泛地将其视为潜在的疾病改善药物，且应对其进行心血管硬终点研究。
