Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), Università degli Studi di Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy.
Internal Medicine and Stroke Care Ward, University Hospital, Policlinico "P. Giaccone", 90127 Palermo, Italy.
Medicina (Kaunas). 2024 Nov 1;60(11):1796. doi: 10.3390/medicina60111796.
The impact of diabetic foot (DF) on the healthcare system represents a major public health problem, leading to a considerable clinical and economic burden. The factors contributing to DF's development and progression are strongly interconnected, including metabolic causes, neuropathy, arteriopathy, and inflammatory changes. Sodium-glucose cotransporter 2 inhibitors (SGLT2-i), novel oral hypoglycemic drugs used as an adjunct to standard treatment, have recently changed the pharmacological management of diabetes. Nevertheless, data about the risk of limb amputation, discordant and limited to canagliflozin, which is currently avoided in the case of peripheral artery disease, have potentially discouraged the design of specific studies targeting DF. There is good evidence for the single immunomodulatory, neuroprotective, and beneficial vascular effects of SGLT2-i. Still, there is no clinical evidence about the early use of SGLT2-i in diabetic foot due to the lack of longitudinal and prospective studies proving the effect of these drugs without confounders. This narrative review aims to discuss the main evidence about the impact of SGLT2-i on the three complications of diabetes implicated in the development of DF, the state of the art, and the potential future implications.
糖尿病足（DF）对医疗体系的影响是一个主要的公共卫生问题，导致了相当大的临床和经济负担。DF 发展和进展的因素密切相关，包括代谢原因、神经病变、血管病变和炎症变化。钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2-i）是一种新型的口服降糖药物，作为标准治疗的辅助药物，最近改变了糖尿病的药物治疗管理。然而，关于截肢风险的数据是不一致的，仅限于卡格列净，而在周围动脉疾病的情况下，目前避免使用卡格列净，这可能阻碍了针对 DF 的特定研究的设计。SGLT2-i 具有单一的免疫调节、神经保护和有益的血管作用，这方面有很好的证据。然而，由于缺乏证明这些药物在没有混杂因素的情况下有效且没有纵向和前瞻性研究，因此在糖尿病足的早期使用 SGLT2-i 方面还没有临床证据。本叙述性综述旨在讨论 SGLT2-i 对糖尿病三种并发症的影响的主要证据，这些并发症与 DF 的发展有关，以及该领域的最新进展和潜在的未来影响。
