磺脲类药物治疗2型糖尿病时若需添加SGLT-2抑制剂,可适当减少剂量以降低“低血糖”风险

2022-09-01 liangying MedSci原创

在磺酰脲类药物治疗中添加SGLT-2抑制剂时,适当减少磺酰脲类药物的剂量是很重要的,可以最小化低血糖风险并稳定疗效。

低血糖是降糖药常见的不良反应,与心血管疾病及死亡的风险增加有关。虽然血糖控制减少了糖尿病患者的心血管事件,但强化血糖控制既没有减少心血管事件,也没有降低2型糖尿病患者的全因死亡率。此外,来自糖尿病心血管风险控制行动(ACCORD)试验的数据表明,与标准治疗相比,强化治疗增加了全因死亡率和心血管死亡率,这可能与低血糖的负面影响有关。

当钠-葡萄糖共转运体2 (SGLT-2)抑制剂与磺酰脲类药物同时使用时,低血糖的风险并没有明确说明会增加。因此,有研究评估了与安慰剂和磺脲类药物相比,同时使用SGLT-2抑制剂和磺脲类药物的低血糖风险。

研究者搜索了Medline、EMBASE、Cochrane中心对照试验注册和Clinicaltrial.gov,找出了比较SGLT-2抑制剂与安慰剂治疗磺脲类2型糖尿病的随机试验。使用Cochrane工具评估每个试验的偏倚风险。低血糖风险比采用Mantel Haenszel法测定。此外,还进行了亚组分析来检验剂量效应。根据干预时间的长短,测量伤害所需数(NNH)。

最后纳入12项研究,包括3761名参与者,进行了相应的系统回顾和荟萃分析。结果发现,低血糖的风险比为1.67(95%CI 1.42-1.97)。在治疗持续时间为24周或更短的情况下,NNH为13(95%CI 9-21),在25至48周的情况下为11(8-18),在48周以上的情况下则为7(5-10)。

纳入研究的偏倚风险评估

亚组分析表明,高剂量和低剂量SGLT-2抑制剂之间没有差异。与低剂量SGLT-2抑制剂相关的风险比为1.56(95%CI 1.30-1.88),与高剂量SGLT-2抑制剂有关的风险比是1.70(95%CI1.42-2.04)。

SGLT-2抑制剂加磺脲类药物与安慰剂加磺脲类药物治疗的患者发生低血糖风险的森林图

该系统回顾和荟萃分析表明,当将SGLT-2抑制剂添加到磺脲类药物治疗糖尿病患者时,低血糖风险增加50%以上,并且这种联合治疗导致每13名患者在治疗持续时间少于治疗前6个月的情况下多发一例低血糖。

SGLT-2抑制剂增加葡萄糖排泄以降低高血糖,这是一种独特的胰岛素非依赖性作用模式,高血糖风险有限。由于SGLT-2抑制剂对心肾预后的有益影响,指南提出了一种糖尿病治疗的新模式——优先使用SGLT-2抑制剂。然而,在接受磺脲类药物治疗的患者中,胰岛素分泌已经独立于血糖水平而受到刺激,加之葡萄糖的消耗效应可能会导致低血糖发生率的增加。由于磺脲类药物的广泛使用和SGLT-2抑制剂在2型糖尿病治疗中的优先地位,联合治疗的风险将导致大量的诱导低血糖病例。

因此,研究者建议在使用SGLT-2抑制剂全剂量治疗时,可适当减少磺酰脲的剂量。此前,也有一项相关研究表明,在使用这种组合治疗的患者中,维持最低剂量的磺酰脲治疗可以确保更好的血糖控制,且不增加低血糖。然而,由于病例数量少和其他限制,需要进一步的研究来证实结。

总之,2型糖尿病患者在使用磺脲类类治疗方案时如添加SGLT-2抑制剂,可能会增加低血糖的风险。这种负面影响可能会导致世界范围内低血糖病例的再显著增加。这些结果强烈表明,在磺酰脲类药物治疗中添加SGLT-2抑制剂时,适当减少磺酰脲类药物的剂量是很重要的,可以最小化低血糖风险并稳定疗效。

参考文献:1.Jiang M, Liu Q, Jiang T, Nizigiyimana P, Lei M. Adding Sodium-Glucose Co-Transporter 2 Inhibitors to Sulfonylureas and Risk of Hypoglycemia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Endocrinol (Lausanne). 2021 Oct 21;12:713192. doi: 10.3389/fendo.2021.713192.

2.Takahashi K, Cho KY, Nakamura A, Miya A, Miyoshi A, Yamamoto C, et al.. Should Sulfonylurea Be Discontinued or Maintained at the Lowest Dose When Starting Ipragliflozin? A Multicenter Observational Study in Japanese Patients With Type 2 DiabetesJ Diabetes Investig (2018). doi:  10.1111/jdi.12913

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  3. [GetPortalCommentsPageByObjectIdResponse(id=1995676, encodeId=1fc019956e668, content=<a href='/topic/show?id=992411149e' target=_blank style='color:#2F92EE;'>#2抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Tue Feb 28 23:12:40 CST 2023, time=2023-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793924, encodeId=57581e9392435, content=<a href='/topic/show?id=722516221ec' target=_blank style='color:#2F92EE;'>#SGLT-2抑制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16221, encryptionId=722516221ec, topicName=SGLT-2抑制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=052a130, createdName=yyj062, createdTime=Mon Dec 12 02:12:40 CST 2022, time=2022-12-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793888, encodeId=f7651e93888a9, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Tue Dec 27 19:12:40 CST 2022, time=2022-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1853046, encodeId=1e051853046fb, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Fri Jun 16 08:12:40 CST 2023, time=2023-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2081997, encodeId=8311208199ed0, content=<a href='/topic/show?id=acf116218e6' target=_blank style='color:#2F92EE;'>#SGLT-2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16218, encryptionId=acf116218e6, topicName=SGLT-2)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a3a2500014, createdName=fmq_28614553, createdTime=Mon Jan 23 19:12:40 CST 2023, time=2023-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1442193, encodeId=85261442193eb, content=<a href='/topic/show?id=802ce3883fa' target=_blank style='color:#2F92EE;'>#磺脲类#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73883, encryptionId=802ce3883fa, topicName=磺脲类)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d3064911832, createdName=passed water, createdTime=Sat Aug 27 14:12:40 CST 2022, time=2022-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1241081, encodeId=761712410810d, content=这个相当有意思,在<a href='/topic/show?id=4f77e665253' target=_blank style='color:#2F92EE;'>#糖尿病#</a>中,大家知道,<a href='/topic/show?id=2573e388589' target=_blank style='color:#2F92EE;'>#磺脲类药物#</a>降糖是很强的,只是大家会顾虑其<a href='/topic/show?id=47c7263550d' target=_blank style='color:#2F92EE;'>#低血糖#</a>的安全性问题,但是,这里联合<a href='/topic/show?id=a1be1622242' target=_blank style='color:#2F92EE;'>#SGLT-2抑制剂#</a>,如<a href='/topic/show?id=1a17528644d' target=_blank style='color:#2F92EE;'>#恩格列净#</a><a href='/topic/show?id=d90393941be' target=_blank style='color:#2F92EE;'>#达格列净#</a>,这样既保证能深度降糖,同时还具有较好的安全性,这确实是一种选择!, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76652, encryptionId=4f77e665253, topicName=糖尿病), TopicDto(id=73885, encryptionId=2573e388589, topicName=磺脲类药物), TopicDto(id=26355, encryptionId=47c7263550d, topicName=低血糖), TopicDto(id=16222, encryptionId=a1be1622242, topicName=SGLT-2抑制剂), TopicDto(id=52864, encryptionId=1a17528644d, topicName=恩格列净), TopicDto(id=93941, encryptionId=d90393941be, topicName=达格列净)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/Random/55971dc507c93968175ce7cc1e177b372a83869f.jpg, createdBy=f63e4754896, createdName=小小医者, createdTime=Fri Aug 26 09:17:43 CST 2022, time=2022-08-26, status=1, ipAttribution=)]
    2022-12-27 tulenzi
  4. [GetPortalCommentsPageByObjectIdResponse(id=1995676, encodeId=1fc019956e668, content=<a href='/topic/show?id=992411149e' target=_blank style='color:#2F92EE;'>#2抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Tue Feb 28 23:12:40 CST 2023, time=2023-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793924, encodeId=57581e9392435, content=<a href='/topic/show?id=722516221ec' target=_blank style='color:#2F92EE;'>#SGLT-2抑制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16221, encryptionId=722516221ec, topicName=SGLT-2抑制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=052a130, createdName=yyj062, createdTime=Mon Dec 12 02:12:40 CST 2022, time=2022-12-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793888, encodeId=f7651e93888a9, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Tue Dec 27 19:12:40 CST 2022, time=2022-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1853046, encodeId=1e051853046fb, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Fri Jun 16 08:12:40 CST 2023, time=2023-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2081997, encodeId=8311208199ed0, content=<a href='/topic/show?id=acf116218e6' target=_blank style='color:#2F92EE;'>#SGLT-2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16218, encryptionId=acf116218e6, topicName=SGLT-2)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a3a2500014, createdName=fmq_28614553, createdTime=Mon Jan 23 19:12:40 CST 2023, time=2023-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1442193, encodeId=85261442193eb, content=<a href='/topic/show?id=802ce3883fa' target=_blank style='color:#2F92EE;'>#磺脲类#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73883, encryptionId=802ce3883fa, topicName=磺脲类)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d3064911832, createdName=passed water, createdTime=Sat Aug 27 14:12:40 CST 2022, time=2022-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1241081, encodeId=761712410810d, content=这个相当有意思,在<a href='/topic/show?id=4f77e665253' target=_blank style='color:#2F92EE;'>#糖尿病#</a>中,大家知道,<a href='/topic/show?id=2573e388589' target=_blank style='color:#2F92EE;'>#磺脲类药物#</a>降糖是很强的,只是大家会顾虑其<a href='/topic/show?id=47c7263550d' target=_blank style='color:#2F92EE;'>#低血糖#</a>的安全性问题,但是,这里联合<a href='/topic/show?id=a1be1622242' target=_blank style='color:#2F92EE;'>#SGLT-2抑制剂#</a>,如<a href='/topic/show?id=1a17528644d' target=_blank style='color:#2F92EE;'>#恩格列净#</a><a href='/topic/show?id=d90393941be' target=_blank style='color:#2F92EE;'>#达格列净#</a>,这样既保证能深度降糖,同时还具有较好的安全性,这确实是一种选择!, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76652, encryptionId=4f77e665253, topicName=糖尿病), TopicDto(id=73885, encryptionId=2573e388589, topicName=磺脲类药物), TopicDto(id=26355, encryptionId=47c7263550d, topicName=低血糖), TopicDto(id=16222, encryptionId=a1be1622242, topicName=SGLT-2抑制剂), TopicDto(id=52864, encryptionId=1a17528644d, topicName=恩格列净), TopicDto(id=93941, encryptionId=d90393941be, topicName=达格列净)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/Random/55971dc507c93968175ce7cc1e177b372a83869f.jpg, createdBy=f63e4754896, createdName=小小医者, createdTime=Fri Aug 26 09:17:43 CST 2022, time=2022-08-26, status=1, ipAttribution=)]
    2023-06-16 jklm09
  5. [GetPortalCommentsPageByObjectIdResponse(id=1995676, encodeId=1fc019956e668, content=<a href='/topic/show?id=992411149e' target=_blank style='color:#2F92EE;'>#2抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Tue Feb 28 23:12:40 CST 2023, time=2023-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793924, encodeId=57581e9392435, content=<a href='/topic/show?id=722516221ec' target=_blank style='color:#2F92EE;'>#SGLT-2抑制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16221, encryptionId=722516221ec, topicName=SGLT-2抑制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=052a130, createdName=yyj062, createdTime=Mon Dec 12 02:12:40 CST 2022, time=2022-12-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793888, encodeId=f7651e93888a9, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Tue Dec 27 19:12:40 CST 2022, time=2022-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1853046, encodeId=1e051853046fb, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Fri Jun 16 08:12:40 CST 2023, time=2023-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2081997, encodeId=8311208199ed0, content=<a href='/topic/show?id=acf116218e6' target=_blank style='color:#2F92EE;'>#SGLT-2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16218, encryptionId=acf116218e6, topicName=SGLT-2)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a3a2500014, createdName=fmq_28614553, createdTime=Mon Jan 23 19:12:40 CST 2023, time=2023-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1442193, encodeId=85261442193eb, content=<a href='/topic/show?id=802ce3883fa' target=_blank style='color:#2F92EE;'>#磺脲类#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73883, encryptionId=802ce3883fa, topicName=磺脲类)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d3064911832, createdName=passed water, createdTime=Sat Aug 27 14:12:40 CST 2022, time=2022-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1241081, encodeId=761712410810d, content=这个相当有意思,在<a href='/topic/show?id=4f77e665253' target=_blank style='color:#2F92EE;'>#糖尿病#</a>中,大家知道,<a href='/topic/show?id=2573e388589' target=_blank style='color:#2F92EE;'>#磺脲类药物#</a>降糖是很强的,只是大家会顾虑其<a href='/topic/show?id=47c7263550d' target=_blank style='color:#2F92EE;'>#低血糖#</a>的安全性问题,但是,这里联合<a href='/topic/show?id=a1be1622242' target=_blank style='color:#2F92EE;'>#SGLT-2抑制剂#</a>,如<a href='/topic/show?id=1a17528644d' target=_blank style='color:#2F92EE;'>#恩格列净#</a><a href='/topic/show?id=d90393941be' target=_blank style='color:#2F92EE;'>#达格列净#</a>,这样既保证能深度降糖,同时还具有较好的安全性,这确实是一种选择!, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76652, encryptionId=4f77e665253, topicName=糖尿病), TopicDto(id=73885, encryptionId=2573e388589, topicName=磺脲类药物), TopicDto(id=26355, encryptionId=47c7263550d, topicName=低血糖), TopicDto(id=16222, encryptionId=a1be1622242, topicName=SGLT-2抑制剂), TopicDto(id=52864, encryptionId=1a17528644d, topicName=恩格列净), TopicDto(id=93941, encryptionId=d90393941be, topicName=达格列净)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/Random/55971dc507c93968175ce7cc1e177b372a83869f.jpg, createdBy=f63e4754896, createdName=小小医者, createdTime=Fri Aug 26 09:17:43 CST 2022, time=2022-08-26, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1995676, encodeId=1fc019956e668, content=<a href='/topic/show?id=992411149e' target=_blank style='color:#2F92EE;'>#2抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Tue Feb 28 23:12:40 CST 2023, time=2023-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793924, encodeId=57581e9392435, content=<a href='/topic/show?id=722516221ec' target=_blank style='color:#2F92EE;'>#SGLT-2抑制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16221, encryptionId=722516221ec, topicName=SGLT-2抑制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=052a130, createdName=yyj062, createdTime=Mon Dec 12 02:12:40 CST 2022, time=2022-12-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793888, encodeId=f7651e93888a9, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Tue Dec 27 19:12:40 CST 2022, time=2022-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1853046, encodeId=1e051853046fb, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Fri Jun 16 08:12:40 CST 2023, time=2023-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2081997, encodeId=8311208199ed0, content=<a href='/topic/show?id=acf116218e6' target=_blank style='color:#2F92EE;'>#SGLT-2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16218, encryptionId=acf116218e6, topicName=SGLT-2)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a3a2500014, createdName=fmq_28614553, createdTime=Mon Jan 23 19:12:40 CST 2023, time=2023-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1442193, encodeId=85261442193eb, content=<a href='/topic/show?id=802ce3883fa' target=_blank style='color:#2F92EE;'>#磺脲类#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73883, encryptionId=802ce3883fa, topicName=磺脲类)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d3064911832, createdName=passed water, createdTime=Sat Aug 27 14:12:40 CST 2022, time=2022-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1241081, encodeId=761712410810d, content=这个相当有意思,在<a href='/topic/show?id=4f77e665253' target=_blank style='color:#2F92EE;'>#糖尿病#</a>中,大家知道,<a href='/topic/show?id=2573e388589' target=_blank style='color:#2F92EE;'>#磺脲类药物#</a>降糖是很强的,只是大家会顾虑其<a href='/topic/show?id=47c7263550d' target=_blank style='color:#2F92EE;'>#低血糖#</a>的安全性问题,但是,这里联合<a href='/topic/show?id=a1be1622242' target=_blank style='color:#2F92EE;'>#SGLT-2抑制剂#</a>,如<a href='/topic/show?id=1a17528644d' target=_blank style='color:#2F92EE;'>#恩格列净#</a><a href='/topic/show?id=d90393941be' target=_blank style='color:#2F92EE;'>#达格列净#</a>,这样既保证能深度降糖,同时还具有较好的安全性,这确实是一种选择!, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76652, encryptionId=4f77e665253, topicName=糖尿病), TopicDto(id=73885, encryptionId=2573e388589, topicName=磺脲类药物), TopicDto(id=26355, encryptionId=47c7263550d, topicName=低血糖), TopicDto(id=16222, encryptionId=a1be1622242, topicName=SGLT-2抑制剂), TopicDto(id=52864, encryptionId=1a17528644d, topicName=恩格列净), TopicDto(id=93941, encryptionId=d90393941be, topicName=达格列净)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/Random/55971dc507c93968175ce7cc1e177b372a83869f.jpg, createdBy=f63e4754896, createdName=小小医者, createdTime=Fri Aug 26 09:17:43 CST 2022, time=2022-08-26, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=1995676, encodeId=1fc019956e668, content=<a href='/topic/show?id=992411149e' target=_blank style='color:#2F92EE;'>#2抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1114, encryptionId=992411149e, topicName=2抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28b7142, createdName=liuquan, createdTime=Tue Feb 28 23:12:40 CST 2023, time=2023-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793924, encodeId=57581e9392435, content=<a href='/topic/show?id=722516221ec' target=_blank style='color:#2F92EE;'>#SGLT-2抑制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16221, encryptionId=722516221ec, topicName=SGLT-2抑制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=052a130, createdName=yyj062, createdTime=Mon Dec 12 02:12:40 CST 2022, time=2022-12-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793888, encodeId=f7651e93888a9, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Tue Dec 27 19:12:40 CST 2022, time=2022-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1853046, encodeId=1e051853046fb, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Fri Jun 16 08:12:40 CST 2023, time=2023-06-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2081997, encodeId=8311208199ed0, content=<a href='/topic/show?id=acf116218e6' target=_blank style='color:#2F92EE;'>#SGLT-2#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16218, encryptionId=acf116218e6, topicName=SGLT-2)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0a3a2500014, createdName=fmq_28614553, createdTime=Mon Jan 23 19:12:40 CST 2023, time=2023-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1442193, encodeId=85261442193eb, content=<a href='/topic/show?id=802ce3883fa' target=_blank style='color:#2F92EE;'>#磺脲类#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=73883, encryptionId=802ce3883fa, topicName=磺脲类)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d3064911832, createdName=passed water, createdTime=Sat Aug 27 14:12:40 CST 2022, time=2022-08-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1241081, encodeId=761712410810d, content=这个相当有意思,在<a href='/topic/show?id=4f77e665253' target=_blank style='color:#2F92EE;'>#糖尿病#</a>中,大家知道,<a href='/topic/show?id=2573e388589' target=_blank style='color:#2F92EE;'>#磺脲类药物#</a>降糖是很强的,只是大家会顾虑其<a href='/topic/show?id=47c7263550d' target=_blank style='color:#2F92EE;'>#低血糖#</a>的安全性问题,但是,这里联合<a href='/topic/show?id=a1be1622242' target=_blank style='color:#2F92EE;'>#SGLT-2抑制剂#</a>,如<a href='/topic/show?id=1a17528644d' target=_blank style='color:#2F92EE;'>#恩格列净#</a><a href='/topic/show?id=d90393941be' target=_blank style='color:#2F92EE;'>#达格列净#</a>,这样既保证能深度降糖,同时还具有较好的安全性,这确实是一种选择!, beContent=null, objectType=article, channel=null, level=null, likeNumber=115, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76652, encryptionId=4f77e665253, topicName=糖尿病), TopicDto(id=73885, encryptionId=2573e388589, topicName=磺脲类药物), TopicDto(id=26355, encryptionId=47c7263550d, topicName=低血糖), TopicDto(id=16222, encryptionId=a1be1622242, topicName=SGLT-2抑制剂), TopicDto(id=52864, encryptionId=1a17528644d, topicName=恩格列净), TopicDto(id=93941, encryptionId=d90393941be, topicName=达格列净)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/Random/55971dc507c93968175ce7cc1e177b372a83869f.jpg, createdBy=f63e4754896, createdName=小小医者, createdTime=Fri Aug 26 09:17:43 CST 2022, time=2022-08-26, status=1, ipAttribution=)]
    2022-08-26 小小医者

    这个相当有意思,在#糖尿病#中,大家知道,#磺脲类药物#降糖是很强的,只是大家会顾虑其#低血糖#的安全性问题,但是,这里联合#SGLT-2抑制剂#,如#恩格列净##达格列净#,这样既保证能深度降糖,同时还具有较好的安全性,这确实是一种选择!

    0

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盘点磺脲类药物的4大要点

长期临床应用证据均表明,SUs除降糖作用之外,还可减少或延缓T2DM并发症的发生。

Diabetol Int:日本2型糖尿病患者使用的各种口服降糖药中磺脲类药物比例的横断面研究

磺酰脲类药物治疗期间会出现适度的体重增加,循环中过量的胰岛素会导致胰岛素依赖性脂肪酸合成,从而进一步导致体重增加。

“一石二鸟”——磺脲类药物在治疗“牙周炎-糖尿病”共病中的作用

磺酰脲类药物可能通过直接作用于牙周炎而产生治疗效果,提示其可能单独应用于牙周炎的治疗。此外,磺脲类药物如果作为治疗牙周炎-糖尿病合并症的药物,可达到“一石二鸟”的效果。

Front Med:磺脲类药物或双胍类药物与降低糖尿病患者类风湿性关节炎风险的相关性

用磺脲类药物或双胍类药物治疗糖尿病可提高自身免疫性疾病的死亡率,抗氧化药物对糖尿病小鼠有潜在的保护作用。

Diabetes Care:2型糖尿病中磺脲类药物对心脏线粒体KATP通道的特异性与主要不良心血管事件风险的关系

SUR除存在于胰岛β细胞外, 还见于其他组织, 如心脏、血管、脑等。

磺脲类药物可增加2型糖尿病患者的癌症风险?最新研究答案是“No”!

磺脲类药物和二甲双胍是最常用的糖尿病药物,占研究人群中所有GLD的64%,而与其他GLD相比,研究发现磺酰脲类药物的使用与癌症风险无关。