Sodium-glucose co-transporter 2 inhibitor: Cardiorenal benefit, bone metabolism, and fracture risk in type 2 diabetes mellitus / 中华内分泌代谢杂志

ABSTRACT

Type 2 diabetes mellitus is commonly associated with cardiovascular, renal complications, osteoporosis and other comorbidities. Sodium-glucose co-transporter 2 inhibitor (SGLT-2i) can reduce blood glucose level in patients with type 2 diabetes mellitus by promoting urine glucose excretion, and has the effect of weight loss and blood pressure reduction. Large randomized controlled clinical trials have shown that SGLT-2i can improve the prognosis of cardiovascular disease and diabetic nephropathy. This article focuses on the effects of SGLT-2i on cardiorenal outcomes and bone metabolism in addition to the glucose-lowering effect. SGLT-2i can improve the prognosis of patients with coronary atherosclerotic cardiovascular disease, reduce the risk of hospitalization for heart failure, reduce cardiovascular diseases and all-cause mortality, and has renal protective effect. Moreover, the cardiorenal protective effect is proved to be consistent in people without type 2 diabetes. SGLT-2i has a regulatory effect on bone mineral ions and bone metabolism related hormones, and its risk of osteoporosis and fracture deserves attention. Although data suggest that canagliflozin may increase fracture risk, meta-analyses of multiple clinical trials have concluded that SGLT-2i does not significantly increase fracture risk. However, for patients with high risk of fracture, bone mineral density and bone turnover biomarkers should be considered to assess the risk of fracture before prescription.