在2型糖尿病患者中,SGLT2抑制剂在临床实践中的心血管风险
Hsuan-Yu Su1, Chen-Yi Yang1, Yu-Hsuan Lee1
1Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
JAMA network open
|October 30, 2024
概括
-葡萄糖携带载体2抑制剂 (SGLT2i) 与迪佩代酶4抑制剂 (DPP4i) 相比,在2型糖尿病 (T2D) 患者中降低了心血管疾病 (CVD) 总发病率. 在高风险患者,特别是女性中,益处最为明显,这表明对弱势个体优先考虑SGLT2i.
科学领域:
- 心脏病学 心脏病学
- 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:
- 心血管疾病 (CVD) 的复发是2型糖尿病 (T2D) 的老年人群的一个重大问题.
- 在临床实践中,对于T2D患者的心血管疾病总发病事件,-葡萄糖共运输体2抑制剂 (SGLT2i) 与二乙酶4抑制剂 (DPP4i) 的比较有效性尚未得到充分证实.
研究的目的:
- 为了比较SGLT2i治疗与DPP4i治疗与T2D患者心血管疾病总事件的相关性.
- 评估SGLT2i在减少第一个和随后的心血管疾病事件中的有效性.
主要方法:
- 一项回顾性队列研究,利用台湾一家领先医院 (2015-2021) 的电子病历.
- 包括成人T2D患者开始SGLT2i或DPP4i治疗 (2016-2019) 随访长达6年.
- 倾向性得分匹配和共享脆弱模型被用于分析总复合心血管疾病事件和亚型,包括重复事件.
主要成果:
- 与DPP4i治疗相比,SGLT2i治疗与总心血管疾病事件的风险降低有关 (HR,0.82;95% CI,0.69-0.98).
- 这种益处在高风险的T2D患者中更为显著,包括那些估计球膜过率<60mL/min/1.73m2,糖尿病相关并发症或心血管疾病史患者.
- 在高风险患者中,SGLT2i显示,与男性相比,女性对心血管疾病总负担的减少更大,特别是那些有心血管疾病史的人.
结论:
- 与DPP4i治疗相比,SGLT2i治疗与T2D患者的心血管总负担降低有关.
- 长期使用SGLT2i可能会优化慢性心血管疾病患者的治疗效益.
- 由于在减少心血管疾病复发方面观察到的好处,建议优先考虑SGLT2i在高风险T2D个体,特别是女性的使用.
相关概念视频
Diabetes Mellitus: Type 2 and Gestational
2.2K
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...
2.2K
Oral Hypoglycemic Agents: Biguanides and Glitazones
176
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...
176
Dipeptidyl Peptidase 4 Inhibitors
173
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...
173
Glucose Transporters
22.5K
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:
22.5K
Diabetes: Symptoms, Diagnosis, and Complications
511
For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is...
511
Oral Hypoglycemic Agents: Sulfonylureas
193
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...
193


