PDF(Pubmed)
Abstract：
Early epidemiologic studies in type 2 diabetes suggested that the long-term risk of microvascular and macrovascular complications increase progressively as glucose concentrations rise, inspiring the pursuit of near euglycaemia as a means of preventing these complications in type 1 and type 2 diabetes. Evidence emerging over the past decade, however, showed that the aggressive efforts often needed to achieve low HbA1c levels can ultimately lead to worse clinical outcomes, greater risk of severe hypoglycaemia, and higher burden of treatment. The acknowledgment of the disappointing results obtained with therapies aimed exclusively at improving glycaemic control has led in recent years to a substantial paradigm shift in the treatment of the diabetic patient. The results obtained first with GLP-1RAs and more recently even more with SGLT2i on mortality and CV events have made it clear how other mechanisms, beyond the hypoglycaemic effect, are at the basis of the benefits observed in several cardiovascular outcome trials. And as evidence of the great revolution of thought we are experiencing, there is the recognition of gliflozins as drugs for the treatment not only of diabetic patients but also of non-diabetic patients suffering from HF, as reported in the latest ESC/HFA guidelines. Surely, we still have a lot to understand, but it is certain that this is the beginning of a new era.
摘要：
早期2型糖尿病的流行病学研究表明，随着葡萄糖浓度的升高，微血管和大血管并发症的长期风险逐渐增加。在1型和2型糖尿病中，鼓励追求接近正常血糖作为预防这些并发症的手段。过去十年出现的证据，然而,表明，积极的努力往往需要实现低HbA1c水平可能最终导致更差的临床结果，严重低血糖的风险更大，和更高的治疗负担。近年来，对专门旨在改善血糖控制的疗法所获得的令人失望的结果的认可导致了糖尿病患者治疗的重大范式转变。首先使用GLP-1RAs获得的结果，以及最近使用SGLT2i获得的更多关于死亡率和CV事件的结果，清楚地表明了其他机制如何，除了降血糖作用，是在几个心血管结局试验中观察到的益处的基础上。作为我们正在经历的伟大思想革命的证据，人们认识到gliflozins不仅可以治疗糖尿病患者，而且可以治疗患有HF的非糖尿病患者，如最新的ESC/HFA指南所述。当然,我们还有很多要了解的,但可以肯定的是，这是一个新时代的开始。
