SGLT2抑制剂和GLP-1受体激动剂联合治疗对接受慢性降糖药治疗的2型糖尿病患者CRT反应和临床结局的影响：一项多中心观察性研究

IF 7.4 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice Pub Date : 2025-09-03 DOI:10.1016/j.diabres.2025.112452

Celestino Sardu , Ludovica Vittoria Marfella , Luca Rinaldi , Ferdinando Carlo Sasso , Domenico Cozzolino , Francesco Nappo , Ausilia Sellitto , Ciro Romano , Caterina Carusone , Nunzia D’Onofrio , Maria Consiglia Trotta , Joshua Riccio , Domenico Cioffi , Mario Volpicelli , Carmine La Marca , Natale Marrazzo , Valerio Giordano , Carlo Fumagalli , Alessandro Landolfi , Marianna Abitabile , Raffaele Marfella

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引用次数: 0

摘要

背景：2型糖尿病（T2DM）会损害接受心脏再同步除颤器治疗（CRTd）患者的预后。虽然钠-葡萄糖共转运蛋白2抑制剂（SGLT2i）和胰高血糖素样肽-1受体激动剂（GLP-1RAs）都有心血管益处，但它们对crtd治疗的T2DM患者的联合影响尚不清楚。方法在这项前瞻性多中心观察性研究中，2257例接受CRTd治疗的T2DM患者被分为三组：SGLT2i单药治疗（874例）、GLP-1RAs单药治疗（808例）和GLP-1RAs/SGLT2i联合治疗（575例）。主要终点是1年随访时的crt应答和心力衰竭住院率。次要终点包括血糖控制、肾功能、炎症/氧化标志物和心脏死亡的变化。结果1年后，联合治疗组的crt应答率（66.3%）显著高于SGLT2i组（59.6%）和GLP-1RAs组（59.2%）（p = 0.014）， hf住院率（15.7%）显著低于GLP-1RAs组（分别为23.5%和24.4%,p = 0.001）。多因素Cox分析证实，联合治疗是1年随访时CRT疗效（HR 1.659, CI 95% [1.32 - 2.085]; p 0.001）和HF住院率降低（0.822,CI 95% [0.751-0.966]; p0.012）的独立预测因子。结论在接受CRTd的T2DM患者中，与单药治疗相比，GLP-1RAs/SGLT2i联合治疗可改善心功能和临床结果。GLP-1RAs/SGLT2i可优化T2DM患者的CRT反应性，降低hf住院率。

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Effects of combination therapy with SGLT2 inhibitors and GLP-1 receptor agonists on CRT response and clinical outcomes in in type 2 diabetes mellitus patients receiving chronic anti-diabetic medications: A multicenter observational study

Background

Type-2-diabetes-mellitus (T2DM) impairs outcomes in patients undergoing cardiac-resynchronization-therapy-with-defibrillator (CRTd). While both sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) have cardiovascular benefits, their combination impact in CRTd-treated T2DM patients remains unclear.

Methods

In this prospective multicenter observational study, 2,257 T2DM patients treated with CRTd were stratified into three groups: SGLT2i monotherapy (n 874), GLP-1RAs monotherapy (n 808), and combination therapy with GLP-1RAs/SGLT2i (n 575). Primary endpoints were CRT-response and heart failure (HF) hospitalizations at 1-year follow-up. Secondary endpoints included changes in glycemic control, renal function, inflammatory/oxidative markers, and cardiac deaths.

Results

At 1 year, the combination therapy group had significantly higher CRT-response rate (66.3 %) compared to SGLT2i (59.6 %) and GLP-1RAs (59.2 %) groups (p = 0.014), and lower HF-hospitalization rates (15.7 % vs. 23.5 % and 24.4 %, respectively; p = 0.001). Multivariate Cox analysis confirmed combination therapy as an independent predictor of CRT response (HR 1.659, CI 95 % [1.320–2.085]; p 0.001) and reduced HF hospitalizations (0.822, CI 95 % [0.751–0.966]; p0.012) at 1 year of follow-up.

Conclusions

In T2DM patients receiving CRTd, combination therapy with GLP-1RAs/SGLT2i was associated with improvements in cardiac function and clinical outcomes compared to monotherapy. GLP-1RAs/SGLT2i could optimize CRT responsiveness and reduce HF-hospitalizations in T2DM patients.

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来源期刊

Diabetes research and clinical practice 医学-内分泌学与代谢

CiteScore

10.30

自引率

3.90%

发文量

862

审稿时长

32 days

期刊介绍： Diabetes Research and Clinical Practice is an international journal for health-care providers and clinically oriented researchers that publishes high-quality original research articles and expert reviews in diabetes and related areas. The role of the journal is to provide a venue for dissemination of knowledge and discussion of topics related to diabetes clinical research and patient care. Topics of focus include translational science, genetics, immunology, nutrition, psychosocial research, epidemiology, prevention, socio-economic research, complications, new treatments, technologies and therapy.