Combination therapy with SGLT2 inhibitors for diabetic kidney disease - 30/05/20
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Graphical abstract |
Highlights |
• | DPP-4i can counteract the elevated glucagon levels induced by SGLT2i. |
• | GLP1-RAs can prevent weight rebound induced by SGLT2i. |
• | ACEI/ARBs can counteract the afferent arteriole vasoconstriction induced by SGLT2i. |
• | SGLT2i combined with diuretics can block the reabsorption of the whole renal tubule. |
Abstract |
Sodium–glucose cotransporter 2 (SGLT2) inhibitors are a novel class of oral antihyperglycemic agents developed in recent years. They could block most glucose reabsorption in renal proximal tubules, thereby exerting glucose lowering effects through glycosuric ways. The renal and cardiovascular protection effects of SGLT2 inhibitors have also been demonstrated both in preclinical studies and clinical trials. However, SGLT2 inhibitors alone could induce an increase in endogenous/hepatic glucose production as well as in fasting plasma glucose levels; a sharp decrease of blood glucose concentration induced by SGLT2 inhibitors could also promote the secretion of counter-regulatory hormones such as glucagon, which has been reported to be associated with the occurrence of glycemic ketoacidosis. Therefore, coadministration of SGLT2 inhibitors and other antihyperglycemic agents should be considered when the therapeutic effect of SGLT2 inhibitors alone was unsatisfactory.
Le texte complet de cet article est disponible en PDF.Abbreviations : SGLT2, DKD, CKD, AHAs, BW, HF, EGP, HGP, FPG, DPP-4, GLP1-RAs, ACEI, ARBs, GIP, RCTs, SBP, NHE
Keywords : ACEI/ARBs, Diabetic kidney disease, DPP-4 inhibitors, GLP-1 receptor agonists, SGLT-2 inhibitors
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Vol 127
Article 110192- juillet 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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