Pharmacological management of youth with type 2 diabetes and diabetic kidney disease: a comprehensive review of current treatments and future directions.
Pharmacological management of youth with type 2 diabetes and diabetic kidney disease: a comprehensive review of current treatments and future directions.
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DOI：
10.1080/14656566.2023.2203319
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发表时间：
2023-06
影响因子：
3.2
通讯作者：
Bjornstad, Petter
中科院分区：
文献类型：
--
作者：
Tommerdahl, Kalie L.;Kula, Alexander J.;Bjornstad, Petter
糖尿病肾病（DKD）是2型糖尿病（T2D）患者死亡的主要原因，超过50%的青少年起病的2型糖尿病患者在成年早期会发展为DKD。由于缺乏早期DKD的可用生物标志物，而此时损伤可能仍可逆，因此在青少年2型糖尿病患者中早期诊断DKD仍然是一个挑战。此外，在启动DKD的及时预防和治疗策略方面存在多种障碍，包括食品药品监督管理局未批准儿科用药；医生对开药、调整剂量和监测的把握程度；以及用药依从性。
对于减缓青少年2型糖尿病患者DKD进展有希望的治疗方法包括二甲双胍、肾素 - 血管紧张素 - 醛固酮系统抑制剂、胰高血糖素样肽 - 1受体激动剂、钠 - 葡萄糖协同转运蛋白2抑制剂、噻唑烷二酮类、磺酰脲类、内皮素受体激动剂和盐皮质激素拮抗剂。新型药物也在研发中，以便与上述药物在肾脏上协同作用。我们全面综述了青少年起病的2型糖尿病中DKD的可用药物治疗策略，包括作用机制、潜在不良反应和肾脏特异性作用，重点关注已发表的儿科和成人试验。
非常需要开展大型临床试验来评估针对青少年起病的2型糖尿病中DKD治疗的药物干预措施。
Diabetic kidney disease (DKD) is a leading cause of mortality in people with type 2 diabetes (T2D) and over 50% of individuals with youth-onset T2D will develop DKD as a young adult. Diagnosis of early-onset DKD remains a challenge in young persons with T2D secondary to a lack of available biomarkers for early DKD while the injuries may still be reversible. Furthermore, multiple barriers exist to initiate timely prevention and treatment strategies for DKD including a lack of Food and Drug Administration approval of medications in pediatrics; provider comfort with medication prescription, titration, and monitoring; and medication adherence. Therapies that have promise for slowing DKD progression in youth with T2D include metformin, renin-angiotensin-aldosterone system inhibitors, glucagon-like peptide-1 receptor agonists, sodium glucose co-transporter 2 inhibitors, thiazolidinediones, sulfonylureas, endothelin receptor agonists, and mineralocorticoid antagonists. Novel agents are also in development to act synergistically on the kidneys with the aforementioned medications. We comprehensively review the available pharmacologic strategies for DKD in youth-onset T2D including mechanisms of action, potential adverse effects, and kidney-specific effects, with an emphasis on published pediatric and adult trials. Large clinical trials evaluating pharmacologic interventions targeting treatment of DKD in youth-onset T2D are strongly needed.
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影响因子：
16.2
作者：
Chiang JL;Kirkman MS;Laffel LM;Peters AL;Type 1 Diabetes Sourcebook Authors
通讯作者：
Type 1 Diabetes Sourcebook Authors
影响因子：
4.1
作者：
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影响因子：
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作者：
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通讯作者：
Bjornstad P
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影响因子：
4.2
作者：
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通讯作者：
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影响因子：
16.2
作者：
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通讯作者：
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