Sodium-Glucose Cotransporter-2 Inhibitors: Who, When & How? Guidance for Use from a Multidisciplinary Practical Approach

Sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitors) have transformed diabetes management by targeting renal glucose reabsorption. Designed initially as antidiabetic agents, their ability to lower blood glucose levels independently of insulin is well-documented. Beyond glycemic control, emerging research has unveiled their profound cardiorenal benefits. By inhibiting SGLT-2 protein, these drugs enhance glucose excretion in urine, reducing blood glucose levels. This mechanism has translated into significant cardiovascular and renal protection, establishing SGLT-2 inhibitors as pivotal in managing not only diabetes but also cardiovascular and renal diseases. Recent studies have illuminated the broader therapeutic potential of SGLT-2 inhibitors beyond diabetes. Evidence indicates their efficacy in managing heart failure, chronic kidney disease (CKD), and cardiovascular complications in individuals with or without diabetes. This expanded therapeutic landscape has catalyzed a paradigm shift in SGLT-2 inhibitor use, positioning them as key agents in the cardiorenal metabolic continuum. Moreover, their role in the secondary prevention of cardiovascular events and slowing CKD progression in T2DM patients has garnered considerable attention. This consensus-based review aims to offer practical guidance in an algorithmic approach to primary care healthcare professionals to optimize SGLT-2 inhibitors utilization and maximize their benefits. The review seeks to empower clinicians to effectively manage patients who may benefit from SGLT-2 inhibitor therapy by addressing common initiation barriers and optimizing treatment strategies. Additionally, it aims to raise awareness among primary care physicians regarding the multifaceted benefits of these medications and overcome clinical inertia in their adoption into routine clinical practice.

Heterogeneity in cardiorenal protection by Sodium glucose cotransporter 2 inhibitors in heart failure across the ejection fraction strata:Systematic review and meta-analysis

BACKGROUND Gliflozins or Sodium glucose cotransporter 2 inhibitors(SGLT2i)are relatively novel antidiabetic medications that have recently been shown to represent favorable effects on patients’cardiorenal outcomes.However,there is shortage of data on potential disparities in this therapeutic effect across different patient subpopulations.AIM To investigate differential effects of SGLT2i on the cardiorenal outcomes of heart failure patients across left ventricular ejection fraction(LVEF)levels.METHODS Literature was searched systematically for the large randomized double-blind controlled trials with long enough follow up periods reporting cardiovascular and renal outcomes in their patients regarding heart failure status and LVEF levels.Data were then meta-analyzed after stratification of the pooled data across the LVEF strata and New York Heart Associations(NYHA)classifications for heart failure using Stata software version 17.0.RESULTS The literature search returned 13 Large clinical trials and 13 post hoc analysis reports.Meta-analysis of the effects of gliflozins on the primary composite outcome showed no significant difference in efficacy across the heart failure subtypes,but higher efficacy were detected in patient groups at lower NYHA classifications(I2=46%,P=0.02).Meta-analyses across the LVEF stratums revealed that a baseline LVEF lower than 30%was associated with enhanced improvement in the primary composite outcome compared to patients with higher LVEF levels at the borderline statistical significance(HR:0.70,95%CI:0.60 to 0.79 vs 0.81,95%CI:0.75 to 0.87;respectively,P=0.06).Composite renal outcome was improved significantly higher in patients with no heart failure than in heart failure patients with preserved ejection fraction(HFpEF)(HR:0.60,95%CI:0.49 to 0.72 vs 0.94,95%CI:0.74 to 1.13;P=0.04).Acute renal injury occurred significantly less frequently in heart failure patients with reduced ejection fraction who received gliflozins than in HFpEF(HR:0.67,95%CI:51 to 0.82 vs 0.94,95%CI:0.82 to 1.06;P=0.01).Volume depletion was consistently increased in response to SGLT2i in all the subgroups.CONCLUSION Heart failure patients with lower LVEF and lower NYHA sub-classifications were found to be generally more likely to benefit from therapy with gliflozins.Further research are required to identify patient subgroups representing the highest benefits or adverse events in response to SGLT2i.

Saudi Consensus on the Usage of Sodium-Glucose Cotransporter-2 Inhibitors on the Management of Chronic Kidney Diseases

According to recent epidemiological data, chronic kidney diseases (CKDs) affect approximately 10% of the global population. Like many countries, CKD is a significant public health issue in Saudi Arabia. The prevalence of CKD in Saudi Arabia is estimated to be around 4.5% of the adult population, with a higher prevalence in older age groups. Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are a class of oral medications used to treat type 2 diabetes mellitus (T2DM). In addition to their glucose-lowering effects, SGLT2i have been shown to have beneficial effects on kidney function in patients with or without T2DM. Therefore, a Saudi task force gathered to develop an explicit, evidence-based consensus on SGLT2i use in CKD Saudi patients. A panel of 14 experts made up a task force. An initial concept proposal was obtained. The proposal was divided into several topics discussed on 24 May 2023. A literature review was carried out. The literature search was completed on 3rd June 2023. A drafted report was distributed to the entire panel. Approval of the recommendations required consensus, defined as a majority approval (i.e. above 75%). The recommendations were revised to accommodate any differences of opinion until a consensus was reached. Recommendations were finally formulated on 21st June 2023. Subsequently, the panel reviewed and discussed the supporting rationale of the revised recommendations. This article presents these practical recommendations.

Glucagon-like-1 receptor agonists and sodium/glucose cotransporter-2 inhibitors combination—are we exploiting their full potential in a real life setting?

BACKGROUND The sodium/glucose cotransporter-2 inhibitors(SGLT-2i)and glucagon-like-1 receptor agonists(GLP-1RA)are antidiabetic agents effective both in hemoglobin A1c(HbA1c)reduction(with a low risk of hypoglycemia)and cardiovascular event prevention.In patients with type 2 diabetes,the add-on value of combination therapy of GLP-1RA and an SGLT-2i seems promising.AIM To investigate whether the efficacy of GLP-1RA and SGLT-2i combination observed in randomized controlled trials translates into therapeutic benefits in the Croatian population during routine clinical practice and follow-up.METHODS We included 200 type 2 diabetes patients with poor glycemic control and analyzed the effects of treatment intensification with(1)GLP-1RA on top of SGLT-2i,(2)SGLT-2i on top of GLP-1RA compared to(3)simultaneous addition of both agents.The primary study endpoint was the proportion of participants with HbA1c<7.0%and/or 5%bodyweight reduction.Secondary outcomes included changes in fasting plasma glucose(FPG),prandial plasma glucose,lowdensity lipoprotein cholesterol,estimated glomerular filtration rate(eGFR),and cardiovascular(CV)incidents assessment over a follow-up period of 12 mo.RESULTS The majority of patients were over 65-years-old,had diabetes duration for more than 10 years.The initial body mass index was 39.41±5.49 kg/m2 and HbA1c 8.32±1.26%.Around half of the patients in all three groups achieved target HbA1c below 7%.A more pronounced decrease in the HbA1c seen with simultaneous SGLT-2i and GLP-1RA therapy was a result of higher baseline HbA1c and not the effect of initiating combination therapy.The number of patients achieving FPG below 7.0 mmol/L was significantly higher in the SGLT-2i group(P=0.021),and 5%weight loss was dominantly achieved in the simultaneous therapy group(P=0.044).A composite outcome(reduction of HbA1c below 7%(53 mmol/mol)with 5%weight loss)was achieved in 32.3%of total patients included in the study.Only 18.2%of patients attained composite outcome defined as HbA1c below 7%(53 mmol/mol)with 5%weight loss and low-density lipoprotein cholesterol<2.5 mmol/L.There were no significant differences between treatment groups.No differences were observed regarding CV incidents or eGFR according to treatment group over a follow-up period.CONCLUSION Combination therapy with GLP-1RA and SGLT-2i is effective in terms of metabolic control,although it remains to be determined whether simultaneous or sequential intensification is better.

Ipragliflozin: A novel sodium-glucose cotransporter 2 inhibitor developed in Japan

Sodium-glucose cotransporter 2(SGLT2) inhibition induces glucosuria and decreases blood glucose levels in diabetic patients and lowers hypoglycemic risk. SGLT1 is expressed in the kidney and intestine; SGLT1 inhibition causes abdominal symptoms such as diarrhea and reduces incretin secretion. Therefore, SGLT2 selectivity is important. Ipragliflozin is highly selective for SGLT2. In type 2 diabetes mellitus(T2DM), urinaryglucose excretion increased to 90 g/24 h after 28 d of treatment with ipragliflozin 300 mg/d. Twelve weeks of ipragliflozin 50 mg/d vs placebo reduced glycated hemoglobin and body weight by 0.65% and 0.66 kg, respectively, in Western T2 DM patients, and by 1.3% and 1.89 kg, respectively, in Japanese patients. Ipragliflozin(highly selective SGLT2 inhibitor) improves glycemic control and reduces body weight and lowers hypoglycemic risk and abdominal symptoms. Ipragliflozin can be a novel anti-diabetic and antiobesity agent.

Sodium glucose cotransporter 2 inhibitors:New horizon of the heart failure pharmacotherapy

Sodium-glucose cotransporter 2(SGLT2)inhibitors have gained momentum as the latest class of antidiabetic agents for improving glycemic control.Large-scale clinical trials have reported that SGLT2 inhibitors reduced cardiovascular outcomes,especially hospitalization for heart failure in patients with type 2 diabetes mellitus who have high risks of cardiovascular disease.Accumulating evidence has indicated that beneficial effects can be observed regardless of the presence or absence of type 2 diabetes mellitus.Accordingly,the Food and Drug Administration approved these agents specifically for treating patients with heart failure and a reduced ejection fraction.It has been concluded that canagliflozin,dapagliflozin,empagliflozin,or ertugliflozin can be recommended for preventing hospitalization associated with heart failure in patients with type 2 diabetes and established cardiovascular disease or those at high cardiovascular risk.In the present review,we explore the available evidence on SGLT2 inhibitors in terms of the cardioprotective effects,potential mechanisms,and ongoing clinical trials that may further clarify the cardiovascular effects of the agents.

Mechanism Underlying Increase of the Serum Magnesium Concentration Observed Following Treatment with Sodium-Glucose Cotransporter 2 Inhibitors

Aim: The EMPA-REG OUTCOME study reported that the sodium-glucose cotransporter 2 inhibitor (SGLT2-i) suppressed cardiovascular (CV) events in patients with type 2 diabetes;we recently suggested that increase of the serum magnesium (Mg) by SGLT2-i’s can, in part, explain this reduction. The objective of this study was to elucidate the mechanism underlying the elevation of the serum Mg level induced by treatment with SGLT2-i’s. Methods: We analyzed the data of 37 patients with type 2 diabetes who underwent clinical evaluation and laboratory assessment at baseline and the end of 3 months. To investigate the relationship between the changes in the serum Mg concentrations during 3 months’ treatment (ΔMg) and other variables, we carried out simple linear regression analysis and multiple linear regression analysis. Results: Three months’ treatment with the SGLT2-i resulted in a significant improvement of the body weight (BW), BMI, hemoglobin A1c (HbA1c), and fasting plasma glucose levels. The serum Mg increased significantly. Simple linear regression analysis revealed an association between the ΔMg and the serum triglyceride, serum Mg at baseline, change of the BW (ΔBW), and change of the HbA1c. Multiple linear regression analysis revealed a significant association between the ΔMg and the serum Mg level at the baseline (r = -0.55, P Conclusion: Our study revealed that a lower serum Mg level at the baseline and BW reduction were significantly associated with an increase in the serum Mg following 3 months’ treatment with SGLT2-i’s.

Expression and Purification of Hydrophilic Domains of Bovine Anion Exchanger,Member 1 and Electrogenic Sodium Bicarbonate Cotransporter 1

[ Objective] To express and purify the intracellular hydrophilic domains of bovine membrane carrier proteins：anion exchanger, member 1 （AE1） and electregenic sodium bicarbonate cotransporter 1 （NBCel）, which were associated with bicarbonate ion transport. [ Method] The hydrophilic domains of bovine AE1 and NBCel were amplified by PCR and inserted into the prokaryotic expression vector pET-28a, respectively. The recombinant plasmids were transformed into the expression strain E. coli BL21 （DE3） and then induced by IPTG. The expressed proteins were purified by nickel ion affinity chromatography and analyzed by 15% SDS-PAGE. [Result] The hydrophilic domains of bovine AE1 and NBCel were amplified respectively by PCR and expressed by prokaryotic expression system with the induction of IPTG. They were mainly expressed in the cyto- plasm of E. coli and high-purity was achieved by nickel ion affinity chromatography. [Condusion] The expression of the hydrophilic domains of bovine AE1 and NBCel provides a major exit route for preparation of antibodies and the regulatory mechanisms of carrier proteins.

达格列净片致严重便秘1例分析

目的 提高医务人员对达格列净片致严重便秘的警惕性,为达格列净的安全使用提供参考。方法 分析1例由达格列净片导致严重便秘患者的诊疗经过,对相关文献进行归纳与总结,探讨钠-葡萄糖共转运体2抑制剂(SGLT-2i)导致严重便秘的发生情况、可能机制和防治措施。结果 患者在使用达格列净片后出现严重便秘,停药后患者便秘症状好转,再次使用达格列净片后患者又出现便秘,立即停药并予润肠通便治疗后,便秘症状好转。其不良反应因果关系评估为“肯定”,故判断该患者严重便秘由达格列净片所致。结论 便秘不仅严重影响患者生活质量,还可能诱发心血管事件,应加强对达格列净片及SGLT-2i类药物致便秘不良反应的重视及用药教育。

Possible mechanism for the regulation of glucose on proliferation, inhibition and apoptosis of colon cancer cells induced by sodium butyrate

AIM： To study the effect of glucose on sodium butyrate- induced proliferation inhibition and apoptosis in HT-29 cell line, and explored its possible mechanisms. METHODS： HT-29 cells were grown in RPMI-1640 medium supplemented with 10% fetal calf serum, and were allowed to adhere for 24 h, and then replaced with experimental medium. Cell survival rates were detected by MTr assay. Apoptosis was detected by TUNEL assay. Glucose transport protein 1 （GLUT1） and monocarboxylate transporter 1 （MCT1） mRNA expression was detected by RT-PCR. RESULTS： Low concentration of glucose induced apoptosis and regulated proliferation in HT-29 cell line, and glucose can obviously inhibit the effect of proliferation inhibition and apoptosis induced by sodium butyrate. Glucose also down-regulated the expression of MCT1mRNA （0.28 ± 0.07 vs 0.19± 0.10, P 〈 0.05）, and decreased the expression of GLUTlmRNA slightly （0.18 ± 0.04 vs 0.13 ± 0.03, P 〈 0.05）. CONCLUSION： Glucose can regulate the effect of proliferation inhibition and apoptosis induced by sodium butyrate and this influence may be associated with the intracellular concentration of glucose and sodium butyrate.

De novo mutation loci and clinical analysis in a child with sodium taurocholate cotransport polypeptide deficiency: A case report

BACKGROUND Sodium taurocholate cotransport polypeptide(NTCP)deficiency disease is a genetic metabolic disorder due to mutations in the SLC10A1 gene and impaired bile acid salt uptake by the basolateral membrane transport protein NTCP in hepatocytes.A variety of clinical manifestations and genetic mutation loci have been reported for this disease.However,specific therapeutic measures are lacking,and the long-term effects are unknown.CASE SUMMARY An infant with elevated bile acids and behavioral neurodevelopmental delay failed to respond to bile acid-lowering therapy.Genetic testing for metabolic liver disease revealed that the child had NTCP deficiency due to the SLC10A1 mutation:c.422dupA(p.Y141X),which is a novel mutation site.The current followup revealed a gradual decrease in bile acid levels after 1 year of age,but the child still had behavioral neurodevelopmental delays.CONCLUSION The clinical manifestations,genetic characteristics,treatment and long-term prognosis due to NTCP deficiency remain poorly defined and need to be further confirmed by more studies and reports.

钠-葡萄糖协同转运蛋白2抑制剂对沉默信息调节因子1信号通路的调控作用及其在糖尿病肾病中发挥肾脏保护作用的机制研究进展

糖尿病肾病(DN)是糖尿病主要并发症之一,是导致终末期肾病的主要原因。钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂是一种新型降糖药物,与其他降糖药物相比,SGLT2抑制剂的降糖优势并不明显,但其肾脏保护作用却很突出。SGLT2抑制剂可以激活沉默信息调节因子1(SIRT1)信号通路促进肾脏细胞自噬,降低氧化应激,改善肾脏缺氧从而保护肾脏,延缓糖尿病肾病进展。SGLT2抑制剂发挥肾脏保护作用的机制可能与其对SIRT1信号通路的影响有关。本文对SGLT2抑制剂通过调控SIRT1发挥肾脏保护作用的研究进展进行综述,旨在总结SGLT2抑制剂对糖尿病肾脏保护作用的机制。

钠-葡萄糖共转运蛋白-2抑制剂联合胰高血糖素样肽-1受体激动剂治疗超重/肥胖2型糖尿病患者的研究进展

钠-葡萄糖共转运蛋白-2抑制剂(SGLT-2i)和胰高血糖素样肽-1受体激动剂(GLP-1RA)是近年来降糖药物的热点研究方向。随着临床的广泛应用,SGLT2抑制剂及GLP-1受体激动剂已不限于用来治疗2型糖尿病(T2DM)的患者血糖,还能从减重、降脂、保护心脏等多个方面间接或直接地改善超重/肥胖2型糖尿病患者的血脂、体重及降低心血管事件发生风险。然而,由于超重/肥胖2型糖尿病的发病机制尚未明确,目前临床关于超重/肥胖2型糖尿病缺少彻底有效的治疗方案,主要为使用传统的不增加体重的降糖药,不能达到良好的治疗效果。因此,本文总结了SGLT2抑制剂及GLP-1受体激动剂降糖减重、调脂、保护心脏的机制及两者联合使用对超重/肥胖2型糖尿病患者的作用效果及安全性,为临床提供可靠的用药参考。

糖尿病患者胃癌术后服用达格列净诱发酮症酸中毒1例及文献分析

达格列净属于钠-葡萄糖协同转运蛋白2抑制剂,是一种新型降糖药物,通过抑制肾小管中钠和葡萄糖的重吸收,降低肾糖阈,促进尿糖排出,从而降低血糖水平。近年来,达格列净诱导糖尿病患者发生非高血糖性酮症酸中毒的报道逐渐增多,此类患者多表现为起病隐匿,容易延误诊断、加重病情。本文对1例胃癌术后服用达格列净出现酮症酸中毒的糖尿病患者进行报道,并对相关文献进行查阅分析,旨在探讨达格列净诱导非高血糖性酮症酸中毒可能的机制,为提高临床用药的安全性提供参考。

钠-葡萄糖协同转运蛋白2抑制剂治疗晚期心力衰竭1例

目的 探讨晚期心力衰竭治疗策略。方法 报告钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂治疗晚期心力衰竭病人1例。该晚期心力衰竭病人合并多种并发症,应用多种利尿剂效果不佳后给予口服50 mg卡格列净,每日1次。结果 病人心力衰竭症状得以改善,N末端-B型钠尿肽前体(NT-proBNP)短期内下降及肾小球滤过率(eGFR)短期上升。结论 SGLT2抑制剂对晚期心力衰竭病人的治疗,短期有效,前景可期。

Effects of glucose-lowering agents on cardiorespiratory fitness

Exercise therapy is essential for the management of type 2 diabetes(T2 D). However, patients with T2 D show lower physical activity and reduced cardiorespiratory fitness than healthy individuals. It would be ideal for clinicians to co-prescribe glucose-lowering agents that improve cardiorespiratory fitness or exercise capacity in conjunction with exercise therapy. Metformin does not improve cardiorespiratory fitness and may attenuate any beneficial effect of exercise in patients with T2 D. In contrast, thiazolidinediones appear to improve cardiorespiratory fitness in patients with T2 D. Although evidence is limited, sodium–glucose cotransporter 2(SGLT2) inhibitors may improve cardiorespiratory fitness in patients with heart failure, and the effect of glucagon-like peptide-1(GLP-1) receptor agonists on cardiorespiratory fitness is controversial. Recent clinical trials have shown that both SGLT2 inhibitors and GLP-1 receptor agonists exert a favorable effect on cardiovascular disease. It becomes more important to choose drugs that have beneficial effects on the cardiovascular system beyond glucose-lowering effects. Further studies are warranted to determine an ideal glucose-lowering agent combined with exercise therapy for the treatment of T2 D.

SGLT2i通过HIF1α/NRF2/HO-1通路对缺氧-复氧心肌细胞老化的保护作用

目的探讨钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)卡格列净在缺氧心肌细胞修复损伤中的作用及机制。方法应用H9C2大鼠心肌细胞构建缺氧-复氧模型,将心肌细胞分为对照组、单纯SGLT2i组、缺氧-复氧组及缺氧-复氧+SGLT2i组。采用蛋白免疫印迹和荧光定量PCR检测心肌细胞老化相关因子SA-β-gal、p16、p21、p53及抗氧化应激相关核因子2相关因子(NRF2)和血红素氧合酶1(HO1)以及具有转录调节作用的低氧诱导因子1α(HIF1α)表达水平,采用微量酶标法检测超氧化物歧化酶(SOD)、丙二醛(MDA)、过氧化氢酶(CAT)及谷胱甘肽过氧化物酶(GSH-Px),免疫荧光检测HIF1α和NRF2核定位,双荧光素酶报告基因实验检测HIF1α与NRF2基因的相互作用。结果与对照组相比,缺氧-复氧组心肌细胞老化相关因子SA-β-gal、p16、p21和p53表达水平明显上升,氧化应激水平增强。给予SGLT2i预处理后,老化相关因子表达水平下降,氧化应激水平下调。进一步检测发现,缺氧-复氧组抗氧化应激相关分子NRF2和HO1蛋白表达下降,并伴随HIF1α表达上升;给予SGLT2i后NRF2与HIF1α表达恢复至正常水平;而下调NRF2基因表达则消除了SGLT2i对缺氧心肌细胞的保护作用。双荧光素酶报告基因检测发现,HIF1α可直接与NRF2基因启动子区域结合,并转录调控其表达。结论SGLT2i通过抑制低氧诱导的HIF1α激活,上调NRF2抗氧化通路,改善缺氧-复氧心肌细胞的氧化应激损伤和老化,对心肌细胞起保护作用。

钠-葡萄糖协同转运蛋白2抑制剂对急性心肌梗死合并2型糖尿病患者临床指标及预后的影响

目的观察钠-葡萄糖协同转运蛋白2抑制剂(SGLT-2i)对急性心肌梗死(AMI)合并2型糖尿病(T2DM)患者临床指标及预后的影响。方法回顾性选取2020年1月至2022年6月于安徽医科大学第二附属医院胸痛中心就诊后确诊AMI合并T2DM患者180例,根据入院后降糖方案分为对照组(79例,给予磺脲类、α-糖苷酶抑制剂、二甲双胍等药物)和观察组(101例,给予达格列净或恩格列净)。患者出院后定期随访,比较2组患者临床指标及主要不良心血管事件(MACE)发生情况。结果所有患者随访6~12个月,结果显示观察组白细胞计数小于对照组[(7.4±1.6)×10^(9)/L比(8.7±1.6)×10^(9)/L],左心室舒张末期内径改善优于对照组[(-0.527±1.462)mm比(1.359±2.111)mm](均P<0.05)。观察组MACE发生率低于对照组[5.4%(2/37)比25.0%(8/32)],差异有统计学意义(P=0.020)。结论SGLT-2i较其他降糖药物12个月内能改善AMI合并T2DM患者的心脏功能及预后,且能减轻该类患者的全身炎症反应。

20例钠-葡萄糖共转运蛋白2抑制剂致福涅尔坏疽病例及文献分析

目的探讨钠-葡萄糖共转运蛋白2抑制剂(SGLT-2i)致福涅尔坏疽(FG)的发生特点,为临床安全用药提供参考。方法采用计算机检索PubMed、Embase、中国知网、万方、维普数据库自建库起至2023年6月有关SGLT-2i致FG的病例报道,并对相关数据进行统计和分析。结果共纳入20篇文献,涉及20例患者。其中,男14例(70.00%),女6例(30.00%);年龄(56.0±11.5)岁;12例(60.00%)描述为肥胖,其中5例为极重度肥胖(体质量指数不低于40 kg/m^(2))。FG发生中位时间为425 d,FG发生时糖化血红蛋白(HbA_(1C))平均值为9.2%。SGLT-2i致FG相关性为很可能的有8例,可能的有12例。20例患者经停药、及时清创引流及给予抗菌药物治疗后转归均良好。结论临床使用SGLT-2i时需注意识别其致FG的危险因素,一旦生殖器或会阴区域出现可疑的肿胀、疼痛等不适,需立即就医,并给予积极治疗。

胰高糖素样肽-1受体激动剂联合钠-葡萄糖共转运蛋白2抑制剂在2型糖尿病中的应用

糖尿病目前是严重威胁人类健康的世界性重大公共卫生问题。因长期血糖控制不佳从而导致各种并发症,严重影响着患者的生活质量。糖尿病的治疗不单单在于血糖的控制,最重要的是并发症的治疗和预防。近年来,对降糖药物的探索中,胰高血糖素样肽-1受体激动剂联合钠葡萄糖协同转运蛋白2抑制剂治疗2型糖尿病且在心血管、肾脏及其他代谢方面有诸多益处。本文综述了胰高血糖素样肽-1受体激动剂联合钠葡萄糖协同转运蛋白2抑制剂在治疗2型糖尿病的应用。