背景:钠葡萄糖共转运蛋白-2(SGLT2)抑制剂可改善2型糖尿病患者的长期心血管和肾脏预后。然而,SGLT2抑制剂在ICU2型糖尿病患者中的安全性尚不确定.我们的目的是进行一项初步研究,以评估依帕列净治疗与生化之间的关系,以及此类患者的临床结果。
方法:我们纳入了18名ICU2型糖尿病患者,根据我们对糖尿病患者的自由血糖控制方案,接受依帕列净(每天10mg)和胰岛素的目标血糖范围为10-14mmol/l(治疗组)。治疗组患者的年龄相匹配,糖化血红蛋白A1c,和ICU持续时间,72例ICU2型糖尿病患者暴露于相同的目标血糖范围,但未接受依帕列净(对照组)。我们比较了电解质和酸碱参数的变化,低血糖,酮症酸中毒,肾功能恶化,尿培养结果,两组之间的医院死亡率。
结果:钠和氯水平的最大增加中位数(IQR)对照组为3(1-10)mmol/l和3(2-8)mmol/l,治疗组为9(3-12)mmol/l和8(3-10)mmol/l(钠的P=0.045,氯化物P=0.059)。我们观察到强离子差异没有差异,pH或碱过量。总的来说,6%每组发生低血糖。治疗组患者和对照组患者均无酮症酸中毒。18%和29%的治疗组和对照组患者发生肾功能恶化,分别为(P=0.54)。22%的治疗组患者和13%的对照组患者尿液培养阳性(P=0.28)。总的来说,治疗组17%的患者和对照组19%的患者在医院死亡(P=0.79)。
结论:在我们对ICU2型糖尿病患者的初步研究中,empagliflozin治疗与钠和氯化物水平升高相关,但与酸碱变化无显著相关,低血糖,酮症酸中毒,肾功能恶化,菌尿,或死亡率。
Sodium glucose co-transporter-2 (SGLT2) inhibitors improve long-term cardiovascular and renal outcomes in individuals with type 2 diabetes. However, the safety of SGLT2 inhibitors in ICU patients with type 2 diabetes is uncertain. We aimed to perform a pilot study to assess the relationship between empagliflozin therapy and biochemical, and clinical outcomes in such patients.
We included 18 ICU patients with type 2 diabetes receiving empagliflozin (10 mg daily) and insulin to target glucose range of 10-14 mmol/l according to our liberal glucose control protocol for patients with diabetes (treatment group). Treatment group patients were matched on age, glycated hemoglobin A1c, and ICU duration with 72 ICU patients with type 2 diabetes exposed to the same target glucose range but who did not receive empagliflozin (control group). We compared changes in electrolyte and acid-base parameters, hypoglycemia, ketoacidosis, worsening kidney function, urine culture findings, and hospital mortality between the groups.
Median (IQR) maximum increase in sodium and chloride levels were 3 (1-10) mmol/l and 3 (2-8) mmol/l in the control group and 9 (3-12) mmol/l and 8 (3-10) mmol/l in the treatment group (P = 0.045 for sodium, P = 0.059 for chloride). We observed no differences in strong ion difference, pH or base excess. Overall, 6% developed hypoglycemia in each group. No patient in the treatment group and one patient in the control group developed ketoacidosis. Worsening kidney function occurred in 18% and 29% of treatment and control group patients, respectively (P = 0.54). Urine cultures were positive in 22% of treatment group patients and 13% of control group patients (P = 0.28). Overall, 17% of treatment group patients and 19% of control group patients died in hospital (P = 0.79).
In our pilot study of ICU patients with type 2 diabetes, empagliflozin therapy was associated with increases in sodium and chloride levels but was not significantly associated with acid-base changes, hypoglycemia, ketoacidosis, worsening kidney function, bacteriuria, or mortality.