钠-葡萄糖共转运蛋白2抑制剂联合二甲双胍治疗2型糖尿病专家共识  

Expert consensus on sodium-glucose cotransporter-2 inhibitors with metformin in patients with type 2 diabetes mellitus

作　　者：《钠-葡萄糖共转运蛋白2抑制剂联合二甲双胍治疗2型糖尿病专家共识》专家组 陈莉明[2] 赵家军 Expert Group for Expert Consensus on Sodium-Glucose Cotransporter-2 Inhibitors with Metformin in Patients with Type 2 Diabetes Mellitus;Chen Liming;Zhao Jiajun

机构地区：[1]不详 [2]天津医科大学朱宪彝纪念医院内分泌科 [3]山东第一医科大学附属省立医院内分泌与代谢病科

出　　处：《国际内分泌代谢杂志》2023年第5期437-448,共12页International Journal of Endocrinology and Metabolism

摘　　要：随着2型糖尿病病情进展,传统的阶梯治疗是一种“Treat to failure”的治疗策略。经过治疗理念的发展和变迁,2型糖尿病治疗策略应该由“Treat to failure”转为追求“Treat to Success”的治疗策略。其中,治疗成功更全面的定义应为通过早期/起始联合治疗达到血糖长期稳定控制,心肾并发症综合管理,和更好的治疗依从性,从而最大程度的减缓或阻止疾病进展,减少微血管和大血管并发症及其相关危险因素。为实现追求治疗成功策略,或糖尿病的综合管理目标,应更早地使用更积极的联合治疗方案、提高治疗依从性、减缓或阻止2型糖尿病进展和远期并发症的发生发展。钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)为新型口服降糖药,除降糖外,还具有确切的心血管和肾脏保护作用,并能改善最终临床结局。二甲双胍是国内外指南一致推荐的基础降糖药。SGLT2i联合二甲双胍可针对2型糖尿病不同的病理生理缺陷,发挥机制互补、协同增效的降糖作用,更有助于维持血糖控制,同时还可以带来多重代谢获益,延缓疾病进展,改善糖尿病临床结局,为国内外指南推荐的“双一线”联合治疗方案。SGLT2i/二甲双胍复方制剂具备两种药物的治疗优势,可进一步简化治疗,具有提高治疗依从性和方便性、降低治疗费用等优势,提供了更多选择。为了让临床医生对SGLT2i联合二甲双胍治疗方案有更全面的认识,根据最新的循证医学证据和研究新进展,制定了本共识。With the progression of type 2 diabetes mellitus,the traditional stepwise treatment is a futile strategy known as“Treat to failure”.With the evolution of treatment concepts,the approach to managing type 2 diabetes should shift from“Treat to failure”to striving for“Treat to Success”.In this context,a more comprehensive definition of“Treat to Success”involves achieving long-term stable blood glucose control through early/initiation combination therapy,comprehensive management of cardiovascular and renal complications,and improving treatment compliance.This approach aims to significantly slow down or halt disease progression and reduce the occurrence of microvascular and macrovascular complications along with their associated risk factors.To achieve the goal of“Treat to Success”or comprehensive diabetes management,it′s advisable to use combination therapy earlier,enhance treatment compliance,and slow down or prevent the progression of type 2 diabetes and its long-term complications.Sodium-glucose cotransporter 2 inhibitors(SGLT2i)are a novel class of oral antidiabetic medications that not only lower blood glucose levels but also offer definite cardiovascular and renal protection,leading to improved clinical outcomes.Metformin is a recommended foundational antidiabetic drug in guidelines worldwide.Combining SGLT2i with metformin can target various pathological and physiological defects of type 2 diabetes,leveraging complementary mechanisms for synergistic glycemic control.This approach not only aids in maintaining blood glucose control but also provides multiple metabolic benefits,slowing disease progression and enhancing clinical outcomes in diabetes,aligning with the dual first-line combination therapy approach recommended by international guide-lines.SGLT2i/metformin combination formulations combine the therapeutic advantages of both medications,further simplifying treatment and increasing treatment compliance,convenience,and cost-effectiveness,providing more options for patients.In order to

关 键 词：钠-葡萄糖共转运蛋白2抑制剂 二甲双胍 糖尿病 2型 动脉粥样硬化性心血管疾病 心力衰竭 慢性肾脏病 共识 

分 类 号：R587.1[医药卫生—内分泌]