Department of Endocrinology and Metabolism, Complejo Hospitalario Dr. Manuel Amador Guerrero, Colón, Panama.
Front Endocrinol (Lausanne). 2023 Jul 20;14:1174692. doi: 10.3389/fendo.2023.1174692. eCollection 2023.
SGLT2 inhibitors (SGLT2i) are now the mainstay therapy for both diabetes and heart failure. publications, meta-analysis, and conference presentations of the eight SGLT2i Cardiovascular Outcomes trials (CVOTS) done in diabetic patients constantly echo that this class of drug decreases mortality, reduces cardiovascular events, and prevents heart failure and kidney disease. This review of medical agencies' SGLT2i analysis (FDA and EMA) helps to understand the reality of SGLT2i results in those trials, avoiding to consider observational and statistically undemonstrated endpoints as validated. They also confirmed the unique diuretic mode of action of SGLT2i, promoting osmotic diuresis, and its potential adverse events secondary to hypovolemia and hematocrit increase. They also support the understanding that the beliefs in SGLT2i morbi-mortality benefits are largely overstated mostly based on undemonstrated endpoints. Finally, it is clear that SGLT2i's antidiabetic action, secondary to its renal mode of action, plateaued after a few months and decreased strongly over time, questioning its long-term goal of maintaining diabetic patients' HbA1c below 7%. Also, this effect in patients with renal impairment is quasi null. We think that this review would be very helpful to every physician treating diabetic patients to better balance belief and reality of SGLT2i prescription effects.
钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）现在是糖尿病和心力衰竭的主要治疗方法。在糖尿病患者中进行的八项 SGLT2i 心血管结局试验（CVOTS）的出版物、荟萃分析和会议报告不断表明，这类药物可降低死亡率、减少心血管事件，并预防心力衰竭和肾脏疾病。本文对医疗监管机构的 SGLT2i 分析（FDA 和 EMA）进行了综述，有助于了解这些试验中 SGLT2i 结果的实际情况，避免将观察性和统计学上未证明的终点视为已验证。它们还证实了 SGLT2i 独特的利尿作用模式，促进渗透性利尿，以及由于血容量不足和血细胞比容增加而导致的潜在不良反应。它们还支持这样一种理解，即基于未证明的终点，SGLT2i 在死亡率和发病率方面的益处被大大夸大了。最后，很明显，SGLT2i 的降糖作用（继发于其肾脏作用模式）在几个月后达到平台期，并随着时间的推移急剧下降，这对其将糖尿病患者的 HbA1c 长期维持在 7%以下的目标提出了质疑。此外，在肾功能受损的患者中，这种作用几乎为零。我们认为，这篇综述对每位治疗糖尿病患者的医生都非常有帮助，有助于更好地平衡 SGLT2i 处方效果的信念和现实。
