Ação dos isglt2 no hipertenso diabético, quando indicar? / Effect of sglt-2 inhibitor in diabetic hypertensive patients, when to indicate?

A doença cardiovascular (DCV) representa um fardo individual e social em pacientes com diabetes mellitus tipo 2 (DM2). A diabetes é uma doença crônica onerosa do ponto de vista social e econômico. O seu tratamento inclui medidas não farmacológicas, como dieta e exercício físico, bem como a adição de medicamentos em pacientes que não atingem controle glicêmico satisfatório através de medidas comportamentais. Medicamentos da classe inibidores de SGLT2 (iSGLT2), objeto deste manuscrito, têm sido associados com a redução de eventos cardiovasculares e mortalidade, além de redução da pressão arterial e peso, sem conferir aumento de risco de hipoglicemia

Cardiovascular disease (CVD) represents an individual and social burden in patients with type 2 diabetes mellitus (T2DM). Diabetes is a chronic, socially and economically costly disease. Its treatment includes non-pharmacological measures, such as diet and exercise, as well as the addition of medication in patients who do not achieve satisfactory glycemic control through behavioral approach. Drugs as SGLT2 inhibitor (SGLT2i), object of this manuscript, have been associated with a reduction in cardiovascular events and mortality, in addition to a reduction in blood pressure and weight, without increasing the risk of hypoglycemia.

Efficacy and safety of sodium-glucose cotransporter-2 inhibitors in type 2 diabetes mellitus with inadequate glycemic control on metformin: a meta-analysis

ABSTRACT Objectives To provide a meta-analysis of the clinical efficacy and safety of sodium glucose co-transporter 2 inhibitors (SGLT2-i), as a combination treatment with metformin in type 2 diabetes mellitus (T2DM) patients with inadequate glycemic control with metformin alone. Materials and methods We have searched randomized controlled trials (RCTs) in the database: MEDLINE, Embase and Cochrane Collaborative database. We used mean differences (MD) to assess the efficacy of glycemic and other clinical parameters, and risk ratios (RR) to evaluate the adverse events for safety endpoints. The heterogeneity was evaluated by I2. Results Finally 9 studies were included. SGLT2-i plus metformin had higher reduction level in HbA1C [MD = -0.50, 95% CI (-0.62, -0.38), p < 0.00001], FPG [MD = -1.12, 95%CI (-1.38, -0.87), p < 0.00001], body weight [MD = -1.72, 95% CI (-2.05, -1.39), p < 0.00001], SBP [MD = -4.44, 95% CI (-5.45, -3.43), p < 0.00001] and DBP [MD = -1.74, 95% CI (-2.40, -1.07), p < 0.00001] compared with metformin monotherapy. However, SGLT2-i plus metformin group had higher risk of genital infection [RR = 3.98, 95% CI (2.38, 6.67), p < 0.00001]. No significant difference was found in the risk of hypoglycemia, urinary tract infection or volume related adverse events. Conclusions Although the risk of genital infection may increase, SGLT2-i plus metformin may provide an attractive treatment option to those T2DM patients who are unable to achieve glycemic control with metformin alone, based on its effects on glycemic control, reducing body weight and lowering blood pressure.