从循证医学角度看致体重降低降糖药物的长期有效性和安全性

Long Term Efficacy and Safety of Antidiabetic Drugs with Weight Loss Effect: an Evidence Based Review

目前具有降低体重的降糖药包括双胍类、α-糖苷酶抑制剂、胰高血糖素样肽-1受体激动剂(glucagon-like peptide-1 receptor agonists,GLP-1RA)及钠-葡萄糖共转运蛋白-2(sodium glucose co-transporter,SGLT-2)抑制剂。二甲双胍能长期有效降糖、减重,具有明确的心血管保护作用。α-糖苷酶抑制剂降低餐后血糖效果明显,具有轻度减重作用,可降低糖耐量受损(impaired glucose tolerance,IGT)人群的心血管事件及新发高血压风险。GLP-1RA降糖疗效持久,减重效果最佳,还能改善血压、血脂、β细胞功能,有一定心血管保护作用。上述3类药物的主要不良反应均为胃肠道反应,低血糖风险小。SGLT-2抑制剂不仅有良好的降糖及减重效应,还有降压及心血管保护作用,可能对肾脏有保护,其主要不良反应为生殖泌尿道感染。

The current antidiabetic drugs which have a weight loss effect include biguanide, alpha glycosidase inhibitors, glucagon-like peptide-1 receptor agonists （GLP-1RAs） and sodium-glucose co-transporter 2 inhibitors （SGLT-2i）. Metformin has long-term effect on glycemic control and weight loss, and provides specific cardiovascular protection. Alpha GIs reduce postprandial blood glucose effectively and lose weight mildly, which significantly reduce risk of cardiovascular events and new high blood pressure in the population with impaired glucose tolerance. GLP-1RAs have lasting hypoglycemic effect and best weight loss, and also improve blood pressure, blood lipids and β cell function. Meanwhile they provide certain cardiovascular protection. The main adverse effect of the three kinds of drug mentioned above is gastrointestinal reaction, and their risk of hypoglycemia is low. SGLT-2i not only have good hypoglycemic and weight loss effect, but also provide antihypertension and cardiovascular protection, and may have kidney protection. The main adverse effect of SGLT-2i is genital and urinary tract infections.[