目的系统评价钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂治疗T2DM患者的安全性及HbA1c达标率。方法检索Pubmed,Embase,Cochrane、Web of science及Scopus数据库从建库至2013年7月的文献。按Cochrane系统评价法评价纳入文献质量并提取相应数据...目的系统评价钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂治疗T2DM患者的安全性及HbA1c达标率。方法检索Pubmed,Embase,Cochrane、Web of science及Scopus数据库从建库至2013年7月的文献。按Cochrane系统评价法评价纳入文献质量并提取相应数据;采用RevMan 5.2软件进行荟萃分析,I2值检验各研究间的异质性,采用α=0.05作为检验水准。结果共纳入17篇随机对照试验(RCTs),T2DM患者5941例。Meta分析结果显示,与安慰剂相比,SGLT2抑制剂治疗后HbA1c达标率较高(疗程≤26周OR:2.49,95%CI:1.90~3.24,P<0.05;疗程>26周OR:2.22,95%CI:1.47~3.34,P<0.05),体重减轻明显(疗程≤26周WMD:-1.72kg,95%CI:-1.96^-1.48,P<0.05;疗程>26周WMD:-2.30kg,95%CI:-2.78^-1.81,P<0.05),低血糖风险小(疗程≤26周RR:1.45,95%CI:0.97~2.16,P>0.05;疗程>26周RR:1.05,95%CI:0.89~1.23,P>0.05),泌尿系感染在短期治疗稍高(RR:1.30,95%CI:1.05~1.76,P<0.05),长期治疗后与安慰剂相比差异无统计学意义(P>0.05),但生殖系统感染的发生率较高(≤26周RR:3.88,95%CI:2.64~5.69,P<0.05;>26周RR:3.24,95%CI:1.95~5.37,P<0.05)。结论与安慰剂相比,SGLT2抑制剂糖化达标率高,能减轻体重,且发生低血糖风险小。展开更多
Latent autoimmune diabetes in adults (LADA) is an autoimmune diabetes of adult-onset with the presence of diabetes associated autoantibodies. Familial renal glucosuria (FRG) is an inherited renal tubular disorder that...Latent autoimmune diabetes in adults (LADA) is an autoimmune diabetes of adult-onset with the presence of diabetes associated autoantibodies. Familial renal glucosuria (FRG) is an inherited renal tubular disorder that causes persistent isolated glucosuria in the absence of hyperglycemia. We report a novel case of LADA and certain FRG. A 44-year-old man was admitted to our hospital for uncontrolled diabetes. Before admission, he had never suffered from diabetic coma and showed an improvement in HbA1c only with diet therapy. His HbA1c was 11.9% (107 mmol/mol), and anti-glutamic acid decarboxylase antibody was 13.0 U/mL. A glucagon stimulation test showed the decrease of insulin secretion: plasma C-peptide (CPR) 0 min, 0.69 ng/mL;CPR 6 min, 0.90 ng/mL. Analysis of genomic DNA revealed a novel heterozygous mutation in the SGLT2 coding gene, SLC5A2 (c.875G >A, p.Cys292Tyr), which was assessed as probably damaging with a score of 0.998 (sensitivity: 0.27;specificity: 0.99) by an in silico analysis. Therefore, he was diagnosed with LADA and certain FRG. He has not shown any symptoms and his HbA1c improved to 6.4% (46 mmol/mol) three months after the introduction of insulin therapy. Our case clearly implies the clinical effectiveness of SGLT2 inhibition in patients with LADA.展开更多
文摘目的系统评价钠-葡萄糖协同转运蛋白2(SGLT2)抑制剂治疗T2DM患者的安全性及HbA1c达标率。方法检索Pubmed,Embase,Cochrane、Web of science及Scopus数据库从建库至2013年7月的文献。按Cochrane系统评价法评价纳入文献质量并提取相应数据;采用RevMan 5.2软件进行荟萃分析,I2值检验各研究间的异质性,采用α=0.05作为检验水准。结果共纳入17篇随机对照试验(RCTs),T2DM患者5941例。Meta分析结果显示,与安慰剂相比,SGLT2抑制剂治疗后HbA1c达标率较高(疗程≤26周OR:2.49,95%CI:1.90~3.24,P<0.05;疗程>26周OR:2.22,95%CI:1.47~3.34,P<0.05),体重减轻明显(疗程≤26周WMD:-1.72kg,95%CI:-1.96^-1.48,P<0.05;疗程>26周WMD:-2.30kg,95%CI:-2.78^-1.81,P<0.05),低血糖风险小(疗程≤26周RR:1.45,95%CI:0.97~2.16,P>0.05;疗程>26周RR:1.05,95%CI:0.89~1.23,P>0.05),泌尿系感染在短期治疗稍高(RR:1.30,95%CI:1.05~1.76,P<0.05),长期治疗后与安慰剂相比差异无统计学意义(P>0.05),但生殖系统感染的发生率较高(≤26周RR:3.88,95%CI:2.64~5.69,P<0.05;>26周RR:3.24,95%CI:1.95~5.37,P<0.05)。结论与安慰剂相比,SGLT2抑制剂糖化达标率高,能减轻体重,且发生低血糖风险小。
文摘Latent autoimmune diabetes in adults (LADA) is an autoimmune diabetes of adult-onset with the presence of diabetes associated autoantibodies. Familial renal glucosuria (FRG) is an inherited renal tubular disorder that causes persistent isolated glucosuria in the absence of hyperglycemia. We report a novel case of LADA and certain FRG. A 44-year-old man was admitted to our hospital for uncontrolled diabetes. Before admission, he had never suffered from diabetic coma and showed an improvement in HbA1c only with diet therapy. His HbA1c was 11.9% (107 mmol/mol), and anti-glutamic acid decarboxylase antibody was 13.0 U/mL. A glucagon stimulation test showed the decrease of insulin secretion: plasma C-peptide (CPR) 0 min, 0.69 ng/mL;CPR 6 min, 0.90 ng/mL. Analysis of genomic DNA revealed a novel heterozygous mutation in the SGLT2 coding gene, SLC5A2 (c.875G >A, p.Cys292Tyr), which was assessed as probably damaging with a score of 0.998 (sensitivity: 0.27;specificity: 0.99) by an in silico analysis. Therefore, he was diagnosed with LADA and certain FRG. He has not shown any symptoms and his HbA1c improved to 6.4% (46 mmol/mol) three months after the introduction of insulin therapy. Our case clearly implies the clinical effectiveness of SGLT2 inhibition in patients with LADA.
