Afsar Baris, Afsar Rengin Elsurer
Suleyman Demirel University, School of Medicine, Department of Nephrology, Isparta, Turkey.
Suleyman Demirel University, School of Medicine, Department of Nephrology, Isparta, Turkey.
Clin Nutr. 2023 Dec;42(12):2338-2352. doi: 10.1016/j.clnu.2023.10.004. Epub 2023 Oct 5.
Diabetes mellitus is a risk factor for muscle loss and sarcopenia. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) or "gliflozins" are one of the newest anti-hyperglycemic drugs. They reduce blood glucose levels by inhibiting renal glucose reabsorption in the early proximal convoluted tubule. Various randomized trials showed that SGLT2i have cardio-protective and reno-protective action. SGLT2i also affect body composition. They usually decrease body fat percentage, visceral and subcutaneous adipose tissue. However, regarding the muscle mass, there are conflicting findings some studies showing detrimental effects and others showed neutral or beneficial effects. This issue is extremely important not only because of the wide use of SGLT2i around globe; but also skeletal muscle mass consumes large amounts of calories during exercise and is an important determinant of resting metabolic rate and skeletal muscle loss hinders energy consumption leading to obesity. In this systematic review, we extensively reviewed the experimental and clinical studies regarding the impact of SGLT2i on muscle mass and related metabolic alterations. Importantly, studies are heterogeneous and there is unmet need to highlight the alterations in muscle during SGLT2i use.
糖尿病是肌肉减少和肌肉减少症的一个风险因素。钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）或“格列净类药物”是最新的抗高血糖药物之一。它们通过抑制近端曲小管早期的肾葡萄糖重吸收来降低血糖水平。各种随机试验表明，SGLT2i具有心脏保护和肾脏保护作用。SGLT2i也会影响身体成分。它们通常会降低体脂百分比、内脏和皮下脂肪组织。然而，关于肌肉质量，存在相互矛盾的研究结果，一些研究显示有不利影响，而另一些研究则显示有中性或有益影响。这个问题极其重要，不仅因为SGLT2i在全球广泛使用；而且骨骼肌质量在运动过程中消耗大量热量，是静息代谢率的重要决定因素，骨骼肌减少会阻碍能量消耗导致肥胖。在本系统评价中，我们广泛回顾了关于SGLT2i对肌肉质量及相关代谢改变影响的实验和临床研究。重要的是，研究存在异质性，突出SGLT2i使用期间肌肉的改变仍存在未满足的需求。
