Koutentakis Michail, Kuciński Jakub, Świeczkowski Damian, Surma Stanisław, Filipiak Krzysztof J, Gąsecka Aleksandra
1st Chair and Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland.
Central Clinical Hospital, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland.
J Cardiovasc Dev Dis. 2023 Nov 16;10(11):465. doi: 10.3390/jcdd10110465.
Sodium-glucose cotransporter-2 (SGLT-2) inhibitors, also called gliflozins or flozins, are a class of drugs that have been increasingly used in the management of type 2 diabetes mellitus (T2DM) due to their glucose-lowering, cardiovascular (CV), and renal positive effects. However, recent studies suggest that SGLT-2 inhibitors might also have a ketogenic effect, increasing ketone body production. While this can be beneficial for some patients, it may also result in several potential unfavorable effects, such as decreased bone mineral density, infections, and ketoacidosis, among others. Due to the intricate and multifaceted impact caused by SGLT-2 inhibitors, this initially anti-diabetic class of medications has been effectively used to treat both patients with chronic kidney disease (CKD) and those with heart failure (HF). Additionally, their therapeutic potential appears to extend beyond the currently investigated conditions. The objective of this review article is to present a thorough summary of the latest research on the mechanism of action of SGLT-2 inhibitors, their ketogenesis, and their potential synergy with the ketogenic diet for managing diabetes. The article particularly discusses the benefits and risks of combining SGLT-2 inhibitors with the ketogenic diet and their clinical applications and compares them with other anti-diabetic agents in terms of ketogenic effects. It also explores future directions regarding the ketogenic effects of SGLT-2 inhibitors.
钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂，也称为格列净类或孚来迪类，是一类药物，由于其降血糖、心血管（CV）和肾脏方面的积极作用，已越来越多地用于2型糖尿病（T2DM）的管理。然而，最近的研究表明，SGLT-2抑制剂可能还具有生酮作用，会增加酮体生成。虽然这对一些患者可能有益，但也可能导致一些潜在的不利影响，如骨密度降低、感染和酮症酸中毒等。由于SGLT-2抑制剂产生的复杂多方面影响，这类最初用于抗糖尿病的药物已被有效用于治疗慢性肾脏病（CKD）患者和心力衰竭（HF）患者。此外，它们的治疗潜力似乎超出了目前所研究的病症范围。这篇综述文章的目的是全面总结关于SGLT-2抑制剂作用机制、生酮作用以及它们与生酮饮食协同治疗糖尿病的最新研究。文章特别讨论了将SGLT-2抑制剂与生酮饮食联合使用的益处和风险及其临床应用，并在生酮作用方面将它们与其他抗糖尿病药物进行比较。文章还探讨了SGLT-2抑制剂生酮作用的未来研究方向。
