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*For the reference
of medical professionals only, don't be asked, outpatient clinics or wards often encounter patients straight to the point, "Doctor, can you prescribe me xx net no,
there are people around to take this medicine The effect is very good"
。 The hypoglycemic effect of "Lijing" drugs is remarkable, and it is widely used in clinical practice
.
It has been more than 5 years since China's first "Liejing" was listed, and we can see more and more "Liejing", "Dapagliflozin", "Enpagliflozin", "Casagliflozin", "Etogliflozin".
.
.
How to choose?
The scientific name of "Leving" drugs is sodium-glucose co-transporter inhibitor (SGLT-2i), which inhibits the reabsorption of sodium and glucose by inhibiting SGLT-2 on the renal tubules, and promotes the excretion of urinary glucose and urine sodium, thereby reducing the level of
glucose in the blood.
Simply put, sugar is excreted from the urine and blood sugar levels are low
.
The mechanism of action does not depend on the function of pancreatic islets, so it is widely applicable to the population
.
SGLT-2i monotherapy can reduce glycosylated hemoglobin (HbA 1c) by 0.
5%-1.
2%, and combination therapy based on metformin can further reduce HbA 1c by 0.
4%-0.
8%, in addition to hypoglycemia , and also has a certain effect
of lowering blood pressure and weight reduction.
.
When choosing hypoglycemic drugs, on the basis of satisfying effective hypoglycemic drugs, it is necessary to take into account the treatment
of complications.
The 2022 version of the ADA Diabetes Diagnosis and Treatment Standards states that ASCVD is recommended for patients with type 2 diabetes with atherosclerotic cardiovascular disease (ASCVD) or high-risk cardiovascular risk or chronic kidney disease (CKD) if there are no contraindications SGLT2 inhibitors with evidence of benefit from CKD, GLP-1RA [1].
We compared clinical studies on cardiovascular events, heart failure, and chronic kidney disease outcomes for each drug and compiled the table below
.
Among them, on February 2, 2021, the National Medical Products Administration (NMPA) of China officially approved the indication of dapagliflozin for the treatment of heart failure with reduced ejection fraction
.
In August 2022, empagliflozin was approved in China for the treatment of heart failure
with preserved ejection fraction.
In September 2022, dapagliflozin was approved for the treatment of chronic kidney disease in China, which shows that the effect of SGLT2i drugs is powerful and extensive
.
Urinary tract and genital tract infection: Because the drug excretes glucose through urine, the concentration of glucose in the urine increases, which increases the risk of urinary tract infection and genital fungal infection, so patients should drink more water when using the drug, keep the vulva clean, and stop the drug in time if there is vulvar itching
.
Recurrent urinary or genital infections within half a year should be used with caution or contraindicated
.
Volume depletion: the drug can inhibit the reabsorption of sodium and glucose, and has the effect of sodium excretion and osmotic diuresis, so there may be a risk of
volume depletion.
If the patient is taking antihypertensive drugs and diuretics at the same time, pay attention to monitor blood pressure, and seek medical attention
in time if dehydration, dizziness, orthostatic hypotension, etc.
occur.
Diabetic ketoacidosis: low incidence, mainly in type 1 diabetes, characterized by low blood glucose levels
.
Avoid a very low-carb diet (with a tendency to produce ketones)
during medication.
Contraindicated in the perioperative period, it is recommended to suspend use
until 24 hours before strenuous exercise.
Amputation: Casagliflozin increases the risk of
lower limb amputation in a population.
In summary, all kinds of net have their own advantages, generally suitable for adult type 2 diabetes mellitus combined with atherosclerotic heart disease, hypertension, obesity, heart failure and mild to moderate chronic kidney disease patients, according to the patient's own situation to choose, pay attention to exclude contraindications, explain medication precautions, as far as possible to avoid the occurrence
of adverse reactions.
Zinman, B.
, Wanner, C.
, Lachin, J.
M.
, Fitchett, D.
, Bluhmki, E.
, Hantel, S.
, Mattheus, M.
, Devins, T.
, Johansen, O.
E.
, Woerle, H.
J.
, Broedl, U.
C.
, Inzucchi, S.
E.
, & EMPA-REG OUTCOME Investigators (2015).
Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes.
The New England journal of medicine, 373(22), 2117–2128.
[3].
Packer Milton, Butler Javed, Filippatos Gerasimos S et al.
Evaluation of the effect of sodium-glucose co-transporter 2 inhibition with empagliflozin on morbidity and mortality of patients with chronic heart failure and a reduced ejection fraction: rationale for and design of the EMPEROR-Reduced trial.
[J] .
Eur.
J.
Heart Fail.
, 2019, 21: 1270-1278.
[4].
Anker S D , Butler J , Filippatos G , et al.
Empagliflozin in Heart Failure with a Preserved Ejection Fraction[J].
The New England journal of medicine, 385(16):1451-1461.
[5].
Wiviott Stephen D, Raz Itamar, Bonaca Marc P et al.
Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes.
[J] .
N.
Engl.
J.
Med.
, 2019, 380: 347-357.
[6].
Dewan Pooja, Solomon Scott D, Jhund Pardeep S et al.
Efficacy and safety of sodium-glucose co-transporter 2 inhibition according to left ventricular ejection fraction in DAPA-HF.
[J] .
Eur.
J.
Heart Fail.
, 2020.
[7].
Heerspink H, BV Stefánsson, Correa-Rotter R , et al.
Dapagliflozin in Patients with Chronic Kidney Disease[J].
The New England journal of medicine, 384(4):389.
[8].
Mahaffey K W, Jardine M J , Severine B , et al.
Canagliflozin and Cardiovascular and Renal Outcomes in Type 2 Diabetes Mellitus and Chronic Kidney Disease in Primary and Secondary Cardiovascular Prevention Groups[J].
Circulation, 140(9):739-750.
[9].
Jardine M J , Zhou Z , Mahaffey K W , et al.
Renal, Cardiovascular, and Safety Outcomes of Canagliflozin by Baseline Kidney Function: A Secondary Analysis of the CREDENCE Randomized Trial[J].
Journal of the American Society of Nephrology, 2020, 31(5):1128-1139.
[10].
Cosentino F , Cannon C P , Cherney D , et al.
Efficacy of Ertugliflozin on Heart Failure–Related Events in Patients With Type 2 Diabetes Mellitus and Established Atherosclerotic Cardiovascular Disease : Results of the VERTIS CV Trial[J].
Circulation, 2020.
[11] Empagliflozin tablets (Oxyphene) instructions; [12] Dapagliflozin tablets (Andatang) instruction manual; [13] Casagliflozin tablets (Aoncore) instructions; [14] Etogliflozin tablets (Metroto) instructions;
In order to understand the reading habits and interests of fans and users of various channels, provide more interesting, useful and attitude content, medical endocrine channels welcome everyone to move their fingers It only takes one minute to complete the following research!
Where to see more endocrinology clinical knowledge? Come to the "doctor's station" and take a look 👇
of medical professionals only, don't be asked, outpatient clinics or wards often encounter patients straight to the point, "Doctor, can you prescribe me xx net no,
there are people around to take this medicine The effect is very good"
。 The hypoglycemic effect of "Lijing" drugs is remarkable, and it is widely used in clinical practice
.
It has been more than 5 years since China's first "Liejing" was listed, and we can see more and more "Liejing", "Dapagliflozin", "Enpagliflozin", "Casagliflozin", "Etogliflozin".
.
.
How to choose?
Mechanism of action
The scientific name of "Leving" drugs is sodium-glucose co-transporter inhibitor (SGLT-2i), which inhibits the reabsorption of sodium and glucose by inhibiting SGLT-2 on the renal tubules, and promotes the excretion of urinary glucose and urine sodium, thereby reducing the level of
glucose in the blood.
Simply put, sugar is excreted from the urine and blood sugar levels are low
.
The mechanism of action does not depend on the function of pancreatic islets, so it is widely applicable to the population
.
SGLT-2i monotherapy can reduce glycosylated hemoglobin (HbA 1c) by 0.
5%-1.
2%, and combination therapy based on metformin can further reduce HbA 1c by 0.
4%-0.
8%, in addition to hypoglycemia , and also has a certain effect
of lowering blood pressure and weight reduction.
Choose Advantage
.
When choosing hypoglycemic drugs, on the basis of satisfying effective hypoglycemic drugs, it is necessary to take into account the treatment
of complications.
The 2022 version of the ADA Diabetes Diagnosis and Treatment Standards states that ASCVD is recommended for patients with type 2 diabetes with atherosclerotic cardiovascular disease (ASCVD) or high-risk cardiovascular risk or chronic kidney disease (CKD) if there are no contraindications SGLT2 inhibitors with evidence of benefit from CKD, GLP-1RA [1].
We compared clinical studies on cardiovascular events, heart failure, and chronic kidney disease outcomes for each drug and compiled the table below
.
Note: ASCVD: atherosclerotic cardiovascular disease; HF: heart failure; CKD: Chronic kidney disease
.
Among them, on February 2, 2021, the National Medical Products Administration (NMPA) of China officially approved the indication of dapagliflozin for the treatment of heart failure with reduced ejection fraction
.
In August 2022, empagliflozin was approved in China for the treatment of heart failure
with preserved ejection fraction.
In September 2022, dapagliflozin was approved for the treatment of chronic kidney disease in China, which shows that the effect of SGLT2i drugs is powerful and extensive
.
Safe to use
Notes
Urinary tract and genital tract infection: Because the drug excretes glucose through urine, the concentration of glucose in the urine increases, which increases the risk of urinary tract infection and genital fungal infection, so patients should drink more water when using the drug, keep the vulva clean, and stop the drug in time if there is vulvar itching
.
Recurrent urinary or genital infections within half a year should be used with caution or contraindicated
.
Volume depletion: the drug can inhibit the reabsorption of sodium and glucose, and has the effect of sodium excretion and osmotic diuresis, so there may be a risk of
volume depletion.
If the patient is taking antihypertensive drugs and diuretics at the same time, pay attention to monitor blood pressure, and seek medical attention
in time if dehydration, dizziness, orthostatic hypotension, etc.
occur.
Diabetic ketoacidosis: low incidence, mainly in type 1 diabetes, characterized by low blood glucose levels
.
Avoid a very low-carb diet (with a tendency to produce ketones)
during medication.
Contraindicated in the perioperative period, it is recommended to suspend use
until 24 hours before strenuous exercise.
Amputation: Casagliflozin increases the risk of
lower limb amputation in a population.
In summary, all kinds of net have their own advantages, generally suitable for adult type 2 diabetes mellitus combined with atherosclerotic heart disease, hypertension, obesity, heart failure and mild to moderate chronic kidney disease patients, according to the patient's own situation to choose, pay attention to exclude contraindications, explain medication precautions, as far as possible to avoid the occurrence
of adverse reactions.
References:
[1].
American Diabetes Association，Standards of Medical Care in Diabetes—2022 Diabetes Care.
2022 Jan; 45(Suppl 1):S1-S264；
Zinman, B.
, Wanner, C.
, Lachin, J.
M.
, Fitchett, D.
, Bluhmki, E.
, Hantel, S.
, Mattheus, M.
, Devins, T.
, Johansen, O.
E.
, Woerle, H.
J.
, Broedl, U.
C.
, Inzucchi, S.
E.
, & EMPA-REG OUTCOME Investigators (2015).
Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes.
The New England journal of medicine, 373(22), 2117–2128.
[3].
Packer Milton, Butler Javed, Filippatos Gerasimos S et al.
Evaluation of the effect of sodium-glucose co-transporter 2 inhibition with empagliflozin on morbidity and mortality of patients with chronic heart failure and a reduced ejection fraction: rationale for and design of the EMPEROR-Reduced trial.
[J] .
Eur.
J.
Heart Fail.
, 2019, 21: 1270-1278.
[4].
Anker S D , Butler J , Filippatos G , et al.
Empagliflozin in Heart Failure with a Preserved Ejection Fraction[J].
The New England journal of medicine, 385(16):1451-1461.
[5].
Wiviott Stephen D, Raz Itamar, Bonaca Marc P et al.
Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes.
[J] .
N.
Engl.
J.
Med.
, 2019, 380: 347-357.
[6].
Dewan Pooja, Solomon Scott D, Jhund Pardeep S et al.
Efficacy and safety of sodium-glucose co-transporter 2 inhibition according to left ventricular ejection fraction in DAPA-HF.
[J] .
Eur.
J.
Heart Fail.
, 2020.
[7].
Heerspink H, BV Stefánsson, Correa-Rotter R , et al.
Dapagliflozin in Patients with Chronic Kidney Disease[J].
The New England journal of medicine, 384(4):389.
[8].
Mahaffey K W, Jardine M J , Severine B , et al.
Canagliflozin and Cardiovascular and Renal Outcomes in Type 2 Diabetes Mellitus and Chronic Kidney Disease in Primary and Secondary Cardiovascular Prevention Groups[J].
Circulation, 140(9):739-750.
[9].
Jardine M J , Zhou Z , Mahaffey K W , et al.
Renal, Cardiovascular, and Safety Outcomes of Canagliflozin by Baseline Kidney Function: A Secondary Analysis of the CREDENCE Randomized Trial[J].
Journal of the American Society of Nephrology, 2020, 31(5):1128-1139.
[10].
Cosentino F , Cannon C P , Cherney D , et al.
Efficacy of Ertugliflozin on Heart Failure–Related Events in Patients With Type 2 Diabetes Mellitus and Established Atherosclerotic Cardiovascular Disease : Results of the VERTIS CV Trial[J].
Circulation, 2020.
[11] Empagliflozin tablets (Oxyphene) instructions; [12] Dapagliflozin tablets (Andatang) instruction manual; [13] Casagliflozin tablets (Aoncore) instructions; [14] Etogliflozin tablets (Metroto) instructions;
In order to understand the reading habits and interests of fans and users of various channels, provide more interesting, useful and attitude content, medical endocrine channels welcome everyone to move their fingers It only takes one minute to complete the following research!
Where to see more endocrinology clinical knowledge? Come to the "doctor's station" and take a look 👇
