Метаболічні ефекти інгібіторів натрійзалежного котранспортера глюкози 2 типу
DOI:
https://doi.org/10.30978/CEES-2022-4-42Ключові слова:
емпагліфлозин, цукровий діабет,, серцево‑судинні ускладнення, хронічна хвороба нирокАнотація
В огляді літератури розглядається нова універсальна молекула емпагліфлозину, якій вдалося змінити глюкозоцентричний підхід в ендокринології на органопротекторний. Результати базових клінічних досліджень, проведених з емпагліфлозином (EMPA‑REG‑OUTCOME, EMPEROR‑REDUCED, EMPEROR‑PRESERVED та EMPULSE), дають підстави стверджувати про здатність емпагліфлозину знижувати випадки серцево‑судинної смерті або госпіталізацію з приводу серцевої недостатності та уповільнювати прогресування хронічної хвороби нирок. Серед підтверджених і потенційно сприятливих метаболічних наслідків прийому емпагліфлозину слід зазначити такі: вибірковий антигіперглікемічний ефект лише в умовах гіперглікемії/глюкозурії, що не залежить ані від продукції інсуліну, ані від чутливості периферичних тканин до інсуліну, а лімітований лише швидкістю клубочкової фільтрації. Цей ефект дає змогу уникати гіпоглікемії навіть у пацієнтів без діабету. Препарат є одним з найбільш довговічних серед пероральних цукрознижувальних засобів і дає змогу протягом 6 — 8 років утримувати досягнуті значення глікозильованого гемоглобіну, відтерміновуючи ініціацію інсулінотерапії у пацієнтів із цукровим діабетом 2 типу. Емпагліфлозин у пацієнтів із цукровим діабетом 2 типу переважав плацебо щодо запобігання смертності внаслідок серцево‑судинних захворювань, нелетального інфаркту міокарда або нелетального інсульту. Ефект спричинений значним зниженням ризику серцево‑судинної смертності без суттєвих змін щодо нелетального інфаркту міокарда або нелетального інсульту. Можливе поєднання з іншими пероральними та ін’єкційними цукрознижувальними препаратами. У разі поєднання з препаратами сульфонілсечовини або інсуліном, останні потребують корекції дози у бік її зменшення. Втрата 2 — 3 кг маси тіла на тлі емпагліфлозину є очікуваним явищем, яке може модифікувати показники артеріального тиску та резистентність до інсуліну. Емпагліфлозин має здатність знижувати стеатоз та поліпшувати показники фіброзу печінки у пацієнтів з неалкогольною жировою хворобою печінки без цукрового діабету 2 типу.
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