Diabetes Obes Metab:SGLT2抑制剂与2型糖尿病患者糖尿病酮症酸中毒风险

2020-05-09 MedSci原创 MedSci原创

SGLT2抑制剂可能会增加2型糖尿病患者发生DKA的风险。不同年龄或随访患者之间的治疗效果可能存在明显差异,提示对于长期使用SGLT2抑制剂的患者或年龄较大的患者应谨慎用药。

近日,代谢内分泌疾病领域权威杂志Diabetes Obesity & Metabolism上发表了一篇研究文章,研究人员旨在评估葡萄糖共转运蛋白2(SGLT2)抑制剂对2型糖尿病患者糖尿病性酮症酸中毒(DKA)的影响。

研究人员检索了PubMed、EMBASE、Cochrane对照试验中心注册系统(CENTRAL)和ClinicalTrials.gov数据库中比较2型糖尿病患者SGLT2抑制剂与对照药物的随机对照试验(RCT),检索时间从数据库成立到2019年6月13日。配对的审阅者独立筛选引文,评估偏倚风险并提取数据。Peto法被用于合并SGLT2抑制剂对DKA效应的主要方法。研究人员使用替代效应测量(风险比)或合并法(Mantel–Haenszel),在零事件试验中使用0.5的连续性校正或广义线性混合模型进行了敏感性分析。研究人员进行了六个预先设定的亚组分析以探索异质性。GRADE法用于评估证据的质量。

该分析共纳入了39项RCT,涉及60580名患者和85次DKA事件。与对照剂相比,SGLT2抑制剂与DKA风险增加相关(SGLT2抑制剂:62/34961(0.18%) vs. 对照剂23/25211(0.09%),Peto比值比(OR)为2.13,95%置信区间(CI )为1.38-3.27,I2=8%;RD发生事件多出1.7次,95%CI为0.6至3.4次事件;高质量证据)。敏感性分析得到类似的结果。通过平均年龄(交互作用p=0.02)、随访时间(交互作用p=0.03)进行的亚组分析显示,在老年患者(60岁或以上)和使用SGLT2抑制剂较长时间(52周以上)的患者中,相对效应会更大。

这些高质量的证据表明,SGLT2抑制剂可能会增加2型糖尿病患者发生DKA的风险。不同年龄或随访患者之间的治疗效果可能存在明显差异,提示对于长期使用SGLT2抑制剂的患者或年龄较大的患者应谨慎用药。

原始出处:

Jiali Liu,et al.SGLT2 inhibitors and risk of diabetic ketoacidosis in patients with type 2 diabetes: systematic review and meta‐analysis of randomized controlled trials.Diabetes Obesity & Metabolism.2020.https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.14075

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    2020-06-23 liuquan
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createdBy=c5dd27335710, createdName=hywen7335, createdTime=Fri Aug 28 10:56:28 CST 2020, time=2020-08-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1995600, encodeId=5487199560031, 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=0, 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 Jun 23 23:56:28 CST 2020, time=2020-06-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1641209, encodeId=c89116412095a, content=<a href='/topic/show?id=8d739553475' target=_blank style='color:#2F92EE;'>#酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95534, encryptionId=8d739553475, topicName=酮症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=790822763597, createdName=ms705947299214030, createdTime=Wed Nov 04 13:56:28 CST 2020, time=2020-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1896654, encodeId=12b81896654f0, content=<a href='/topic/show?id=4a391158248' target=_blank style='color:#2F92EE;'>#MET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11582, encryptionId=4a391158248, topicName=MET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18fc139, createdName=一闲, createdTime=Mon Dec 07 09:56:28 CST 2020, time=2020-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1888140, encodeId=87a418881408e, content=<a href='/topic/show?id=d56611584ec' target=_blank style='color:#2F92EE;'>#Meta#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11584, encryptionId=d56611584ec, topicName=Meta)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d8f4110, createdName=guojianrong, createdTime=Wed Mar 10 04:56:28 CST 2021, time=2021-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793844, encodeId=ab2d1e93844a2, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Sun Dec 27 13:56:28 CST 2020, time=2020-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1639461, encodeId=b0ef1639461ef, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Tue Mar 23 19:56:28 CST 2021, time=2021-03-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1852367, encodeId=0dd8185236e88, 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=17, 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=Sat Feb 20 16:56:28 CST 2021, time=2021-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1761405, encodeId=cc041e6140559, content=<a href='/topic/show?id=9bea33520d' target=_blank style='color:#2F92EE;'>#BET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3352, encryptionId=9bea33520d, topicName=BET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a1a37427546, createdName=ms5439512287675881, createdTime=Tue Feb 02 19:56:28 CST 2021, time=2021-02-02, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1902431, encodeId=fa4c190243115, content=<a href='/topic/show?id=c097591ed5' target=_blank style='color:#2F92EE;'>#Diabetes#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5917, encryptionId=c097591ed5, topicName=Diabetes)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0045169, createdName=木头人513, createdTime=Mon Sep 07 18:56:28 CST 2020, time=2020-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1676168, encodeId=de4616e61683c, content=<a href='/topic/show?id=6bac955861e' target=_blank style='color:#2F92EE;'>#酸中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95586, encryptionId=6bac955861e, topicName=酸中毒)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c5dd27335710, createdName=hywen7335, createdTime=Fri Aug 28 10:56:28 CST 2020, time=2020-08-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1995600, encodeId=5487199560031, 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=0, 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 Jun 23 23:56:28 CST 2020, time=2020-06-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1641209, encodeId=c89116412095a, content=<a href='/topic/show?id=8d739553475' target=_blank style='color:#2F92EE;'>#酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95534, encryptionId=8d739553475, topicName=酮症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=790822763597, createdName=ms705947299214030, createdTime=Wed Nov 04 13:56:28 CST 2020, time=2020-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1896654, encodeId=12b81896654f0, content=<a href='/topic/show?id=4a391158248' target=_blank style='color:#2F92EE;'>#MET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11582, encryptionId=4a391158248, topicName=MET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18fc139, createdName=一闲, createdTime=Mon Dec 07 09:56:28 CST 2020, time=2020-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1888140, encodeId=87a418881408e, content=<a href='/topic/show?id=d56611584ec' target=_blank style='color:#2F92EE;'>#Meta#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11584, encryptionId=d56611584ec, topicName=Meta)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d8f4110, createdName=guojianrong, createdTime=Wed Mar 10 04:56:28 CST 2021, time=2021-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793844, encodeId=ab2d1e93844a2, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Sun Dec 27 13:56:28 CST 2020, time=2020-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1639461, encodeId=b0ef1639461ef, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Tue Mar 23 19:56:28 CST 2021, time=2021-03-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1852367, encodeId=0dd8185236e88, 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=17, 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=Sat Feb 20 16:56:28 CST 2021, time=2021-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1761405, encodeId=cc041e6140559, content=<a href='/topic/show?id=9bea33520d' target=_blank style='color:#2F92EE;'>#BET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3352, encryptionId=9bea33520d, topicName=BET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a1a37427546, createdName=ms5439512287675881, createdTime=Tue Feb 02 19:56:28 CST 2021, time=2021-02-02, status=1, ipAttribution=)]
    2020-12-07 一闲
  6. [GetPortalCommentsPageByObjectIdResponse(id=1902431, encodeId=fa4c190243115, content=<a href='/topic/show?id=c097591ed5' target=_blank style='color:#2F92EE;'>#Diabetes#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5917, encryptionId=c097591ed5, topicName=Diabetes)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0045169, createdName=木头人513, createdTime=Mon Sep 07 18:56:28 CST 2020, time=2020-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1676168, encodeId=de4616e61683c, content=<a href='/topic/show?id=6bac955861e' target=_blank style='color:#2F92EE;'>#酸中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95586, encryptionId=6bac955861e, topicName=酸中毒)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c5dd27335710, createdName=hywen7335, createdTime=Fri Aug 28 10:56:28 CST 2020, time=2020-08-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1995600, encodeId=5487199560031, 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=0, 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 Jun 23 23:56:28 CST 2020, time=2020-06-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1641209, encodeId=c89116412095a, content=<a href='/topic/show?id=8d739553475' target=_blank style='color:#2F92EE;'>#酮症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95534, encryptionId=8d739553475, topicName=酮症)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=790822763597, createdName=ms705947299214030, createdTime=Wed Nov 04 13:56:28 CST 2020, time=2020-11-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1896654, encodeId=12b81896654f0, content=<a href='/topic/show?id=4a391158248' target=_blank style='color:#2F92EE;'>#MET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11582, encryptionId=4a391158248, topicName=MET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18fc139, createdName=一闲, createdTime=Mon Dec 07 09:56:28 CST 2020, time=2020-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1888140, encodeId=87a418881408e, content=<a href='/topic/show?id=d56611584ec' target=_blank style='color:#2F92EE;'>#Meta#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11584, encryptionId=d56611584ec, topicName=Meta)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d8f4110, createdName=guojianrong, createdTime=Wed Mar 10 04:56:28 CST 2021, time=2021-03-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1793844, encodeId=ab2d1e93844a2, content=<a href='/topic/show?id=5a3f1621e7d' target=_blank style='color:#2F92EE;'>#SGLT#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=16217, encryptionId=5a3f1621e7d, topicName=SGLT)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Sun Dec 27 13:56:28 CST 2020, time=2020-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1639461, encodeId=b0ef1639461ef, content=<a href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Tue Mar 23 19:56:28 CST 2021, time=2021-03-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1852367, encodeId=0dd8185236e88, 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=17, 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=Sat Feb 20 16:56:28 CST 2021, time=2021-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1761405, encodeId=cc041e6140559, content=<a href='/topic/show?id=9bea33520d' target=_blank style='color:#2F92EE;'>#BET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3352, encryptionId=9bea33520d, topicName=BET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a1a37427546, createdName=ms5439512287675881, createdTime=Tue Feb 02 19:56:28 CST 2021, time=2021-02-02, status=1, ipAttribution=)]
    2021-03-10 guojianrong
  7. [GetPortalCommentsPageByObjectIdResponse(id=1902431, encodeId=fa4c190243115, content=<a href='/topic/show?id=c097591ed5' target=_blank style='color:#2F92EE;'>#Diabetes#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5917, encryptionId=c097591ed5, topicName=Diabetes)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0045169, createdName=木头人513, createdTime=Mon Sep 07 18:56:28 CST 2020, time=2020-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1676168, encodeId=de4616e61683c, content=<a href='/topic/show?id=6bac955861e' target=_blank style='color:#2F92EE;'>#酸中毒#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95586, encryptionId=6bac955861e, topicName=酸中毒)], attachment=null, authenticateStatus=null, createdAvatar=null, 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href='/topic/show?id=afda591646' target=_blank style='color:#2F92EE;'>#DIA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=5916, encryptionId=afda591646, topicName=DIA)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=987022654425, createdName=ms9608593228839890, createdTime=Tue Mar 23 19:56:28 CST 2021, time=2021-03-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1852367, encodeId=0dd8185236e88, 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=17, 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=Sat Feb 20 16:56:28 CST 2021, time=2021-02-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1761405, encodeId=cc041e6140559, content=<a href='/topic/show?id=9bea33520d' target=_blank style='color:#2F92EE;'>#BET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3352, encryptionId=9bea33520d, topicName=BET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a1a37427546, createdName=ms5439512287675881, createdTime=Tue Feb 02 19:56:28 CST 2021, time=2021-02-02, status=1, ipAttribution=)]
    2020-12-27 tulenzi
  8. 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    2021-02-20 jklm09
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