对于2型糖尿病患者,SGLT2的结局是:用甲福明或RAS的背景治疗是否重要?
Kah Suan Chong1, Yi-Hsin Chang1,2, Meng-Hsuan Lin3
1Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Frontiers in endocrinology
|July 12, 2024
概括
同时使用甲胺或氨酸-血管新生系统抑制剂 (RASis) 并不会改变2型糖尿病患者的结局,这些患者接受了-葡萄糖携带载体-2 抑制剂 (SGLT2i) 治疗. 这种现实世界的证据证实SGLT2i的安全概况不会受到这些常见的联合治疗的影响.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 内分泌学 在内分泌学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 关于甲福明和-血管新生系统抑制剂 (RASis) 与-葡萄糖携带载体-2 抑制剂 (SGLT2i) 对结局的联合作用的现实证据有限.
- 了解这些相互作用对于优化2型糖尿病 (T2D) 治疗策略至关重要.
研究的目的:
- 调查是否同时使用甲福明或RASis改变SGLT2i相关的T2D患者的结局.
- 提供关于SGLT2i与常见抗高血糖和抗高血压药物结合使用的安全性和有效性的真实数据.
主要方法:
- 三个电子健康记录数据库 (2016年5月 - 2017年12月) 的回顾性分析.
- SGLT2i使用者根据同时使用甲福明或RASI使用被分类.
- 倾向性得分匹配和元分析被用于评估平均估计的淋巴细胞过率 (eGFR) 变化和 eGFR 减少的时间 (30%,40%,50%).
主要成果:
- 在倾向性得分匹配后,分析了含有和不含有甲福林/RASis的SGLT2i用户的显著队列.
- 虽然观察到最初的eGFR下降,但无论是甲福林还是RASI都没有在30%,40%或50%的值显著改变SGLT2i相关的eGFR降低.
- 对于eGFR降低的危险比率在组之间没有显著差异 (例如,30%的eGFR降低:metformin的HR 1.02 [0.87-1.20],RASis的HR 1.09 [0.92-1.31]).
结论:
- 同时使用甲福明或RASis不会改变T2D患者与SGLT2i治疗相关的结局.
- 这些发现支持SGLT2抑制剂的已确定的安全性,无论是否同时接受甲福林或RASI治疗.
- 实际数据证实,常见的联合药物不会对SGLT2i的脏保护作用产生负面影响.
相关概念视频
Oral Hypoglycemic Agents: Biguanides and Glitazones
187
Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood...
187
Dipeptidyl Peptidase 4 Inhibitors
180
Dipeptidyl peptidase 4 (DPP-4) is a serine protease widely distributed in the body. It's involved in the inactivation of GLP-1 and GIP hormones, which are crucial for insulin regulation. DPP-4 inhibitors, such as sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina), and vildagliptin (Galvus), help increase the proportion of active GLP-1, enhancing insulin secretion. These inhibitors work by competitively binding to DPP-4. This binding causes a...
180
Oral Hypoglycemic Agents: Sulfonylureas
199
Sulfonylureas are oral hypoglycemic agents utilized in treating type 2 diabetes. They are characterized by their unique sulfonylurea chemical structure. The family of sulfonylureas is divided into generations. First-generation sulfonylureas, including tolbutamide (Orinase), chlorpropamide (Diabinese), and tolazamide (Tolinase), trigger insulin release from pancreatic β cells and enhance peripheral tissues' insulin sensitivity. The second-generation members, such as glipizide...
199
Oral Hypoglycemic Agents: Glinides
152
Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively...
152
Diabetes Mellitus: Type 2 and Gestational
2.3K
Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
2.3K
Glucose Transporters
22.6K
Glucose transporters facilitate the transport of glucose across the cell membrane. In addition to glucose, some glucose transporters can also aid the movement of other hexoses such as fructose, mannose, and galactose.
Facilitated diffusion-glucose transporters (GLUTs) are encoded by the solute-linked carrier (SLC) family 2, subfamily A gene family, or SLC2A. The 14 GLUT protein members are distributed into three classes:
Facilitated diffusion-glucose transporters (GLUTs) are encoded by the solute-linked carrier (SLC) family 2, subfamily A gene family, or SLC2A. The 14 GLUT protein members are distributed into three classes:
22.6K


