medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-435medsovet-8625Research ArticleСАХАРНЫЙ ДИАБЕТDIABETES MELLITUSГлюкозурия как основной механизм-ассоциированный эффект ингибиторов натрий-глюкозного котранспортера 2: есть ли повод для беспокойства?Glucosuria as a major mechanism-associated effect of sodium-glucose cotransporter 2 inhibitors: Is there cause for concern?https://orcid.org/0000-0001-6385-540XДемидоваТ. Ю.DemidovaT. Yu.

Демидова Татьяна Юльевна, д.м.н., профессор, заведующая кафедрой эндокринологии лечебного факультета

117997, Москва, ул. Островитянова, д. 1

Tatiana Yu. Demidova, Dr. Sci. (Med.), Professor, Head of the Department of Endocrinology, Faculty of Medicine

1, Ostrovityanov St., Moscow, 117997

t.y.demidova@gmail.comhttps://orcid.org/0000-0002-1385-0245ИзмайловаМ. Я.IzmaylovaM. Ya.

Измайлова Марьям Ярагиевна, ассистент кафедры эндокринологии лечебного факультета

117997, Москва, ул. Островитянова, д. 1

Maryam Ya. Izmaylova, Assistant of the Department of Endocrinology, Faculty of Medicine

1, Ostrovityanov St., Moscow, 117997

maremizm@gmail.comРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian Federation202401112024016172182Copyright © Демидова Т.Ю., Измайлова М.Я., 20242024Демидова Т.Ю., Измайлова М.Я.Demidova T.Y., Izmaylova M.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8625Введение

Введение. Одним из основных механизмов действия ингибиторов натрий-глюкозного котранспортера 2 (иНГЛТ2) является увеличение почечной экскреции глюкозы и натрия, развитие глюкозурии на фоне снижения уровней суточной гликемии. Частота развития глюкозурии у пациентов без СД, получающих иНГЛТ2 для лечения ХСН или ХБП, малоизучена.

Цель

Цель. Оценить в реальной клинической практике частоту развития и выраженность глюкозурии у пациентов с ХСН, получающих иНГЛТ2, как на фоне сопутствующего СД 2 типа, так и без СД2.

Материалы и методы

Материалы и методы. В одномоментное, проспективное, наблюдательное исследование было включено 230 пациентов с ХСН, получающих иНГЛТ2, находившихся в отделении кардиологии ГБУЗ ГКБ им. В.П. Демихова ДЗ г. Москвы.

Результаты

Результаты. Средний возраст пациентов составил 74 [66; 83] года. Медиана ФВ ЛЖ составила 36 [29; 44] %, NTproBNP 1019 [423; 2355] пг/мл. ХСНнФВ регистрировалась у 64,81% больных, ХСНунФВ – у 17,13% и 18,06% имели ХСНсФВ. СД2 страдали 38,7% пациентов с ХСН. Среди пациентов с ХСН «феномен глюкозурии», обусловленный приемом ингибиторов НГЛТ2, наблюдался у 31,16% лиц без СД2 и у 52,27% больных ХСН с сопутствующим СД2.

Выводы

Выводы. У пациентов с ХСН, получающих иНГЛТ2, глюкозурия развивалась у каждого 3-го пациента, без явных нарушений углеводного обмена, и у каждого 2-го с СД2. Глюкозурический эффект иНГЛТ2 не является обязательным событием даже для пациентов с СД2, что может влиять на частоту побочных событий в широкой клинической практике. Кардиопротективные преимущества иНГЛТ2 могут быть обусловлены другими механизмами, не связанными с экскрецией глюкозы, которая рассматривается как суррогатный предиктор благоприятного прогноза. Для определения кардиопротективных механизмов иНГЛТ2 и прогностической ценности медикаментозной глюкозурии требуются дополнительные исследования.

Introduction

Introduction. One of the main mechanisms of action of SGLT2 inhibitors is an increase in renal excretion of glucose and sodium, development of glucosuria against the background of decreased levels of daily glycemia. The frequency of glucosuria development in patients without DM/prediabetes, receiving SGLT2 inhibitors for the treatment of CHD or CKD, as a consequence of the mechanism of action of SGLT2 inhibitors inhibitors is poorly studied and seems to be very interesting.

Aim

Aim. To evaluate in real clinical practice the frequency of the development and severity of glucosuria in patients with CHF treated with inhibitors of SGLT2 inhibitors both on the background of concomitant DM2 and without type 2 DM.

Materials and methods

Materials and methods. Within the framework of a one-stage, prospective, observational study we evaluated the frequency of development and severity of glucosuria in patients with CHF, receiving SGLT2 inhibitors inhibitors, who were in the cardiology department of V.P. Demikhov State Clinical Hospital of Moscow. A total of 230 patients were included in the analysis.

Results

Results. The mean age of the patients was 74 [66; 83] years. Median LVEF was 36 [29; 44] %, NTproBNP 1019 [423; 2355] pg/ml. Heart failure with reduced ejection fraction (HFrEF) was recorded in 64.81% of patients, 17.13% had HF with mildly reduced ejection fraction and 18.06% had a СHF preserved ejection fraction. DM2 was present in 38.7 percent of patients with СHF.  Among patients with CHF, the ‘glucosuria phenomenon’ due to the administration of SGLT2 inhibitors was observed in 31.16% of those without DM2, and in 52.27% of СHF patients with concomitant DM2.

Conclusion

Conclusion. In patients with CHF receiving SGLT2 inhibitors therapy, the ‘glucosuria phenomenon’ developed in one in three patients without overt carbohydrate metabolism abnormalities and one in two with DM2. The findings suggest that the glucosuria effect of SGLT2 inhibitors is not a required event even in patients with DM2, which may influence the incidence of adverse events in general clinical practice. And the cardioprotective benefits of SGLT2 inhibitors may be due to other mechanisms unrelated to glucose excretion, which, according to recent studies, is considered a surrogate predictor of favorable prognosis concerning CHF and renal outcomes. Nevertheless, additional clinical and experimental studies are required to determine the cardioprotective mechanisms of SGLT2 inhibitors and the predictive value of drug-induced glucosuria.

 

 

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The authors declare that there are no conflicts of interest present.