Dapagliflozin in young people with type 2 diabetes.
Dapagliflozin in young people with type 2 diabetes.
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DOI：
10.1016/s2213-8587(22)00075-4
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发表时间：
2022-05
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William V Tamborlane及其同事提供的试验数据，评估了一种新的预防2型糖尿病药物在年轻人（18 - 24岁）中的作用，为这个新兴的，高风险的和未充分研究的人群提供了重要的治疗见解。1在美国，近1400万19岁以下的人患有肥胖症，患2型糖尿病的风险增加。2肥胖和其他代谢疾病的发病率上升预计将在2017年至2060年期间使年轻人的2型糖尿病发病率增加600%。2，3与2型糖尿病成人患者相比，在年轻人中观察到的代谢表型更严重，包括更大的胰岛素抵抗和胰腺β细胞功能更快的恶化，4增加了糖尿病微血管和大血管并发症的风险。5从患有2型糖尿病的皮马印第安人获得的肾活检样本显示，无论活检时的年龄和糖尿病持续时间如何，年轻人的肾脏结构病变比患有2型糖尿病的成年人更严重。6尽管年轻人2型糖尿病并发症负担沉重，但目前针对这一人群的治疗选择很少。SGLT 2抑制剂是降低2型糖尿病成人心脏和肾脏疾病风险的高效疗法7，但美国食品药品监督管理局尚未批准这些药物用于18岁以下人群。青少年和青年T2D的治疗选择（TODAY）和恢复胰岛素分泌（RISE）试验显示，成人发作与青年发作的2型糖尿病的生理学不同，这表明需要在年轻人中进行专门的2型糖尿病临床试验。4 Tamborlane及其同事1展示了来自第一个安慰剂对照、随机、3期试验的数据。
The trial data presented by William V Tamborlane and colleagues, evaluating the effects of a novel adjunctive type 2 diabetes medication in young people (aged 18–24), provide an important therapeutic insight into this burgeoning, high-risk, and understudied population. 1 Nearly 14 million people younger than 19 years in the USA have obesity and are at increased risk of type 2 diabetes. 2 Rising rates of obesity and other metabolic conditions are projected to increase the incidence of type 2 diabetes in young people by 600% between 2017 and 2060. 2, 3 The more severe metabolic phenotype observed in young people versus adults with type 2 diabetes, including greater insulin resistance and more rapid deterioration of pancreatic β-cell function, 4 increases their risk of the microvascular and macrovascular complications of diabetes. 5 Kidney biopsy samples obtained from Pima Indians with type 2 diabetes show more severe kidney structural lesions in young people than in adults with type 2 diabetes irrespective of age at biopsy and diabetes duration. 6 Despite the burden of complications in type 2 diabetes in young people, current therapeutic options for this population are scarce.SGLT2 inhibitors are highly effective therapies that reduce the risk of heart and kidney disease in adults with type 2 diabetes, 7 but these medications are not approved by the US Food and Drugs Administration for people younger than 18 years. The Treatment Options for T2D in Adolescents and Youth (TODAY) and Restoring Insulin Secretion (RISE) trials have shown differing physiology in adult-onset vs. youth-onset type 2 diabetes, indicating that dedicated clinical trials in young people with type 2 diabetes are needed. 4 Tamborlane and colleagues1 presented data from the first placebo-controlled, randomised, phase 3 trial of the