SGLT2 Inhibitors – The New Standard of Care for Cardiovascular, Renal and Metabolic Protection in Type 2 Diabetes: A Narrative Review

IF 3.8 3区 医学 Q2 Medicine
Samuel Seidu, Vicki Alabraba, Sarah Davies, Philip Newland-Jones, Kevin Fernando, Stephen C. Bain, Jane Diggle, Marc Evans, June James, Naresh Kanumilli, Nicola Milne, Adie Viljoen, David C. Wheeler, John P. H. Wilding
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Abstract

A substantial evidence base supports the use of sodium-glucose cotransporter-2 inhibitors (SGLT2is) in the treatment of type 2 diabetes mellitus (T2DM). This class of medicines has demonstrated important benefits that extend beyond glucose-lowering efficacy to protective mechanisms capable of slowing or preventing the onset of long-term cardiovascular, renal and metabolic (CVRM) complications, making their use highly applicable for organ protection and the maintenance of long-term health outcomes. SGLT2is have shown cost-effectiveness in T2DM management and economic savings over other glucose-lowering therapies due to reduced incidence of cardiovascular and renal events. National and international guidelines advocate SGLT2i use early in the T2DM management pathway, based upon a plethora of supporting data from large-scale cardiovascular outcome trials, renal outcomes trials and real-world studies. While most people with T2DM would benefit from CVRM protection through SGLT2i use, prescribing hesitancy remains, potentially due to confusion concerning their place in the complex therapeutic paradigm, variation in licensed indications or safety perceptions/misunderstandings associated with historical data that have since been superseded by robust clinical evidence and long-term pharmacovigilance reporting. This latest narrative review developed by the Improving Diabetes Steering Committee (IDSC) outlines the place of SGLT2is within current evidence-informed guidelines, examines their potential as the standard of care for the majority of newly diagnosed people with T2DM and sets into context the perceived risks and proven advantages of SGLT2is in terms of sustained health outcomes. The authors discuss the cost-effectiveness case for SGLT2is and provide user-friendly tools to support healthcare professionals in the correct application of these medicines in T2DM management. The previously published IDSC SGLT2i Prescribing Tool for T2DM Management has undergone updates and reformatting and is now available as a Decision Tool in an interactive pdf format as well as an abbreviated printable A4 poster/wall chart.

Abstract Image

SGLT2 抑制剂--保护 2 型糖尿病患者心血管、肾脏和代谢功能的新标准:叙述性综述
钠-葡萄糖共转运体-2 抑制剂(SGLT2is)用于治疗 2 型糖尿病(T2DM)已获得大量证据支持。这类药物已显示出重要的益处,不仅具有降糖疗效,还具有保护机制,能够减缓或预防长期心血管、肾脏和代谢(CVRM)并发症的发生,因此非常适合用于器官保护和维持长期健康结果。与其他降糖疗法相比,SGLT2is 在治疗 T2DM 方面具有成本效益,并能降低心血管和肾脏事件的发生率,从而节约经济成本。基于大规模心血管结果试验、肾脏结果试验和真实世界研究的大量支持性数据,国家和国际指南提倡在 T2DM 治疗的早期阶段使用 SGLT2i。虽然大多数 T2DM 患者都能通过使用 SGLT2i 从 CVRM 保护中获益,但他们在处方上仍然犹豫不决,这可能是由于他们对 SGLT2i 在复杂的治疗范式中的地位感到困惑、许可适应症存在差异或对历史数据的安全认知/误解,而这些历史数据已经被可靠的临床证据和长期的药物警戒报告所取代。这篇由改善糖尿病指导委员会(IDSC)撰写的最新叙述性综述概述了 SGLT2is 在当前循证指南中的地位,探讨了其作为大多数新诊断 T2DM 患者的标准治疗方案的潜力,并从持续健康结果的角度阐述了 SGLT2is 的已知风险和已证实优势。作者讨论了 SGLT2is 的成本效益案例,并提供了便于使用的工具,以支持医护人员在 T2DM 管理中正确应用这些药物。之前出版的《IDSC SGLT2i T2DM 管理处方工具》经过了更新和重新格式化,现在可作为交互式 pdf 格式的决策工具以及简短的可打印 A4 海报/挂图使用。
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来源期刊
Diabetes Therapy
Diabetes Therapy Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
6.90
自引率
7.90%
发文量
130
审稿时长
6 weeks
期刊介绍: Diabetes Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all areas of diabetes. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Diabetes Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.
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