The Kidney & Transplant Practice, Mount Elizabeth Novena Hospital, Singapore, Singapore.
Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia-Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Nephrology (Carlton). 2023 Aug;28(8):415-424. doi: 10.1111/nep.14167. Epub 2023 May 8.
Recent clinical studies have demonstrated the effectiveness of SGLT-2 inhibitors in reducing the risks of cardiovascular and renal events in both patients with and without type 2 diabetes mellitus. Consequently, many international guidelines have begun advocating for the use of SGLT-2 inhibitors for the purpose of organ protection rather than as simply a glucose-lowering agent. However, despite the consistent clinical benefits and available strong guideline recommendations, the utilization of SGLT-2 inhibitors have been unexpectedly low in many countries, a trend which is much more noticeable in low resource settings. Unfamiliarity with the recent focus in their organ protective role and clinical indications; concerns with potential adverse effects of SGLT-2 inhibitors, including acute kidney injury, genitourinary infections, euglycemic ketoacidosis; and their safety profile in elderly populations have been identified as deterring factors to their more widespread use. This review serves as a practical guide to clinicians managing patients who could benefit from SGLT-2 inhibitors treatment and instill greater confidence in the initiation of these drugs, with the aim of optimizing their utilization rates in high-risk populations.
最近的临床研究表明,SGLT-2 抑制剂在降低有或没有 2 型糖尿病患者的心血管和肾脏事件风险方面具有疗效。因此,许多国际指南开始提倡将 SGLT-2 抑制剂用于器官保护,而不仅仅是作为一种降低血糖的药物。然而,尽管 SGLT-2 抑制剂具有一致的临床益处和强有力的指南推荐,但在许多国家,SGLT-2 抑制剂的使用率出人意料地低,在资源有限的环境中这种趋势更为明显。对其在器官保护作用和临床适应证方面的新关注不熟悉;对 SGLT-2 抑制剂可能产生的不良反应的担忧,包括急性肾损伤、泌尿生殖系统感染、血糖正常性酮症酸中毒;以及在老年人群中的安全性特征,这些都是阻碍其更广泛应用的因素。本综述旨在为可能受益于 SGLT-2 抑制剂治疗的患者的临床医生提供实用指南,并增强他们对这些药物的应用信心,从而优化高危人群的药物使用率。