Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China.
Eur Rev Med Pharmacol Sci. 2023 Jun;27(12):5784-5794. doi: 10.26355/eurrev_202306_32817.
As the prevalence of diabetes rises, the use of antidiabetic drugs becomes more frequent. Thus, focusing on the effects of these drugs on water-sodium balance and electrolyte regulation is necessary. This review discusses the effects and the mechanisms behind them. Several sulfonylureas, such as chlorpropamide, methanesulfonamide, and tolbutamide, exhibit water-retaining properties. Other sulfonylureas, such as glipizide, glibenclamide, acetohexamide, and tolazamide, are not antidiuretic or even diuretic. Numerous clinical studies showed that metformin can reduce serum magnesium concentrations and may have an effect on the cardiovascular system, but the specific mechanism remains to be discussed. Different opinions exist about the mechanisms of thiazolidinedione-induced fluid retention. Sodium-glucose cotransporter 2 inhibitors can cause osmotic diuresis and natriuresis and elevated serum potassium and magnesium concentrations. Glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors can enhance urine sodium excretion. At the same time, increased urinary sodium caused by sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 agonists and dipeptidyl peptidase-4 inhibitors reduce blood pressure and plasma volume, thereby protecting the heart. Insulin has a sodium-retaining effect and is also associated with hypokalemia, hypomagnesemia, and hypophosphatemia. Several of the aforementioned pathophysiological changes and mechanisms have been discussed, and conclusions have been drawn. However, further investigation and discussion are still warranted.
随着糖尿病患病率的上升，抗糖尿病药物的使用变得更加频繁。因此，关注这些药物对水钠平衡和电解质调节的影响是必要的。本文讨论了这些药物的作用及其机制。几种磺酰脲类药物，如氯丙嗪、甲磺酰胺和甲苯磺丁脲，具有保水作用。其他磺酰脲类药物，如格列吡嗪、格列本脲、乙酰甲羟胺和甲苯磺丁脲，不具有抗利尿作用，甚至具有利尿作用。许多临床研究表明，二甲双胍可以降低血清镁浓度，可能对心血管系统有影响，但具体机制仍需探讨。关于噻唑烷二酮类药物引起的液体潴留的机制存在不同意见。钠-葡萄糖共转运蛋白 2 抑制剂可引起渗透性利尿和利钠作用，并升高血清钾和镁浓度。胰高血糖素样肽-1 受体激动剂和二肽基肽酶-4 抑制剂可增强尿钠排泄。同时，钠-葡萄糖共转运蛋白 2 抑制剂、胰高血糖素样肽-1 激动剂和二肽基肽酶-4 抑制剂增加的尿钠可降低血压和血浆容量，从而保护心脏。胰岛素具有保钠作用，也与低钾血症、低镁血症和低磷血症有关。上述一些病理生理变化和机制已经讨论过，并得出了结论。然而，仍需要进一步的研究和讨论。
