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Geriatrik Popülasyonda Sodyum Glukoz Ko-Transporter 2 İnhibitörü(SGLT2i) Kullanımı

Yıl 2021, Cilt: 5 Sayı: 2, 158 - 164, 29.08.2021
https://doi.org/10.25048/tudod.910260

Öz

Amaç: Yaşlılarda diyabet tedavisi ve takibi daha zor ve hassastır. Sodyum glukoz ko-transporter tip 2 (SGLT2) inhibitörleri yeni
geliştirilmiş antidiyabetik ajanlardır. Geriatrik yaş grubunda, SGLT2 inhibitörlerinin kullanımı yan etkileri açısından daha riskli olabilir.
Biz SGLT2 inhibitörlerinin geriatrik yaş grubunda kullanılmasının hastalardaki etkinliğini ve tolerabilitesini değerlendirmeyi planladık.

Gereç ve Yöntemler: Çalışmaya, merkezimizde tip 2 DM tanısı ile empagliflozin veya dapagliflozin tedavisi başlanmış 65 yaş üstü
hastalar alındı. Çalışmaya toplam 52 hasta dahil edildi. Çalışma retrospektif dosya tarama olarak dizayn edildi. SGLT2 inhibitörü
tedavisi öncesi ve sonrası biyokimyasal veriler ve ilaca bağlı yan etkiler ve ilaç kesilme bilgileri kaydedildi.

Bulgular: Hastaların SGLT2 inhibitörü başlandıktan sonra açlık kan şekeri (AKŞ), tokluk kan şekeri (TKŞ), ve HbA1c değerlerinde
istatistiksel olarak anlamlı derecede azalma izlendi. Hastaların üre ve kreatinin değerlerinde tedavi sonrası artış izlenirken, eGFR
değerinde düşme izlendi. Tedavi sonrası spot idrarda albümin/kreatinin oranında azalma, hemoglobin ve hematokrit değerlerinde artış
izlendi. 31 hastada (%59,6) hiçbir şikâyet bildirilmemiş ve yan etki saptanmamıştır. 21 hastada (%40,3) SGLT2 inhibitörü ile ilişkili olduğu düşünülen yan etkiler izlenmiştir. Toplamda 52 hastadan 41 hastada (%78,8) tedaviye devam edilirken, 11 hastada (%21,2) tedavi
kesilmiştir.

Sonuç: 65 yaş üstü tip 2 diyabet hastalarında SGLT 2 inhibitörü tedavisi ile glisemik kontrol başarılıdır, yan etkileri ve ilaç kesilme
oranları kabul edilebilir sınırlardadır

Kaynakça

  • 1. American Diabetes Association. 12. Older adults: Standards of Medical Care in Diabetes-2019. Diabetes Care 2019;42:S139–S147.
  • 2. Kirkman MS, Briscoe VJ, Clark N et al. Diabetes in older adults. Diabetes Care 2012; 35: 2650–64.
  • 3. 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. doi:10.1111/ggi.12654
  • 4. 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: 2117–2128.
  • 5. Zelniker TA, Wiviott SD, Raz I, et al. SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet. 2019;393:31–39. doi:10.1016/S0140- 6736(18)32590-X
  • 6. Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000 Aug 12;321:405-12. doi: 10.1136/bmj.321.7258.405.
  • 7. Ferrannini E, Seman L, Seewaldt-Becker E, et al. A PhaseIIb, randomized, placebo-controlled study of the SGLT2 inhibitor empagliflozin in patients with type 2 diabetes. Diabetes Obes Metab 2013;15:721–8.
  • 8. Häring HU, Merker L, Seewaldt-Becker E, et al. EMPA-REG MET Trial Investigators. Empagliflozin as add-on to metformin in patients with type 2 diabetes: a 24-week, randomized, double-blind, placebo-controlled trial. Diabetes Care. 2014 Jun;37:1650-9. doi: 10.2337/dc13-2105.
  • 9. Cahn A, Mosenzon O, Wiviott SD, et al. Efficacy and Safety of Dapagliflozin in the Elderly: Analysis Fromthe DECLARE-TIMI 58 Study. Diabetes Care. 2020 Feb;43(2):468-475. doi: 10.2337/dc19-1476.
  • 10. Ito H, Matsumoto S, Izutsu T, et al. Comparison of the changes in the factors associated with the renal prognosis of non-elderly and elderly subjects treated with empagliflozin- a retrospective observation study in Japanese patients with type 2 diabetes. Diabetes Metab Syndr Obes. 2019 Sep 9;12:1783-1794. doi: 10.2147/DMSO.S221655.
  • 11. Wanner C.,Inzucchi S.E., Lachin J.M., Fitchett D., et al. Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes. N. Engl. J. Med. 2016;375:323–334. doi: 10.1056/NEJMoa1515920.
  • 12. Neal B.,Perkovic V., Mahaffey K.W., et al. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N. Engl. J. Med. 2017;377:644–657. doi: 10.1056/NEJMoa1611925.
  • 13. Petrykiv S.I.,Laverman G.D., de Zeeuw D., Heerspink H.J.L. The albuminuria-lowering response to dapagliflozin is variable and reproducible among individual patients. Diabetes Obes. Metab. 2017;19:1363–1370. doi: 10.1111/dom.12936.
  • 14. Garofalo C, Borrelli S, Liberti ME, et al. SGLT2 Inhibitors: Nephroprotective Efficacy and Side Effects. Medicina (Kaunas). 2019 Jun 11;55:268. doi: 10.3390/medicina55060268.
  • 15. Ghanim H, Abuaysheh S, Hejna J, et al. Dapagliflozin suppresses hepcidin and increases erythropoiesis. J Clin Endocrinol Metab. 2020 Feb11. pii: dgaa057. doi: 10.1210/clinem/dgaa057.
  • 16. 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 Feb 25;141:704-707. doi: 10.1161/CIRCULATIONAHA.119.044235.
  • 17. Imprialos KP, Boutari C, Stavropoulos K, et al. Stroke paradox with SGLT-2 inhibitors: a play of chanceor a viscosity-mediatedreality? J Neurol Neuro surg Psychiatry. 2017 Mar;88:249-253. doi: 10.1136/jnnp-2016-314704.
  • 18. Monteiro P, Bergenstal RM, Toural E, et al. Efficacy and safety of empagliflozin in older patients in the EMPA-REG OUTCOME® trial. Age Ageing. 2019 Nov 1;48(6):859-866. doi: 10.1093/ageing/afz096.
  • 19. Hirji I, Guo Z, Andersson SW, et al. Incidence of urinary tract infection among patients with type 2 diabetes in the UK General Practice Research Database (GPRD). J Diabetes Complications 2012;26: 513–6.

Use of Sodium Glucose Co-Transporter 2 Inhibitor (SGLT2i) in Geriatric Population

Yıl 2021, Cilt: 5 Sayı: 2, 158 - 164, 29.08.2021
https://doi.org/10.25048/tudod.910260

Öz

Aim: Diabetes treatment and follow-up is more difficult and sensitive in the elderly. Sodium glucose co-transporter type 2 (SGLT2)
inhibitors are newly developed antidiabetic agents. In the geriatric age group, the use of SGLT2 inhibitors may be riskier in terms of side
effects. We planned to evaluate the effect and tolerability of using SGLT2 inhibitors in geriatric patients.
Material and Methods: Patients over 65 years of age with a diagnosis of type 2 DM who were started on empagliflozin or dapagliflozin
in our center were included in the study. A total of 52 patients were included in the study. The study was designed as a retrospective file
scan. Before and after SGLT2 inhibitor treatment, biochemical data, drug-related side effects and drug withdrawal information were
recorded.
Results: A statistically significant decrease was observed in the fasting blood glucose (FBG), postprandial blood glucose (PPBG), and
HbA1c values of the patients after the SGLT2 inhibitor was started. While the urea and creatinine values of the patients increased after
the treatment, a decrease was observed in the eGFR value. After treatment, a decrease in albumin/creatinine ratio in spot urine and an
increase in hemoglobin and hematocrit values were observed. No complaints were reported in 31 patients (59.6%) and no side effects
were detected. Side effects associated with SGLT2 inhibitor were observed in 21 patients (40.3%). In total, treatment was continued in 41
patients (78.8%) out of 52 patients, while treatment was discontinued in 11 patients (21.2%).
Conclusion: In type 2 DM population over 65 years of age, glycemic control with SGLT 2 inhibitor treatment is successful, side effects
and drug withdrawal rates are within acceptable limits.

Kaynakça

  • 1. American Diabetes Association. 12. Older adults: Standards of Medical Care in Diabetes-2019. Diabetes Care 2019;42:S139–S147.
  • 2. Kirkman MS, Briscoe VJ, Clark N et al. Diabetes in older adults. Diabetes Care 2012; 35: 2650–64.
  • 3. 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. doi:10.1111/ggi.12654
  • 4. 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: 2117–2128.
  • 5. Zelniker TA, Wiviott SD, Raz I, et al. SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet. 2019;393:31–39. doi:10.1016/S0140- 6736(18)32590-X
  • 6. Stratton IM, Adler AI, Neil HA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000 Aug 12;321:405-12. doi: 10.1136/bmj.321.7258.405.
  • 7. Ferrannini E, Seman L, Seewaldt-Becker E, et al. A PhaseIIb, randomized, placebo-controlled study of the SGLT2 inhibitor empagliflozin in patients with type 2 diabetes. Diabetes Obes Metab 2013;15:721–8.
  • 8. Häring HU, Merker L, Seewaldt-Becker E, et al. EMPA-REG MET Trial Investigators. Empagliflozin as add-on to metformin in patients with type 2 diabetes: a 24-week, randomized, double-blind, placebo-controlled trial. Diabetes Care. 2014 Jun;37:1650-9. doi: 10.2337/dc13-2105.
  • 9. Cahn A, Mosenzon O, Wiviott SD, et al. Efficacy and Safety of Dapagliflozin in the Elderly: Analysis Fromthe DECLARE-TIMI 58 Study. Diabetes Care. 2020 Feb;43(2):468-475. doi: 10.2337/dc19-1476.
  • 10. Ito H, Matsumoto S, Izutsu T, et al. Comparison of the changes in the factors associated with the renal prognosis of non-elderly and elderly subjects treated with empagliflozin- a retrospective observation study in Japanese patients with type 2 diabetes. Diabetes Metab Syndr Obes. 2019 Sep 9;12:1783-1794. doi: 10.2147/DMSO.S221655.
  • 11. Wanner C.,Inzucchi S.E., Lachin J.M., Fitchett D., et al. Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes. N. Engl. J. Med. 2016;375:323–334. doi: 10.1056/NEJMoa1515920.
  • 12. Neal B.,Perkovic V., Mahaffey K.W., et al. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N. Engl. J. Med. 2017;377:644–657. doi: 10.1056/NEJMoa1611925.
  • 13. Petrykiv S.I.,Laverman G.D., de Zeeuw D., Heerspink H.J.L. The albuminuria-lowering response to dapagliflozin is variable and reproducible among individual patients. Diabetes Obes. Metab. 2017;19:1363–1370. doi: 10.1111/dom.12936.
  • 14. Garofalo C, Borrelli S, Liberti ME, et al. SGLT2 Inhibitors: Nephroprotective Efficacy and Side Effects. Medicina (Kaunas). 2019 Jun 11;55:268. doi: 10.3390/medicina55060268.
  • 15. Ghanim H, Abuaysheh S, Hejna J, et al. Dapagliflozin suppresses hepcidin and increases erythropoiesis. J Clin Endocrinol Metab. 2020 Feb11. pii: dgaa057. doi: 10.1210/clinem/dgaa057.
  • 16. 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 Feb 25;141:704-707. doi: 10.1161/CIRCULATIONAHA.119.044235.
  • 17. Imprialos KP, Boutari C, Stavropoulos K, et al. Stroke paradox with SGLT-2 inhibitors: a play of chanceor a viscosity-mediatedreality? J Neurol Neuro surg Psychiatry. 2017 Mar;88:249-253. doi: 10.1136/jnnp-2016-314704.
  • 18. Monteiro P, Bergenstal RM, Toural E, et al. Efficacy and safety of empagliflozin in older patients in the EMPA-REG OUTCOME® trial. Age Ageing. 2019 Nov 1;48(6):859-866. doi: 10.1093/ageing/afz096.
  • 19. Hirji I, Guo Z, Andersson SW, et al. Incidence of urinary tract infection among patients with type 2 diabetes in the UK General Practice Research Database (GPRD). J Diabetes Complications 2012;26: 513–6.
Toplam 19 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makalesi
Yazarlar

Işılay Taşkaldıran 0000-0002-1390-7571

Şerife Kuşkonmaz 0000-0002-2602-1657

Cavit Çulha 0000-0002-9275-2538

Yayımlanma Tarihi 29 Ağustos 2021
Kabul Tarihi 27 Temmuz 2021
Yayımlandığı Sayı Yıl 2021 Cilt: 5 Sayı: 2

Kaynak Göster

APA Taşkaldıran, I., Kuşkonmaz, Ş., & Çulha, C. (2021). Use of Sodium Glucose Co-Transporter 2 Inhibitor (SGLT2i) in Geriatric Population. Turkish Journal of Diabetes and Obesity, 5(2), 158-164. https://doi.org/10.25048/tudod.910260
AMA Taşkaldıran I, Kuşkonmaz Ş, Çulha C. Use of Sodium Glucose Co-Transporter 2 Inhibitor (SGLT2i) in Geriatric Population. Turk J Diab Obes. Ağustos 2021;5(2):158-164. doi:10.25048/tudod.910260
Chicago Taşkaldıran, Işılay, Şerife Kuşkonmaz, ve Cavit Çulha. “Use of Sodium Glucose Co-Transporter 2 Inhibitor (SGLT2i) in Geriatric Population”. Turkish Journal of Diabetes and Obesity 5, sy. 2 (Ağustos 2021): 158-64. https://doi.org/10.25048/tudod.910260.
EndNote Taşkaldıran I, Kuşkonmaz Ş, Çulha C (01 Ağustos 2021) Use of Sodium Glucose Co-Transporter 2 Inhibitor (SGLT2i) in Geriatric Population. Turkish Journal of Diabetes and Obesity 5 2 158–164.
IEEE I. Taşkaldıran, Ş. Kuşkonmaz, ve C. Çulha, “Use of Sodium Glucose Co-Transporter 2 Inhibitor (SGLT2i) in Geriatric Population”, Turk J Diab Obes, c. 5, sy. 2, ss. 158–164, 2021, doi: 10.25048/tudod.910260.
ISNAD Taşkaldıran, Işılay vd. “Use of Sodium Glucose Co-Transporter 2 Inhibitor (SGLT2i) in Geriatric Population”. Turkish Journal of Diabetes and Obesity 5/2 (Ağustos 2021), 158-164. https://doi.org/10.25048/tudod.910260.
JAMA Taşkaldıran I, Kuşkonmaz Ş, Çulha C. Use of Sodium Glucose Co-Transporter 2 Inhibitor (SGLT2i) in Geriatric Population. Turk J Diab Obes. 2021;5:158–164.
MLA Taşkaldıran, Işılay vd. “Use of Sodium Glucose Co-Transporter 2 Inhibitor (SGLT2i) in Geriatric Population”. Turkish Journal of Diabetes and Obesity, c. 5, sy. 2, 2021, ss. 158-64, doi:10.25048/tudod.910260.
Vancouver Taşkaldıran I, Kuşkonmaz Ş, Çulha C. Use of Sodium Glucose Co-Transporter 2 Inhibitor (SGLT2i) in Geriatric Population. Turk J Diab Obes. 2021;5(2):158-64.

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