钠-葡萄糖共转运体-2 抑制剂在 1 型糖尿病中的应用:潜在使用建议框架》。

IF 3.8 3区 医学 Q2 Medicine
Diabetes Therapy Pub Date : 2024-12-01 Epub Date: 2024-10-16 DOI:10.1007/s13300-024-01657-9
Djordje S Popovic, Dimitrios Patoulias, Theocharis Koufakis, Paschalis Karakasis, Nikolaos Papanas
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引用次数: 0

摘要

随着超重/肥胖症发病率的不断上升,大多数患者的血糖控制仍不理想,1 型糖尿病患者的心血管疾病发病率和死亡率仍高得令人难以接受,因此迫切需要在治疗手段中引入非胰岛素降糖药物。鉴于钠-葡萄糖协同转运体-2 抑制剂(SGLT2is)的降血糖作用机制与内源性胰岛素分泌无关,而且观察到的心肾功能获益与其降糖特性无关,因此可以推测,使用钠-葡萄糖协同转运体-2 抑制剂(SGLT2is)可为 T1D 患者带来获益,类似于在 2 型糖尿病、慢性肾脏病(CKD)和心力衰竭患者中观察到的获益。随机对照试验的现有证据表明,SGLT2is 作为胰岛素的辅助治疗可适度降低 T1D 患者的糖化血红蛋白和体重。此外,SGLT2is 还能改善白蛋白尿,从而延缓或预防 T1D 患者出现慢性肾脏病。然而,使用 SGLT2is 会增加 T1D 患者发生糖尿病酮症酸中毒(DKA)的风险。本评论旨在根据个体发生 DKA 的风险水平、血糖控制不足和相关心肾并发症的存在情况,就 SGLT2is 在成人 T1D 患者中的潜在使用提供实用建议框架。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Sodium-Glucose Co-transporter-2 Inhibitors in Type 1 Diabetes Mellitus: The Framework for Recommendations for Their Potential Use.

The growing prevalence of overweight/obesity, the persistence of inadequate glycemic control among the majority of affected individuals, and the still unacceptably high risk of cardiovascular morbidity and mortality among population with type 1 diabetes mellitus (T1D), impose an urgent need for the introduction of non-insulin glucose-lowering agents in the therapeutic armamentarium. Given that their antihyperglycemic mechanism of action is independent of endogenous insulin secretion and that the observed cardio-renal benefits are unrelated to their glucose-lowering properties, one can speculate that the use of sodium-glucose co-transporter-2 inhibitors (SGLT2is) could provide benefits in T1D, similar to the ones observed among individuals with type 2 diabetes mellitus, chronic kidney disease (CKD), and heart failure. Available evidence from randomized controlled trials suggests that treatment with SGLT2is as adjunct to insulin in T1D results in modest reductions in glycated hemoglobin and body weight. Additionally, SGLT2is ameliorate albuminuria, and thus delay or prevent the development of CKD in T1D. However, use of SGLT2is is associated with an increased risk of diabetic ketoacidosis (DKA) in T1D. This commentary aims at providing a framework for practical recommendations regarding the potential use of SGLT2is in adults with T1D, based on the individual's risk level for DKA development, the presence of inadequate glycemic control and related cardio-renal complications.

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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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