Sodium-glucose transport: role in diabetes mellitus and potential clinical implications.
Sodium-glucose transport: role in diabetes mellitus and potential clinical implications.
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DOI：
10.1097/mnh.0b013e32833bec06
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发表时间：
2010-09
影响因子：
3.2
通讯作者：
Sharma K
中科院分区：
文献类型：
--
作者：
Vallon V;Sharma K
就疗效和减少糖尿病人群并发症而言，目前血糖控制的选择并不是最理想的。选择性抑制近端小管SGLT2可增加尿糖排泄，从而降低血糖水平，这可能是一种新的治疗方法。在没有临床相关低血糖或容量状态或肾小球滤过率持续变化的情况下，SGLT2抑制剂可增加2型糖尿病患者的葡萄糖排泄，改善血糖控制。这与体重降低有关，可能会降低收缩压。血糖增加似乎会增加生殖器感染的风险，但可能不会增加尿路感染的风险。SGLT2抑制剂在不引起胰岛素分泌增加、临床相关低血糖或体重增加的情况下降低血糖的能力构成了一个重大进步。增加葡萄糖排泄的能力为治疗卡路里过剩状况提供了有力的手段。关于SGLT2抑制的长期效应，重要的问题仍有待解决，需要进行更多的临床研究。为了确定这些化合物的安全性，需要探索潜在的肾外效应。此外，这些药物是否能降低葡萄糖对肾细胞的直接毒性，而不依赖于高血糖，从而减缓或防止糖尿病肾病的进行性发展，这还有待确定。
Current options for glycemic control is less than optimal in terms of efficacy and to reduce complications in the diabetic population. Selective inhibition of SGLT2 in the proximal tubule increases urinary glucose excretion thereby reducing plasma glucose levels, which may present a novel therapeutic approach. SGLT2 inhibitors enhance glucose excretion and improve glycemic control in patients with type 2 diabetes in the absence of clinically relevant hypoglycemia or sustained changes in volume status or glomerular filtration rate. This is associated with lowering of body weight and may reduce systolic blood pressure. The increased glucosuria appears to increase the risk of genital infections but may not increase the risk of urinary tract infections. The ability of SGLT2 inhibitors to reduce plasma glucose without inducing increased insulin secretion, clinically relevant hypoglycemia, or weight gain constitutes a major advance. The ability of increased glucose excretion provides a powerful means to treat caloric excess conditions. Important questions remain to be resolved and more clinical research is needed on the long-term effects of SGLT2 inhibition. Potential extrarenal effects need to be explored in order to determine the safety of these compounds. It also remains to be determined whether these drugs lower the toxicity of glucose directly on renal cells, independent of hyperglycemia, which may slow or prevent the progressive nature of diabetic nephropathy.