减肥/代谢手术后使用SGLT2抑制剂:风险/收益平衡

IF 4.6 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM
André J. Scheen
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引用次数: 1

摘要

减肥/代谢手术和钠-葡萄糖协同转运蛋白2抑制剂(SGLT2is)在2型糖尿病(T2DM)超重/肥胖患者的治疗中越来越受欢迎。因此,在临床实践中,接受减肥/代谢手术的患者也接受SGLT2i治疗的可能性相当普遍。风险和收益都已报告。一方面,据报道,在减肥/代谢手术后的几天/几周内,出现了几例血糖正常的糖尿病酮症酸中毒病例。原因多种多样,但热量(碳水化合物)摄入的大幅减少可能起到了至关重要的作用。因此,SGLT2is应在干预前几天停止使用(如果术前限制性饮食是为了减少肝脏体积,则应停止使用),只有在热量(碳水化合物)摄入充足时才重新使用。另一方面,SGLT2is可能对降低餐后低血糖的风险发挥有利作用,餐后低血糖是接受减肥/代谢手术治疗的患者中报告的并发症。肝葡萄糖生成增加和白细胞介素-1β生成减少被认为是这种保护作用的可能潜在机制。最后,SGLT2is是否能延长手术后糖尿病的缓解期,并改善受益于减肥/代谢手术的T2DM患者的预后,还有待研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Use of SGLT2 inhibitors after bariatric/metabolic surgery: Risk/benefit balance

Bariatric/metabolic surgery and sodium-glucose cotransporter 2 inhibitors (SGLT2is) are becoming increasingly popular for the management of overweight/obese patients with type 2 diabetes mellitus (T2DM). Consequently, the chance that a patient undergoing bariatric/metabolic surgery is also treated with an SGLT2i would be rather common in clinical practice. Both risks and benefits have been reported. On the one hand, several cases of euglycemic diabetic ketoacidosis have been reported within the few days/weeks after bariatric/metabolic surgery. The causes are diverse but a drastic reduction in caloric (carbohydrate) intake most probably plays a crucial role. Thus, SGLT2is should be stopped a few days (and even more if a pre-operative restricted diet is prescribed to reduce liver volume) before the intervention and reintroduced only when the caloric (carbohydrate) intake is sufficient. On the other hand, SGLT2is may exert a favorable effect to reduce the risk of postprandial hypoglycemia, a complication reported among patients who have been treated with bariatric/metabolic surgery. An increased hepatic glucose production and a reduced production of interleukin-1β have been proposed as possible underlying mechanisms for this protective effect. Finally, whether SGLT2is could prolong diabetes remission following surgery and improve the prognosis of patients with T2DM who benefit from bariatric/metabolic surgery remains to be investigated.

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来源期刊
Diabetes & metabolism
Diabetes & metabolism 医学-内分泌学与代谢
CiteScore
12.00
自引率
4.20%
发文量
86
审稿时长
13 days
期刊介绍: A high quality scientific journal with an international readership Official publication of the SFD, Diabetes & Metabolism, publishes high-quality papers by leading teams, forming a close link between hospital and research units. Diabetes & Metabolism is published in English language and is indexed in all major databases with its impact factor constantly progressing. Diabetes & Metabolism contains original articles, short reports and comprehensive reviews.
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