Vasiliu Octavian
Department of Psychiatry, 'Dr Carol Davila' University Emergency Central Military Hospital, 010816 Bucharest, Romania.
Exp Ther Med. 2023 Feb 6;25(3):125. doi: 10.3892/etm.2023.11824. eCollection 2023 Mar.
Metabolic dysfunctions have been reported in patients diagnosed with severe mental illnesses who are undergoing treatment with antipsychotics, especially second-generation agents. Sodium-glucose co-transporter 2 inhibitors (SGLT2Is) and glucagon-like peptide receptor agonists are new-generation antidiabetics whose favourable effects in the treatment of diabetes mellitus in the non-psychiatric population may raise interest in their use in patients presenting with severe mental illnesses and metabolic comorbidities possibly related to the use of antipsychotics. The objectives of this review were to investigate the evidence to support the use of SGLT2Is in this population and to find the most important aspects that need to be addressed by future research. A total of one preclinical trial, two guideline-format clinical recommendations, one systematic review and one case report were found, and their conclusions were analysed. The results support the following conclusions: i) SGLT2Is may be combined with metformin in selected cases of type 2 diabetes mellitus in the context of antipsychotic treatment, as they have been associated with favourable metabolic effects; and ii) data for the recommendation of SGLT2Is as second-line treatment in patients with diabetes mellitus who are also treated with olanzapine or clozapine are supported by very limited preclinical and clinical evidence. Further high-quality, large-scale research is needed in the field of the management of metabolic dysfunctions in patients with severe psychiatric illnesses who undergo treatment with second-generation antipsychotics.
据报道，在接受抗精神病药物治疗的重度精神疾病患者中存在代谢功能障碍，尤其是在使用第二代药物的患者中。钠-葡萄糖协同转运蛋白2抑制剂（SGLT2Is）和胰高血糖素样肽受体激动剂是新一代抗糖尿病药物，它们在非精神科人群中治疗糖尿病的良好效果可能会引发人们对其在患有重度精神疾病且可能与使用抗精神病药物相关的代谢合并症患者中应用的兴趣。本综述的目的是调查支持在该人群中使用SGLT2Is的证据，并找出未来研究需要解决的最重要方面。共检索到1项临床前试验、2项指南形式的临床建议、1项系统评价和1例病例报告，并对其结论进行了分析。结果支持以下结论：i）在抗精神病药物治疗的背景下，SGLT2Is在2型糖尿病的特定病例中可与二甲双胍联合使用，因为它们具有良好的代谢效应；ii）关于将SGLT2Is推荐为同时接受奥氮平或氯氮平治疗的糖尿病患者二线治疗的数据，其临床前和临床证据非常有限。在接受第二代抗精神病药物治疗的重度精神疾病患者的代谢功能障碍管理领域，还需要进一步的高质量、大规模研究。
