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Role of sodium-glucose co-transporter-2 inhibitors in the management of nonalcoholic fatty liver disease

World Journal of Gastroenterology 2019年第28期25卷 3664-3668页

作者： Anastasia Kontana Konstantinos Tziomalos First Propedeutic Department of Internal Medicine Medical School Aristotle University of Thessaloniki AHEPA Hospital

Nonalcoholic fatty liver disease (NAFLD) is the most prevalent cause of chronic liver disease worldwide. NAFLD is considerably more frequent in patients with type 2 diabetes mellitus (T2DM) than in the general population and is also more severe histologically in this group. Sodium-glucose co-transporter-2 (SGLT2) inhibitors, the newest class of antidiabetic agents, appear to represent a promising option for the management of NAFLD in patients with T2DM. In a number of studies, treatment with SGLT2 inhibitors resulted in a reduction in hepatic steatosis and in transaminase levels. However, existing studies are small, their follow-up period was short and none evaluated the effects of SGLT2 inhibitors on liver histology. Accordingly, larger studies are needed to verify these preliminary results and define the role of SGLT2 inhibitors in the treatment of NAFLD in patients with T2DM.

关键词： Nonalcoholic fatty liver disease Type 2 diabetes mellitus Sodium-glucose co-transporter-2 inhibitors Steatosis Fibrosis Transaminases

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Using real world data to assess cardiovascular outcomes of two antidiabetic treatment classes

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World Journal of Diabetes 2018年第12期9卷 252-257页

作者： Manfred Paul Stapff CMO TriNetX Inc.

AIM To evaluate the effect on cardiovascular outcomes of sodium-glucose co-transporter-2(SGLT2) inhibitors in a real world setting by analyzing electronic medical records.METHODS We used Tri Net X, a global federated research network providing statistics on electronic health records(EHR). The analytics subset contained EHR from approximately 38 Million patients in 35 Health Care Organizations in the United States. The records of 46,909 patients who had taken SGLT2 inhibitors were compared to 189,120 patients with dipeptidyl peptidase(DPP) 4 inhibitors. We identified five potential confounding factors and built respective strata: elderly, hypertension, chronic kidney disease(CKD), and co-medication with either insulin or metformin. Cardiovascular events were countedas stroke(ICD10 code: I63) or myocardial infarction(ICD10: I21) occurring within three years after the first instance of the respective medication in the patients' records.RESULTS Of the 46909 patients with SGLT2 inhibitors in their EHR, 1667 patients(3.6%) had an ICD code for stroke or for myocardial infarction within the first three years after the first instance of the medication. In the control group, there were 10680 events of 189120 patients(5.6%), which represents a risk ratio of 0.63(95%CI: 0.60-0.66). The overall incidence of stroke or myocardial infarction in the strata with a potential confounding risk factor reached from 4.9% in patients taking metformin to 12.5% in the stratum with the highest risk(concomitant CKD). In all strata, the difference in risk of experiencing a cardiovascular event was similarly in favor of SGLT2 vs control, with Risk Ratio ranging from 0.62 to 0.81.coNCLUSION Real world data replicated the results from randomized clinical trials, confirmed the cardiovascular advantages of SGLT2 inhibitors, and showed its applicability to the US population.

关键词： Sodium-glucose co-transporter-2 inhibitors Cardiovascular events Clinical trials Electronic medical records Dipeptidyl peptidase 4 inhibitors Real world evidence Diabetes

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