[1]彭雅茗,杨 艳,周广举.SGLT2抑制剂对糖尿病患者骨折、截肢的影响[J].医学信息,2020,33(23):22-26.[doi:10.3969/j.issn.1006-1959.2020.23.008]
　PENG Ya-ming,YANG Yan,ZHOU Guang-ju.Effect of SGLT2 Inhibitor on Fracture and Amputation of Diabetic Patients[J].Medical Information,2020,33(23):22-26.[doi:10.3969/j.issn.1006-1959.2020.23.008]
点击复制

SGLT2抑制剂对糖尿病患者骨折、截肢的影响()
分享到：

医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
33卷
期数:
2020年23期
页码:
22-26
栏目:
综述
出版日期:
2020-12-01

文章信息/Info

Title:
Effect of SGLT2 Inhibitor on Fracture and Amputation of Diabetic Patients
文章编号:
1006-1959（2020）23-0022-05
作者:
彭雅茗; 杨 艳; 周广举
（川北医学院附属医院内分泌科，四川 南充 637000）
Author(s):
PENG Ya-ming; YANG Yan; ZHOU Guang-ju
(Department of Endocrinology,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan,China)
关键词:
钠葡萄糖协同转运蛋白2抑制剂; 糖尿病; 骨密度; 骨代谢; 骨折; 截肢
Keywords:
Sodium-glucose cotransporter 2 inhibitor; Diabetesmellitus; Bone mineral density; Bonemetabolism; Fracture; Amputation
分类号:
R587.7
DOI:
10.3969/j.issn.1006-1959.2020.23.008
文献标志码:
A
摘要:
钠葡萄糖协同转运蛋白2（SGLT2）抑制剂是一种新型口服降血糖药物，其降糖机制是抑制SGLT2，减少葡萄糖的重吸收。研究发现，SGLT2抑制剂可能导致骨折、截肢风险增加。本文主要对SGLT2抑制剂对糖尿病患者骨代谢、骨密度、骨折、截肢的影响及其影响因素进行综述，旨在为高危患者的临床用药提供参考。
Abstract:
Sodium-glucose cotransporter 2 (SGLT2) inhibitor is a new type of oral hypoglycemic drug,its hypoglycemic mechanism is to inhibit SGLT2 and reduce glucose re-absorption. It has been reported that SGLT2 inhibitor may increase the risk of fracture and amputation.The present paper seeks to summarize relevantresearch on the effects and possible influencing factors of SGLT2 inhibitor on bone metabolism, bone mineral density, fracture and amputation in patients with diabetes mellitus,toprovide reference for clinical medication of high-risk patients.

参考文献/References:

[1]Ogurtsova K,da Rocha Fernandes JD,Huang Y,et al.IDF Diabetes Atlas:Global estimates for the prevalence of diabetes for 2015 and 2040[J].Diabetes Research and Clinical Practice,2017(128):40-50． [2]Matthews DR,Li Q,Perkovic V,et al.Effects of canagliflozin on amputation risk in type 2 diabetes:the CANVAS Program[J].Diabetologia,2019,62(6):926-938． [3]Neal B,Perkovic V,Mahaffey KW,et al.Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes[J].New England Journal of Medicine,2017,377(7):644-657． [4]Alba M,Xie J,Fung A,et al.The effects of canagliflozin,a sodium glucose co-transporter 2 inhibitor,on mineral metabolism and bone in patients with type 2 diabetes mellitus[J].Current Medical Research and Opinion,2016,32(8):1375-1385． [5]Vilaca T,Walsh J,Eastell R.Discordant pattern of peripheral fractures in diabetes:a meta-analysis on the risk of wrist and ankle fractures[J].Osteoporosis International,2019,30(1):135-143． [6]Gherman D,Dumitrescu CI,Ciocan A,et al.Histopathological changes in major amputations due to diabetic foot - a review[J].Romanian Journal of Morphology and Embryology,2018,59(3):699-702． [7]Kaneko M,Narukawa M.Effects of Sodium-glucose Cotransporter 2 Inhibitors on Amputation,Bone Fracture,and Cardiovascular Outcomes in Patients with Type 2 Diabetes Mellitus Using an Alternative Measure to the Hazard Ratio[J].Clinical Drug Investigation,2019,39(2):179-186． [8]Erythropoulou-Kaltsidou A,Polychronopoulos G,Tziomalos K.Sodium-Glucose Co-Transporter 2 Inhibitors and Fracture Risk[J].Diabetes Therapy,2020,11(1):7-14. [9]Katsiki N,Dimitriadis G,Hahalis G,et al.Sodium-glucose co-transporter-2 inhibitors(SGLT2i)use and risk of amputation:an expert panel overview of the evidence[J].Metabolism:Clinical and Experimental,2019(96):92-100. [10]Compston J.Type 2 diabetes mellitus and bone[J].Journal of Internal Medicine,2018,283(2):140-153． [11]Moayeri A,Mohamadpour M,Mousavi SF,et al.Fracture risk in patients with type 2 diabetes mellitus and possible risk factors:a systematic review and meta-analysis[J].Therapeutics and Clinical Risk Management,2017(13):455-468． [12]Yamamoto M,Yamaguchi T,Yamauchi M,et al．Diabetic patients have an increased risk of vertebral fractures independent of BMD or diabetic complications[J].Journal of Bone and Mineral Research,2009,24(4):702-709． [13]Wallander M,Axelsson KF,Nilsson AG,et al.Type 2 Diabetes and Risk of Hip Fractures and Non-Skeletal Fall Injuries in the Elderly:A Study From the Fractures and Fall Injuries in the Elderly Cohort(FRAILCO)[J].Journal of Bone and Mineral Research,2017,32(3):449-460． [14]Liu J,Cao L,Qian YW,et al.The association between risk of limb fracture and type 2 diabetes mellitus[J].Oncotarget,2018,9(58):31302-31310． [15]Ostergaard L,Finnerup NB,Terkelsen AJ,et al.The effects of capillary dysfunction on oxygen and glucose extraction in diabetic neuropathy[J].Diabetologia,2015,58(4):666-677． [16]Hicks CW,Selvin E.Epidemiology of Peripheral Neuropathy and Lower Extremity Disease in Diabetes[J].Current Diabetes Reports,2019,19(10):86． [17]Elgzyri T,Larsson J,Thorne J,et al.Outcome of ischemic foot ulcer in diabetic patients who had no invasive vascular intervention[J].European Journal of Vascular and Endovascular Surgery,2013,46(1):110-117. [18]Shin JY,Roh SG,Lee NH,et al.Influence of Epidemiologic and Patient Behavior-Related Predictors on Amputation Rates in Diabetic Patients:Systematic Review and Meta-Analysis[J].International Journal of Lower Extremity Wounds,2017,16(1):14-22． [19]Trujillo JM,Nuffer WA.Impact of Sodium-Glucose Cotransporter 2 Inhibitors on Nonglycemic Outcomes in Patients with Type 2 Diabetes[J].Pharmacotherapy,2017,37(4):481-491． [20]Taylor SI,Blau JE,Rother KI.Possible adverse effects of SGLT2 inhibitors on bone[J].The Lancet Diabetes&Endocrinology,2015,3(1):8-10． [21]Vinke JSJ,Heerspink HJL,de Borst MH.Effects of sodium glucose cotransporter 2 inhibitors on mineral metabolism in type 2 diabetes mellitus[J].Current Opinion in Nephrology and Hypertension,2019,28(4):321-327． [22]de Jong MA,Petrykiv SI,Laverman GD,et al.Effects of Dapagliflozin on Circulating Markers of Phosphate Homeostasis[J].Clinical Journal of the American Society of Nephrology,2019,14(1):66-73． [23]Blevins TC,Farooki A.Bone effects of canagliflozin,a sodium glucose co-transporter 2 inhibitor,in patients with type 2 diabetes mellitus[J].Postgraduate Medicine,2017,129(1):159-168. [24]Thrailkill KM,Nyman JS,Bunn RC,et al.The impact of SGLT2 inhibitors, compared with insulin,on diabetic bone disease in a mouse model of type 1 diabetes[J].Bone,2017(94):141-151. [25]Yabe D,Yasui A,Ji L,et al.Safety and tolerability of empagliflozin in East Asian patients with type 2 diabetes:Pooled analysis of phase I-III clinical trials[J].J Diabetes Investig,2019,10(2):418-428． [26]Schwartz AV,Johnson KC,Kahn SE,et al.Effect of 1 year of an intentional weight loss intervention on bone mineral density in type 2 diabetes:results from the Look AHEAD randomized trial[J].Journal of Bone and Mineral Research,2012,27(3):619-627． [27]Bilezikian JP,Watts NB,Usiskin K,et al．Evaluation of Bone Mineral Density and Bone Biomarkers in Patients With Type 2 Diabetes Treated With Canagliflozin[J].Journal of Clinical Endocrinology and Metabolism,2016,101(1):44-51． [28]Thrailkill KM,Bunn RC,Uppuganti S,et al.Genetic ablation of SGLT2 function in mice impairs tissue mineral density but does not affect fracture resistance of bone[J].Bone,2020(133):115254． [29]Bolinder J,Ljunggren O,Johansson L,et al.Dapagliflozin maintains glycaemic control while reducing weight and body fat mass over 2 years in patients with type 2 diabetes mellitus inadequately controlled on metformin[J].Diabetes,Obesity&Metabolism,2014,16(2):159-169. [30]Rosenstock J,Frias J,Pall D,et al.Effect of ertugliflozin on glucose control,body weight,blood pressure and bone density in type 2 diabetes mellitus inadequately controlled on metformin monotherapy(VERTIS MET)[J].Diabetes,Obesity&Metabolism,2018,20(3):520-529. [31]Zhou Z,Jardine M,Perkovic V,et al.Canagliflozin and fracture risk in individuals with type 2 diabetes:results from the CANVAS Program[J].Diabetologia,2019,62(10):1854-1867． [32]Watts NB,Bilezikian JP,Usiskin K,et al.Effects of Canagliflozin on Fracture Risk in Patients With Type 2 Diabetes Mellitus[J].Journal of Clinical Endocrinology and Metabolism,2016,101(1):157-166． [33]Perkovic V,Jardine MJ,Neal B,et al.Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy[J].New England Journal of Medicine,2019,380(24):2295-2306． [34]Zinman B,Wanner C,Lachin JM,et al.Empagliflozin, Cardiovascular Outcomes,and Mortality in Type 2 Diabetes[J].New England Journal of Medicine,2015,373(22):2117-2128． [35]Monteiro P,Bergenstal RM,Toural E,et al.Efficacy and safety of empagliflozin in older patients in the EMPA-REG OUTCOME(R) trial[J].Age and Ageing,2019,48(6):859-866. [36]Wiviott SD,Raz I,Bonaca MP,et al.Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes[J].New England Journal of Medicine,2019,380(4):347-357. [37]Toulis KA,Bilezikian JP,Thomas GN,et al.Initiation of dapagliflozin and treatment-emergent fractures[J].Diabetes,Obesity&Metabolism,2018,20(4):1070-1074． [38]Kashiwagi A,Shestakova MV,Ito Y,et al.Safety of Ipragliflozin in Patients with Type 2 Diabetes Mellitus:Pooled Analysis of Phase II/III/IV Clinical Trials[J].Diabetes Therapy,2019,10(6):2201-2217． [39]Cheng L,Li YY,Hu W,et al.Risk of bone fracture associated with sodium-glucose cotransporter-2 inhibitor treatment:A meta-analysis of randomized controlled trials[J].Diabetes and Metabolism,2019,45(5):436-445． [40]Tang HL,Li DD,Zhang JJ,et al.Lack of evidence for a harmful effect of sodium-glucose co-transporter 2(SGLT2)inhibitors on fracture risk among type 2 diabetes patients:a network and cumulative meta-analysis of randomized controlled trials[J].Diabetes, Obesity&Metabolism,2016,18(12):1199-1206． [41]Donnan JR,Grandy CA,Chibrikov E,et al.Comparative safety of the sodium glucose co-transporter 2(SGLT2)inhibitors:a systematic review and meta-analysis[J].BMJ Open,2019,9(1):e022577． [42]Ruanpeng D,Ungprasert P,Sangtian J,et al.Sodium-glucose cotransporter 2(SGLT2)inhibitors and fracture risk in patients with type 2 diabetes mellitus:A meta-analysis[J].Diabetes/Metabolism Research and Reviews,2017,33(6). [43]Fralick M,Kim SC,Schneeweiss S,et al.Fracture Risk After Initiation of Use of Canagliflozin:A Cohort Study[J].Annals of Internal Medicine,2019,170(3):155-163． [44]Leon Jimenez D,Lopez Chozas JM,Espino Montoro A,et al.Could renin-angiotensin-aldosterone system activation explain the amputations associated with canagliflozin?The nitric oxide hypothesis[J].Diabetes Research and Clinical Practice,2019(148):10-13. [45]Behnammanesh G,Durante ZE,Peyton KJ,et al.Canagliflozin Inhibits Human Endothelial Cell Proliferation and Tube Formation[J].Frontiers in Pharmacology,2019(10):362． [46]Khouri C,Cracowski JL,Roustit M.SGLT-2 inhibitors and the risk of lower-limb amputation:Is this a class effect[J].Diabetes, Obesity&Metabolism,2018,20(6):1531-1534． [47]Tanaka A,Node K.Increased amputation risk with canagliflozin treatment:behind the large cardiovascular benefit[J].Cardiovascular Diabetology,2017,16(1):129． [48]Chang HY,Singh S,Mansour O,et al.Association Between Sodium-Glucose Cotransporter 2 Inhibitors and Lower Extremity Amputation Among Patients With Type 2 Diabetes[J].JAMA Intern Med,2018,178(9):1190-1198． [49]Yang JY,Wang T,Pate V,et al.Sodium-glucose co-transporter-2 inhibitor use and risk of lower-extremity amputation:Evolving questions,evolving answers[J].Diabetes,Obesity&Metabolism,2019,21(5):1223-1236． [50]Ueda P,Svanstrom H,Melbye M,et al.Sodium glucose cotransporter 2 inhibitors and risk of serious adverse events:nationwide register based cohort study[J].BMJ,2018(363):k4365． [51]Sung J,Padmanabhan S,Gurung S,et al.SGLT2 inhibitors and amputation risk:Real-world data from a diabetes foot wound clinic[J].J Clin Transl Endocrinol,2018(13):46-47. [52]Dawwas GK,Smith SM,Park H.Cardiovascular outcomes of sodium glucose cotransporter-2 inhibitors in patients with type 2 diabetes[J].Diabetes,Obesity&Metabolism,2019,21(1):28-36． [53]Udell JA,Yuan Z,Ryan P,et al.Cardiovascular outcomes and mortality after initiation of canagliflozin:Analyses from the EASEL Study[J].Endocrinol Diabetes Metab,2020,3(1):e00096． [54]Ryan PB,Buse JB,Schuemie MJ,et al.Comparative effectiveness of canagliflozin,SGLT2 inhibitors and non-SGLT2 inhibitors on the risk of hospitalization for heart failure and amputation in patients with type 2 diabetes mellitus:A real-world meta-analysis of 4 observational databases(OBSERVE-4D[J].Diabetes, Obesity&Metabolism,2018,20(11):2585-2597. [55]Yuan Z,DeFalco FJ,Ryan PB,et al.Risk of lower extremity amputations in people with type 2 diabetes mellitus treated with sodium-glucose co-transporter-2 inhibitors in the USA:A retrospective cohort study[J].Diabetes,Obesity&Metabolism,2018,20(3):582-589. [56]Jabbour S,Seufert J,Scheen A,et al.Dapagliflozin in patients with type 2 diabetes mellitus:A pooled analysis of safety data from phase IIb/III clinical trials[J].Diabetes, Obesity&Metabolism,2018,20(3):620-628． [57]Inzucchi SE,Iliev H,Pfarr E,et al.Empagliflozin and Assessment of Lower-Limb Amputations in the EMPA-REG OUTCOME Trial[J].Diabetes Care,2018,41(1):e4-e5． [58]Li D,Yang JY,Wang T,et al.Risks of diabetic foot syndrome and amputation associated with sodium glucose co-transporter 2 inhibitors:A Meta-analysis of Randomized Controlled Trials[J].Diabetes and Metabolism,2018,44(5):410-414. [59]Papadokostaki E,Rizos E,Tigas S,et al.Canagliflozin and Amputation Risk:Evidence So Far[J].International Journal of Lower Extremity Wounds,2020,19(1):21-26．

相似文献/References:

[1]张西园.糖尿病与结直肠癌患者预后相关研究进展[J].医学信息,2018,31(01):55.[doi:10.3969/j.issn.1006-1959.2018.01.020]
　ZHANG Xi-yuan.Research Progress in the Relationship between Diabetes and the Prognosis of Colorectal Cancer[J].Medical Information,2018,31(23):55.[doi:10.3969/j.issn.1006-1959.2018.01.020]
[2]耿金萍.综合护理对甲状腺良性肿瘤并糖尿病患者手术效果的影响分析[J].医学信息,2018,31(01):163.[doi:10.3969/j.issn.1006-1959.2018.01.064]
　GENG Jin-ping.Analysis of the Effect of Comprehensive Nursing on the Surgical Effect of Thyroid Benign Tumor and Diabetic Patients[J].Medical Information,2018,31(23):163.[doi:10.3969/j.issn.1006-1959.2018.01.064]
[3]李雯婷,谈世华,余江明,等.踝肱指数检测在住院糖尿病患者中的重复性研究[J].医学信息,2018,31(03):159.[doi:10.3969/j.issn.1006-1959.2018.03.058]
　LI Wen-ting,TAN Shi-hua,YU Jiang-ming,et al.Study on Reproducibility of Ankle-brachial Index in Inpatients with Diabetes Mellitus[J].Medical Information,2018,31(23):159.[doi:10.3969/j.issn.1006-1959.2018.03.058]
[4]刘 静.冠状动脉粥样硬化性心脏病合并糖尿病的血脂检验结果分析[J].医学信息,2018,31(04):154.[doi:10.3969/j.issn.1006-1959.2018.04.057]
　LIU Jing.Analysis of Blood Lipid Test Results in Coronary Atherosclerotic Heart Disease Complicated with Diabetes Mellitus[J].Medical Information,2018,31(23):154.[doi:10.3969/j.issn.1006-1959.2018.04.057]
[5]谢勇丽,苏晓清,张雅薇.糖尿病痛性周围神经病变患者情绪调查分析[J].医学信息,2018,31(05):14.[doi:10.3969/j.issn.1006-1959.2018.05.005]
　XIE Yong-li,SU Xiao-qing,ZHANG Ya-wei.Investigation and Analysis of Mood in Patients with Diabetic Peripheral Neuropathy[J].Medical Information,2018,31(23):14.[doi:10.3969/j.issn.1006-1959.2018.05.005]
[6]张雅薇,朱明慧.首发为动眼神经麻痹的糖尿病合并动眼神经麻痹误诊为痛性眼肌麻痹1例分析[J].医学信息,2018,31(05):23.[doi:10.3969/j.issn.1006-1959.2018.05.008]
　ZHANG Ya-wei,ZHU Ming-hui.An Analysis of a Case of Diabetes Mellitus with Oculomotor Nerve Palsy Misdiagnosed as Painful Ophthalmoplegia[J].Medical Information,2018,31(23):23.[doi:10.3969/j.issn.1006-1959.2018.05.008]
[7]张宇宁.黄酮类化合物治疗糖尿病及其并发症的研究[J].医学信息,2018,31(05):50.[doi:10.3969/j.issn.1006-1959.2018.05.018]
　ZHANG Yu-ning.Study on Flavonoids in the Treatment of Diabetes Mellitus and its Complications[J].Medical Information,2018,31(23):50.[doi:10.3969/j.issn.1006-1959.2018.05.018]
[8]柳 梅.头孢哌酮钠舒巴坦钠治疗糖尿病并发尿路感染的 临床效果观察[J].医学信息,2018,31(07):139.[doi:10.3969/j.issn.1006-1959.2018.07.047]
　LIU Mei.Clinical Efficacy of Cefoperazone Sodium and Sulbactam Sodium in Treatment of Diabetes Complicated with Urinary Tract Infection[J].Medical Information,2018,31(23):139.[doi:10.3969/j.issn.1006-1959.2018.07.047]
[9]吕桂英.影响糖尿病患者药物治疗依从性相关因素临床分析[J].医学信息,2018,31(08):109.[doi:10.3969/j.issn.1006-1959.2018.08.036]
　LV Gui-ying.Clinical Analysis of Factors Related to Compliance with Drug Therapy in Patients with Diabetes Mellitus[J].Medical Information,2018,31(23):109.[doi:10.3969/j.issn.1006-1959.2018.08.036]
[10]刘爱君.糖化血红蛋白测定在糖尿病诊断中的应用价值分析[J].医学信息,2018,31(08):161.[doi:10.3969/j.issn.1006-1959.2018.08.057]
　LIU Ai-jun.Analysis of the Value of Determination of Glycosylated Hemoglobin in the Diagnosis of Diabetes Mellitus[J].Medical Information,2018,31(23):161.[doi:10.3969/j.issn.1006-1959.2018.08.057]

更新日期/Last Update: 1900-01-01