Yaşlı hastalarda SGLT2 inhibitörü kullanımı: laboratuvar değerlendirilmesi

Year 2022, Volume: 3 Issue: 3, 142 - 146, 26.09.2022

Enes Seyda Şahiner Oğuzhan Zengin

https://doi.org/10.47582/jompac.1143184

Abstract

Amaç: Bu çalışmada Tip-2 Diabetes mellitus (T2DM) ile takipli, empagliflozin veya dapagliflozin kullanan 65 yaş üzeri bireylerde sodyum glukoz kotrasporter 2 (SGLT2) inhibitorü kullanımına bağlı laboratuar parametrelerinde ortaya çıkan sonuçları incelemeyi amaçladık.
Gereç ve Yöntem: 65 yaş üzeri T2DM ile takipli mevcut tedavisine empagliflozin (günde bir kez 10 mg) veya dapagliflozin (günde bir kez 10 mg) eklenmiş 140 hasta iki gruba ayrıldı. Tedavi başlangıcında ve tedavinin 24. haftasındaki laboratuar sonuçları, ilaca bağlı yan etkiler kaydedildi. Çalışma retrospektif olarak tasarlandı.
Bulgular: Her iki grupta da anlamlı açlık kan şekeri ve HbA1c düşüşleri gözlendi. Dapagliflozin grubunda lipid parametrelerinde anlamlı düşüş görüldü. Empagliflozin grubunda fosfor değerlerinde yükselme saptandı. Her iki grupta ise hemoglobin ve kalsiyum değerlerinde anlamlı artış meydana geldi. Toplam yan etkiler açısından anlamlı farklılık saptanmadı..
Sonuç: Kan şekeri regülasyonu dışında birçok olumlu etkileri olan ve yeni etki mekanizmaları keşfedilmeye devam edilen SGLT2 inhibitörleri uygun hasta gruplarında öncelikle tercih edilebilecek preperatlar olduğunu düşünüyoruz.

Keywords

SGLT2 inhibitörleri, yaşlı hastalar, empagliflozin, dapagliflozin, diabetes mellitus

Laboratory changes in older patients using SGLT2 inhibitors

Abstract

Aim: In this study, we aimed to investigate the results of laboratory parameters related to the use of sodium glucose cotransporter 2 (SGLT2) inhibitors in individuals over 65 years of age who were using empagliflozin or dapagliflozin for the treatment of type 2 diabetes mellitus (T2DM).
Material and Method: A total of 140 patients over 65 years of age who had empagliflozin (10 mg once daily) or dapagliflozin (10 mg once daily) added to their current treatment for T2DM were divided into two groups. Laboratory results at the beginning of treatment and at the 24th week of treatment and drug-related adverse events were noted. The study was retrospectively designed.
Results: Significant decreases in fasting blood glucose and HbA1c were observed in both groups. There was a significant decrease in lipid parameters in the dapagliflozin group. Phosphorus values were elevated in the empagliflozin group. In both groups, there was a significant increase in hemoglobin and calcium values. There was no significant difference in terms of adverse events.
Conclusion: We think that SGLT2 inhibitors, which have many positive effects other than blood sugar regulation with new mechanisms of action that continue to be discovered, can be administered as the primary treatment for appropriate patient groups.

Keywords

SGLT2 inhibitors, older patients, empagliflozin, dapagliflozin, diabetes mellitus

References

• American Diabetes Association, older adults: Standards of Medical Care in Diabetes. Diabetes Care 2019; 42: 139–47.
• Kirkman MS, Briscoe VJ, Clark N, et al. Diabetes in older adults. Diabetes Care 2012; 35: 2650–64.
• ItoH, OmotoT, Abe M, et al. Relationships between the duration of illness and the current status of diabetes in elderly patients with type 2 diabetes mellitus. Geriatr Gerontol Int 2017; 17: 24–30.
• Öten E, Çapraz M. The effect of body mass index on osteoporosis and fracture risk in patients with type 2 diabetes mellitus. J Health Sci Med 2021; 4: 882-5.
• Pradhan A, Vohra S, Vishwakarma P, Sethi R. Review on sodium-glucose cotransporter 2 inhibitor in diabetes mellitus and heart failure. J Family Med Prim Care 2019; 8: 1855-62.
• Brown AJM, Lang C, McCrimmon R, Struthers A. Does dapagliflozin regress left ventricular hypertrophy in patients with type 2 diabetes? A prospective, double-blind, randomised, placebo controlled study. BMC Cardiovasc Disorders 2017; 17: 229.
• Mordi NA, Mordi IR, Singh JS, et al. Renal and Cardiovascular Effects of sodium-glucose cotransporter 2 (SGLT2) inhibition in combination with loop Diuretics in diabetic patients with Chronic Heart Failure (RECEDE-CHF): protocol for a randomised controlled double-blind cross-over trial. BMJ Open 2017; 7: e018097.
• Lytvyn Y, Bjornstad P, Udell JA, Lovshin JA, Cherney DZI. Sodium glucose cotransporter-2 inhibition in heart failure: potential mechanisms, clinical applications, and summary of clinical trials. Circulation 2017; 136: 1643-58.
• Hasan FM, Alsahli M, Gerich JE. SGLT2 inhibitors in the treatment of type 2 diabetes. Diabetes Res Clin Pract 2014; 104: 297-322
• Brunton, S.A. The potential role of sodium glucose co-transporter 2 inhibitors in the early treatment of type 2 diabetes mellitus. Int J Clin Pract 2015; 69: 1071-87.
• United States Census Bureau, International Database.
• Uthman L, Homayr A, Juni RP, et al. Empagliflozin and dapagliflozin reduce ROS generation and restore NO bioavailability in tumor necrosis factor αstimulated human coronary arterial endothelial cells. Cell Physiol Biochem. 2019; 53: 865-86.
• Zinman B, Wanner C, Lachin JM, et al; EMPA-REG OUTCOME Investigators. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 2015; 373: 2117–28.
• Taşkaldıran I, Kuşkonmaz Ş, Çulha C. Use of sodium glucose co-transporter 2 inhibitor (SGLT2i) in geriatric population. Turk J Diab Obes 2021; 2: 158-64.
• Ghanim H, Abuaysheh S, Hejna J, et al. Dapagliflozin suppresses hepcidin and increases erythropoiesis. J Clin Endocrinol Metab 2020 Feb11. pii: dgaa057.
• Mazer CD, Hare GMT, Connelly PW, et al. Effect of empagliflozin on erythropoietin levels, iron stores, and red blood cell morphology in patients with type 2 diabetes mellitus and coronary artery disease. Circulation 2020; 141: 704-7.
• Imprialos KP, Boutari C, Stavropoulos K, et al. Stroke paradox with SGLT-2 inhibitors: a play of chanceor a viscosity-mediated reality? J Neurol Neurosurg Psychiatry 2017; 88: 249-53.
• Donato AJ, Machin DR, Lesniewski LA. Mechanisms of dysfunction in the aging vasculature and role in age-related disease. Circ Res 2018; 123: 825- 48.
• Steven S, Oelze M, Hanf A, et al. The SGLT2 inhibitor empagliflozin improves the primary diabetic complications in ZDF rats. Redox Biol 2017; 13: 370-85.
• Briand F, Mayoux E, Brousseau E, et al. Empagliflozin, via switching metabolism toward lipid utilization, moderately increases LDL cholesterol levels through reduced LDL catabolism. Diabetes 2016; 65: 2032-8.
• Mustroph J, Wagemann O, Lücht CM, et al. Empagliflozin reduces Ca/calmodulin‐dependent kinase II activity in isolated ventricular cardiomyocytes. ESC Heart Fail 2018; 5: 642-8.
• Taylor SI, Blau JE, Rother KI. Possible adverse effects of SGLT2 inhibitors on bone. Lancet Diabetes Endocrinol 2015; 3: 8-10.
• Oren Steen, Ronald M Goldenberg, The role of sodium-glucose cotransporter 2 inhibitors in the management of type 2 diabetes. Can J Diabetes 2017; 41: 517-23.
• Ruanpeng D, Ungprasert P, Sangtian J, Harindhanavudhi T. Sodium-glucose cotransporter 2 (SGLT2) inhibitors and fracture risk in patients with type 2 diabetes mellitus: a meta-analysis. Diabetes Metab Res Rev 2017; 33: 10.1002/dmrr.2903.
• Anker SD, Butler J. Empagliflozin, calcium, and SGLT1/2 receptor affinity: another piece of the puzzle. ESC Heart Fail 2018; 5: 549–51.
• Lunder M, Janić M, Japelj M, Juretič A, Janež A, Šabovič M. Empagliflozin on top of metformin treatment improves arterial function in patients with type 1 diabetes mellitus. Cardiovasc Diabetol 2018; 17: 153.