Sodium-dependent glucose transporter 2 inhibitors effects on myocardial function in patients with type 2 diabetes and asymptomatic heart failure

BACKGROUND Sodium-dependent glucose transporter 2 inhibitors(SGLT2i)have shown efficacy in reducing heart failure(HF)burden in a very heterogeneous groups of patients,raising doubts about some contemporary assumptions of their mechanism of action.We previously published a prospective observational study that evaluated mechanisms of action of SGLT2i in patients with type 2 diabetes who were in HF stages A and B on dual hypoglycemic therapy.Two groups of patients were included in the study:the ones receiving SGLT2i as an add-on agent to metformin and the others on dipeptidyl peptidase-4 inhibitors as an add-on to metformin due to suboptimal glycemic control.AIM To evaluate the outcomes regarding natriuretic peptide,oxidative stress,inflammation,blood pressure,heart rate,cardiac function,and body weight.METHODS The study outcomes were examined by dividing each treatment arm into two subgroups according to baseline parameters of global longitudinal strain(GLS),N-terminal pro-brain natriuretic peptide,myeloperoxidase(MPO),high-sensitivity C-reactive protein(hsCRP),and systolic and diastolic blood pressure.To evaluate the possible predictors of observed changes in the SGLT2i arm during follow-up,a rise in stroke volume index,body mass index(BMI)decrease,and lack of heart rate increase,linear regression analysis was performed.RESULTS There was a greater reduction of MPO,hsCRP,GLS,and blood pressure in the groups with higher baseline values of mentioned parameters irrespective of the therapeutic arm after 6 months of follow-up.Significant independent predictors of heart rate decrease were a reduction in early mitral inflow velocity to early diastolic mitral annular velocity at the interventricular septal annulus ratio and BMI,while the predictor of stroke volume index increase was SGLT2i therapy itself.CONCLUSION SGLT2i affect body composition,reduce cardiac load,improve diastolic/systolic function,and attenuate the sympathetic response.Glycemic control contributes to the improvement of heart function,blood pressure control,oxidative stress,and reduction in inflammation.

Effects of sodium-dependent glucose transporter 2 inhibitors in patients with type 2 diabetes mellitus and asymptomatic heart failure

Sodium-dependent glucose transporter 2 inhibitors(SGLT2i)have been increa-singly used with proven efficacy in patients with heart failure(HF),regardless of diabetes status.GrubićRotkvićet al recently published an observational study on SGLT2i therapy in patients with type 2 diabetes mellitus and asymptomatic HF.They found that the use of SGLT2i led to reduced cardiac load and improved cardiovascular performance,reinforcing the evolving paradigm that SGLT2i are not merely glucose-lowering agents but are integral to the broader management of cardiovascular risk in patients with type 2 diabetes mellitus.The study by GrubićRotkvićet al contributes to the growing body of literature supporting the early use of SGLT2i in patients with diabetic cardiomyopathy,offering a potential strategy to mitigate the progression of HF.Future larger studies should be con-ducted to confirm these findings,and explore the long-term cardiovascular bene-fits of SGLT2i,particularly in asymptomatic patients at risk of developing HF.

Effectiveness and mechanisms of sodium-dependent glucose transporter 2 inhibitors in type 2 diabetes and heart failure patients

We comment on an article by GrubićRotkvićet al published in the recent issue of the World Journal of Cardiology.We specifically focused on possible factors affecting the therapeutic effectiveness of sodium-dependent glucose transporter inhibitors(SGLT2i)in patients with type 2 diabetes mellitus(T2DM)and their impact on comorbidities.SGLT2i inhibits SGLT2 in the proximal tubules of the kidneys,lowering blood glucose levels by inhibiting glucose reabsorption by the kidneys and causing excess glucose to be excreted in the urine.Previous studies have demonstrated a role of SGLT2i in cardiovascular function in patients with diabetes who take metformin but still have poor glycemic control.In addition,SGLT2i has been shown to be effective in anti-apoptosis,weight loss,and cardiovascular protection.Accordingly,it is feasible to treat patients with T2DM with cardiovascular or renal diseases using SGLT2i.

GLUT1、GLUT2介导的葡萄糖摄取对小鼠牙齿早期发育的影响

目的:探究葡萄糖转运蛋白(glucose transporter,GLUT)1、GLUT2介导的葡萄糖摄取对小鼠牙齿早期发育的影响。方法:收集胚胎13.5 d(embryonic day 0.5,E13.5)、E14.5、E16.5、E18.5和出生后1 d(postnatal day 1,P1)时期的下颌磨牙牙胚、上颌切牙牙胚;实时荧光定量聚合酶链反应(real time-quantitative polymerase chain reaction,RT-qPCR)和Western blot检测牙胚中Glut1、Glut2 mRNA和蛋白水平;免疫组织化学染色检测牙胚中GLUT1、GLUT2、Ki67、糖原水平。将下颌磨牙牙胚在无糖DMEM培养基、高糖且含不同浓度的根皮素(0、0.25、0.5 mmol/L)的DMEM培养基中培养9 d;并对其进行苏木精-伊红(hematoxylin-eosin,HE)染色。结果:(1)在E13.5时期,GLUT1在成釉器中高表达,细胞增殖活跃,糖原在牙板和牙囊中大量沉积;在E14.5、E18.5时期,GLUT1在成釉器中表达逐渐降低,细胞增殖减少,糖原在成釉器和牙乳头中大量沉积;在P1时期,GLUT1在中间层和内釉上皮中表达较多,细胞增殖增多,糖原在牙乳头中少量沉积。在整个牙胚发育阶段,GLUT2表达相对较少。(2)GLUT1在前成釉细胞、前成牙本质细胞中高表达,而在分化后的成釉细胞、成牙本质细胞中表达较少;GLUT2与GLUT1呈现相反的表达趋势。(3)0.5 mmol/L根皮素能够抑制E13.5时期外植体牙胚发育,0.25 mmol/L根皮素不抑制E13.5、E14.5时期外植体牙胚发育,但能够导致牙胚变小,且具有根皮素浓度依赖性。无糖培养基能够抑制E13.5、E14.5时期外植体牙胚发育。结论:GLUT1、GLUT2在牙齿早期发育中的表达受到精确的时空调控,由GLUT1、GLUT2介导的葡萄糖摄取在小鼠牙齿早期发育中发挥重要作用。

Effects of octreotide on glucose transporter type 2expression in obese rat small intestine

AIM： TO investigate the effects of the somatostatin analogue, octreotide, on maltose and sucrase activities and expression of glucose transporter type 2 （GLUT2） in obese rat intestinal mucosa. METHODS： We divided 49 Sprague-Dawley rats into a group of 31 high fat diet-induced obese rats and a group of 18 normal controls. The obese rats were separated into an octreotide treated group 9f 16 rats and an obese group of 15. The intervention （：jroup was injected with octreotide at 40 ±g/kg body weight every 12 h for 8 d. Rat body weight was measured weekly to calculate Lee＇s index. After euthanization, maltase and sucrase activities in the small intestine were measured by activity assays, and the fasting plasma glucose level was measured. The expression of GLUT2 in small intestinal mucosa was analyzed by immunohistochemistry, reverse transcriptase polymerase chain reaction and Western blotting assays. RESULTS： Body weight, Lee＇s index, fasting plasma glucose level, maltase activity in small intestinal mucosa, mucosa and apical GLUT2, GLUT2 mRNA and protein expression levels were all significantly higher in the obese group than in the normal control group （605.61 ± 141.00 vs 378.54 ±111.75, 337.61 ± 10.82 vs 318.73 ± 20.10, 8.60± 1.38 vs 7.33 ± 0.70, 156.01 ± 58.81 vs 50.43 ± 30.49, 390 744.2± 62 469.21 vs 170 546.50 ± 50 646.14, 26 740.18 ±3809.60 vs 354.98± 57.19, 0.26± 0.11 vs 0.07± 0.02, and 2.08 ± 0.59 vs 1.27 ± 0.38, respectively, all P 〈 0.01）. Sucrase activity did not differ between the two groups. Octreotide intervention significantly decreased the body weight and fasting plasma glucose level of obese rats （508.27 ± 94.39 vs 605.61 ± 141.00, 7.58 ± 1.51 vs 8.60±1.38, respectively, all P 〈 0.05）. The intestinal mucosa and apical GLUT2, expression of GLUT2 mRNA and protein were also significantly lower in the octreotide intervention group than in the obese group （269 975.2 ± 53 730.94 vs 390 744.2 ± 62 469.21, 3758.06 ± 364.51 vs 26 740.18 ± 3809.60, 0.08 ± 0.02 vs 0.26 ±0.11, and 1.31 ± 0.27 vs 2.08 ±0.59, respectively, all P 〈 0.01）. CONCLUSION： High fat dietinduced obesity is associated with elevated intestinal maltase activity, GLUT2 expression, and permanent apical GLUT2 in the small intestinal mucosa of rats. Octreotide can inhibit these effects.

Role of sodium-glucose co-transporter-2 inhibitors in the management of nonalcoholic fatty liver disease

Nonalcoholic fatty liver disease (NAFLD) is the most prevalent cause of chronic liver disease worldwide. NAFLD is considerably more frequent in patients with type 2 diabetes mellitus (T2DM) than in the general population and is also more severe histologically in this group. Sodium-glucose co-transporter-2 (SGLT2) inhibitors, the newest class of antidiabetic agents, appear to represent a promising option for the management of NAFLD in patients with T2DM. In a number of studies, treatment with SGLT2 inhibitors resulted in a reduction in hepatic steatosis and in transaminase levels. However, existing studies are small, their follow-up period was short and none evaluated the effects of SGLT2 inhibitors on liver histology. Accordingly, larger studies are needed to verify these preliminary results and define the role of SGLT2 inhibitors in the treatment of NAFLD in patients with T2DM.

No signature of selection on the C-terminal region of glucose transporter 2 with the evolution of avian nectarivory

Background:Flying birds,especially those that hover,need to meet high energetic demands.Birds that meet this demand through nectarivory face the added challenges of maintaining homeostasis in the face of spikes in blood sugar associated with nectar meals,as well as transporting that sugar to energetically demanding tissues.Nectarivory has evolved many times in birds and we hypothesized that the challenges of this dietary strategy would exert selective pressure on key aspects of metabolic physiology.Specifically,we hypothesized we would find convergent or parallel amino acid substitutions among different nectarivorous lineages in a protein important to sensing,regulating,and transporting glucose,glucose transporter 2(GLUT2).Methods:Genetic sequences for GLUT2 were obtained from ten pairs of nectarivorous and non-nectarivorous sister taxa.We performed PCR amplification of the intracellular C-terminal domain of GLUT2 and adjacent protein domains due to the role of this region in determination of transport rate,substrate specificity and glucosensing.Results:Our findings have ruled out the C-terminal regulatory region of GLUT2 as a target for selection by sugar-rich diet among avian nectarivores,though selection among hummingbirds,the oldest avian nectarivores,cannot be discounted.Conclusion:Our results indicate future studies should examine down-stream targets of GLUT2-mediated glucosensing and insulin secretion,such as insulin receptors and their targets,as potential sites of selection by nectarivory in birds.

SGLT-2抑制剂达格列净治疗早期糖尿病肾病的临床效果和安全性分析

目的分析在早期糖尿病肾病治疗中采用钠-葡萄糖协同转运蛋白2(Sodium-dependent Glucose Transporters 2,SGLT-2)抑制剂达格列净的疗效和安全性。方法选取2022年3月—2023年12月北京市第六医院收治的100例早期糖尿病肾病患者为研究对象,以随机数表法分为研究组和对照组,各50例。给予全部患者常规治疗,研究组加用达格列净治疗,对照组加用二甲双胍治疗,对比两组血糖水平、肾功能和不良反应发生情况。结果治疗后,研究组空腹血糖为(5.16±0.77)mmol/L,餐后2 h血糖为(7.11±1.38)mmol/L,糖化血红蛋白为(5.05±0.73)%,低于对照组,差异有统计学意义(t=4.592、5.020、5.093,P均<0.05)。治疗后,研究组尿白蛋白/肌酐比值、肾小球过滤率优于对照组,差异有统计学意义(P均<0.05)。研究组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论在早期糖尿病肾病治疗中采用SGLT-2抑制剂达格列净疗效显著,可以有效降低血糖水平,改善肾功能,降低不良反应发生率。

青钱柳多糖调节胰岛和肝脏葡萄糖转运蛋白4转位干预2型糖尿病大鼠的作用机制

目的 观察青钱柳多糖调节胰岛和肝脏葡萄糖转运蛋白4(GLUT4)转位改善2型糖尿病(T2DM)大鼠外周胰岛抵抗的作用。方法 建立T2DM大鼠模型(给予高脂饲料后注射链脲佐菌素35 mg·kg^(-1)),将造模成功的大鼠随机分为模型对照组,青钱柳多糖提取物小、大剂量组(5,10 g·kg^(-1))和盐酸二甲双胍组(0.25 g·kg^(-1)),每组9只,给药8周。测定空腹血糖、血脂变化;苏木精-伊红染色法观察胰岛和肝脏病理形态的改变;免疫组化法观察胰岛磷酸化磷酯酰肌醇3激酶(p-PI3K)、磷酸化丝氨酸苏氨酸蛋白激酶1(p-Akt1)、GLUT4蛋白的表达;免疫荧光观察肝脏和胰岛GLUT4转位。结果 与模型对照组比较,青钱柳多糖提取物小、大剂量组和盐酸二甲双胍组大鼠胰岛和肝脏结构较完整,血糖下降(P<0.05),高密度脂蛋白升高(P<0.05),胰岛p-PI3K、p-Akt1、GLUT4蛋白表达升高(P<0.05),肝脏和胰岛GLUT4转位增强(P<0.05)。结论 青钱柳多糖可调节T2DM大鼠糖脂紊乱,其机制可能是增强胰岛p-PI3K、p-Akt1、GLUT4蛋白的表达,促进肝脏和胰岛GLUT4转位,从而调节外周胰岛抵抗。

达格列净对2型糖尿病非增殖期视网膜病变的影响

目的:探讨达格列净对2型糖尿病非增殖期视网膜病变(non-proliferative diabetic retinopathy,NPDR)的影响。方法:选取2021年10月—2023年6月湖南师范大学附属湘东医院收治的88例2型糖尿病NPDR患者。随机将其分为观察组及对照组,各44例。两组均给予常规降糖治疗,观察组加用达格列净治疗。比较两组治疗前后血糖指标及相关指标。分析血管内皮生长因子(vascular endothelial growth factor,VEGF)与血糖波动指标的相关性。结果:治疗后,两组空腹血糖(fasting blood glucose,FBG)、餐后2 h血糖(2 h postprandial blood glucose,2 h PBG)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)、血糖水平标准差(standard deviation of blood glucose,SDBG)、餐后血糖波动幅度(postprandial glucose excursion,PPGE)、最大血糖波动幅度(large amplitude glycemic excursion,LAGE)均下降,观察组SDBG、PPGE、LAGE均低于对照组,差异有统计学意义(P<0.05)。治疗后,两组VEGF、黄斑中心凹厚度均下降,最佳矫正视力(best-corrected visual acuity,BCVA)升高,观察组VEGF、黄斑中心凹厚度均低于对照组,BCVA高于对照组,差异有统计学意义(P<0.05)。Pearson相关性分析结果显示:VEGF与SDBG、PPGE、LAGE均呈正相关(P<0.05)。结论:达格列净能够改善血糖波动,降低VEGF水平,对2型糖尿病NPDR有保护作用。

Chlorogenic Acid Maintains Glucose Homeostasis through Modulating the Expression of SGLT-1,GLUT-2,and PLG in Different Intestinal Segments of Sprague-Dawley Rats Fed a High-Fat Diet

Objective To reveal the effects and related mechanisms of chlorogenic acid(CGA)on intestinal glucose homeostasis.Methods Forty male Sprague-Dawley rats were randomly and equally divided into four groups:normal chow(NC),high-fat diet(HFD),HFD with low-dose CGA(20 mg/kg,HFD-LC),and HFD with high-dose CGA(90 mg/kg,HFD-HC).The oral glucose tolerance test was performed,and fast serum insulin(FSI)was detected using an enzyme-linked immunosorbent assay.The m RNA expression levels of glucose transporters(Sglt-1 and Glut-2)and proglucagon(Plg)in different intestinal segments(the duodenum,jejunum,ileum,and colon)were analyzed using quantitative real-time polymerase chain reaction.SGLT-1 protein and the morphology of epithelial cells in the duodenum and jejunum was localized by using immunofluorescence.Results At both doses,CGA ameliorated the HFD-induced body weight gain,maintained FSI,and increased postprandial 30-min glucagon-like peptide 1 secretion.High-dose CGA inhibited the HFD-induced elevation in Sglt-1 expression.Both CGA doses normalized the HFD-induced downregulation of Glut-2 and elevated the expression of Plg in all four intestinal segments.Conclusion An HFD can cause a glucose metabolism disorder in the rat intestine and affect body glucose homeostasis.CGA can modify intestinal glucose metabolism by regulating the expression of intestinal glucose transporters and Plg,thereby controlling the levels of blood glucose and insulin to maintain glucose homeostasis.

SGLT-2抑制剂对2型糖尿病肾病患者的心血管保护作用

目的:探究钠-葡萄糖共转运蛋白2抑制剂(SGLT-2i)治疗2型糖尿病肾病患者的临床疗效及心血管保护作用。方法:选择2018年1月到2021年12月于我院内分泌科、心血管内科住院的2型糖尿病肾病患者376例,按治疗方案的不同分为对照组(177例,采用常规治疗方案)和SGLT-2i组(199例,在常规治疗方案的基础上联合使用SGLT-2i),且两组患者持续治疗1年。对比两组患者治疗12个月后血糖、血压、血脂、尿酸、人体质量指数、肾功能相关指标及主要不良心血管事件的发生情况,并记录药物的不良反应。结果:治疗12个月后,与对照组比较,SGLT-2i组的血压、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、尿微量白蛋白/肌酐(UACR)、肌酐(Cr)、尿素氮(BUN)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、尿酸(UA)水平均显著降低,估算的肾小球滤过率(eGFR)、高密度脂蛋白胆固醇(HDL-C)、白蛋白(Alb)、丙氨酸氨基转移酶(ALT)水平均显著升高(P<0.05或<0.01)。SGLT-2i组的急性心肌梗死(1.51%比6.21%)、因心力衰竭住院的发生率(2.51%比6.78%)均显著低于对照组,泌尿系感染的发生率(8.54%比1.69%)显著高于对照组(P均<0.05)。结论:SGLT-2i不仅能有效控制血糖,而且还有减轻体重、降低血压、改善血脂、降低尿酸、改善肾脏高滤过、减少尿蛋白的作用以及特有的心血管获益优势,但需注意泌尿系统感染风险。

钠-葡萄糖共转运蛋白2抑制剂对急性心肌梗死合并2型糖尿病患者的安全性及有效性评价

目的:探究钠-葡萄糖共转运蛋白2抑制剂(sodium-glucose co-transporter-2 inhibitor,SGLT2i)对合并2型糖尿病(type 2 diabetes mellitus,T2DM)的急性心肌梗死(acute myocardial infarction,AMI)患者的疗效及安全性。方法:研究纳入2018年1月至2023年1月,在首都医科大学附属北京安贞医院行PCI手术且合并T2DM的AMI患者共2 170例,其中357例患者使用SGLT2i,并根据患者出院带药是否使用SGLT2i分成两组:SGLT2i组和常规降糖组,通过倾向性匹配法进行1:1匹配。本研究主要有效性终点事件为支架术后12个月内心血管不良事件(major adverse cardiovascular events,MACE),包含全因死亡、非致命心肌梗死、或缺血相关血运重建,主要安全终点事件为严重出血事件。结果:通过倾向评分匹配成功357对,两组患者基线特征基本一致,差异无统计学意义。研究平均随访(11.7±1.4)个月。与常规降糖组相比,达格列净组的主要有效性终点事件(HR=0.47,95%CI 0.27~0.81,P=0.006)以及次要终点事件中缺血相关血运重建(HR=0.53,95%CI:0.30~0.93,P=0.026)的发生率较低。两组的主要安全性终点事件(HR=0.72,95%CI:0.29~1.81,P=0.492)、全因死亡(HR=0.49,95%CI:0.23~1.06,P=0.069)和心肌梗死(HR=0.62,95%CI:0.32~1.18,P=0.142)发生率差异未见统计学意义。结论:SGLT2i可以降低合并2型糖尿病的急性心肌梗死患者的MACE、心肌梗死或缺血相关血运重建发生率,同时并不增加安全事件风险。

Photoactivation of GLUT4 translocation promotes glucose uptake via PI3-K/Akt2 signaling in 3T3-L1 adipocytes

Insulin resistance is a hallmark of the metabolic syndrome and type 2 diabetes.Dysfunction of PI-3K/Akt signaling was involved in insulin resistance.Glucose transporter 4(GLUT4)is a keyfactor for glucose uptake in muscle and adipose tissues,which is closely regulated by Pi-3K/Aktsignaling in response to insulin treatment.Low-power laser irradiation(LPLI)has been shown toregulate various physiological processes and induce the synthesis or release of multiple moleculessuch as growth factors,which(especially red and near infrared light)is mainly through theactivation of mitochondrial respiratory chain and the initiation of intracellular signaling path-ways.Nevertheless,it is unclear whether LPLI could promote glucose uptake through activationof PI-3K/Akt/GLUT4 signaling in 3T3L-1 adipocytes.In this study,we investigated how LPLIpromoted glucose uptake through activation of PI-3K/Akt/GLUT4 signaling path way.Here,we showed that GLUT4 was localized to the Golgi apparatus and translocated from cytoplasm tocytomembrane upon LPLI treatment in 3T3L-1 adipocytes,which enhanced glucose uptake.Moreover,we found that glucose uptake was mediated by the PI3-K/Akt2 signaling,but notAkt1 upon LPLI treatment with Akt isoforms gene silence and PI3-K/Akt inhibitors.Collec-tively,our results indicate that PI3-K/Akt2/GLUT4 signaling act as the key regulators forimprovement of glucose uptake under LPLI treatment in 3T3L-i adipocytes.More importantly,our findings suggest that activation of PI3-K/Akt2/GLUT4 signaling by LPLI may provideguidance in practical applications for promotion of glucose uptake in insulin-resistant adiposetissue.

钠-葡萄糖共转运蛋白2抑制剂对射血分数保留心力衰竭中冠状动脉微血管功能障碍的影响

射血分数保留的心力衰竭(heart failure with preserved ejection fraction,HFp EF)约占心力衰竭的50%,且呈增长趋势。HFp EF的发病机制目前仍不完全清楚,临床上缺乏有效的治疗方法。近年来的研究证据表明,冠状动脉微血管功能障碍在HFp EF的发生发展中发挥关键作用。钠-葡萄糖共转运蛋白2 (sodium-dependent glucose transporters 2,SGLT2)抑制剂显著改善射血分数减低的心力衰竭(heart failure with reduced ejection fraction,HFrEF)患者的临床预后且独立于血糖控制,其已被推荐为HFrEF患者的基础治疗药物。SGLT2抑制剂具有广泛的生物学功能。SGLT2抑制剂通过抑制炎症和氧化应激、减轻胰岛素抵抗、维持内皮功能等作用改善冠状动脉微血管功能。目前,尽管仍缺少足够的循证医学证据,SGLT2抑制剂仍被认为是治疗HFpEF的理想方案。

钠-葡萄糖协同转运蛋白2抑制剂治疗心力衰竭的临床综合评价体系构建与实践

目的:建立钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂治疗心力衰竭的临床综合评价体系,并进行实证评价,旨在为其抗心力衰竭的临床价值提供参考。方法:通过文献分析、专家访谈、安全信号挖掘等手段,结合德尔菲法,根据相关文件及指南,围绕药学特性、安全性、有效性、可及性、经济性和其他属性形成SGLT2抑制剂治疗心力衰竭的综合评价体系,并开展多维度的数据整合与分析研判。结果:构建了一套科学、客观、可量化的SGLT2抑制剂抗心力衰竭的临床综合评价体系。对各维度评价结果加权综合分析后,达格列净得分为83.14分,恩格列净为78.36分,艾托格列净为73.70分,卡格列净为70.18分。结论:基于目前的证据,SGLT2抑制剂各品种在心力衰竭治疗中有不同的优势。该评价体系及实证结果可为SGLT2抑制剂用于心力衰竭的临床治疗提供科学、有效、安全、经济的直观证据。

《2023年欧洲心脏病学会心力衰竭指南》更新解读

《2023欧洲心脏病学会心力衰竭(下称心衰)指南》(下称《2023ESC指南》)更新纳入了自2021版指南之后的众多最新的循证医学证据,包括多项大型随机对照试验和荟萃分析。本次更新内容主要包括慢性心衰、急性心衰及心衰合并症三大方面。慢性心衰方面,钠-葡萄糖共转运蛋白2(SGLT2)抑制剂的出现为射血分数轻度降低的心衰及射血分数保留的心衰治疗带来了重要选择,成为目前唯一被推荐用于治疗全射血分数心衰的药物。急性心衰住院患者出院前及出院后前6周内采取强化策略,早期启动循证药物并快速滴定治疗,以减少心衰再入院和死亡率。对于2型糖尿病和慢性肾脏疾病患者,推荐使用SGLT2抑制剂及醛固酮受体拮抗剂类药物非奈利酮以降低心衰住院或心血管死亡的风险,静脉补铁治疗用于铁缺乏合并心衰患者以改善心衰症状和生活质量。《2023 ESC指南》更新对于心衰防治具有重大的指导性意义。

钠-葡萄糖协同转运蛋白-2抑制剂治疗多囊卵巢综合征的研究进展

多囊卵巢综合征(PCOS)是育龄期女性中常见的内分泌代谢疾病,与胰岛素抵抗、肥胖、高雄激素血症以及心血管疾病风险密切相关。钠-葡萄糖协同转运蛋白-2(SGLT-2)抑制剂作为一类治疗2型糖尿病的药物,近年来在PCOS患者中的应用受到了广泛关注。SGLT-2抑制剂不仅可以改善PCOS患者的胰岛素敏感性、降低脂肪含量,还能降低雄激素水平、调节月经周期,并在降低体质量、体质指数和血压方面表现出显著效果。此外,SGLT-2抑制剂还展现出潜在的心血管保护作用。然而,尽管该药物表现出良好的治疗前景,但仍需要更多的研究来评估其长期安全性和对不同表型PCOS的疗效。

SGLT2i对糖尿病心肌保护作用及机制研究进展

钠-葡萄糖协同转运蛋白-2抑制剂(SGLT2i)是新型的降糖药物,通过其独特的降糖机制来调整患者的血糖。目前的很多研究发现SGLT2i在降低血糖的同时也能使患者的心功能受益,但是目前其作用机制尚未完全明确,本文对其相关机制的研究进展进行综述。

SGLT2抑制剂与GLP-1受体激动剂对2型糖尿病患者血糖指标的影响研究

目的探讨2型糖尿病(type 2 diadetes mellitus,T2DM)患者应用钠-葡萄糖共转运蛋白-2(sodium-glucose transporter 2,SGLT2)抑制剂与胰高血糖素样肽1(glucagon-like peptide-1,GLP1)受体激动剂的效果。方法选取2022年2月—2023年3月四平市中心人民医院收治的153例T2DM患者,按治疗方法不同分为对照1组(二甲双胍治疗)、对照2组(二甲双胍+SGLT2抑制剂治疗)与研究组(二甲双胍+SGLT2抑制剂+GLP-1受体激动剂治疗),各51例。比较3组血糖指标、胰岛功能和不良反应发生情况。结果治疗后,3组空腹血糖、餐后2 h血糖、糖化血糖蛋白指标均较治疗前降低,对照2组和研究组均较对照1组低,且研究组低于对照2组,差异有统计学意义(P均<0.05)。治疗后,3组空腹胰岛素水平下降,对照2组和研究组均较对照1组高,且研究组高于对照2组;而胰岛素抵抗指数降低,且对照2组和研究组均较对照1组低,且研究组低于对照2组,差异有统计学意义(P均<0.05)。3组不良反应发生率比较,差异无统计学意义(P>0.05)。结论SGLT2抑制剂与GLP-1受体激动剂在2型糖尿病中的应用效果好,有利于改善患者血糖指标和胰岛素功能,且不会增加不良反应,安全性高。