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Roy M, Parveen R, Khan P, Majid H, Pathak M, Saxena R, Nidhi. A systematic review on effect of sodium-glucose cotransporter-2 inhibitors on the metabolic and endocrinological profile of patients with polycystic ovarian syndrome. Expert Opin Pharmacother 2024:1-8. [PMID: 39312193 DOI: 10.1080/14656566.2024.2407513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 09/18/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Polycystic ovarian syndrome (PCOS) has been a common metabolic and endocrinal disorder, prevalent amongst women belonging to the reproductive age group. The aim of this systematic review was to assess the safety and efficacy profile of sodium-glucose cotransporter 2 (SGLT2) inhibitors (Canagliflozin, Dapagliflozin, Empagliflozin, and Licogliflozin) for the treatment of women suffering from PCOS. METHODS A literature search in PubMed, Science Direct, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov was conducted for randomized clinical trials of SGLT-2 inhibitors in PCOS patients by applying predetermined inclusion and exclusion criteria. The articles in English language were included. RESULTS Four randomized controlled trials including 146 subjects were included in the review. The clinical studies indicated a significant decrease in the levels of total testosterone, free androgen index, total body fat, homeostasis model assessment-estimated insulin resistance (HOMA-IR), body mass index (BMI), dehydroepiandrosterone sulfate (DHEAS) and fasting plasma glucose (FPG). However, no significant difference was reported in levels of sex hormone-binding globulin (SHBG). Overall, there was improvement in metabolic and endocrine profiles, suggesting a potentially beneficial impact of SGLT2 inhibitors in the management of PCOS. CONCLUSION There is a requirement for large extensive clinical trials to demonstrate the efficacy of SGLT-2 inhibitors in PCOS patients.
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Affiliation(s)
- Madhura Roy
- Department of Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
| | - Rizwana Parveen
- Department of Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
| | - Parvej Khan
- Department of Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
| | - Haya Majid
- Department of Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
| | - Mani Pathak
- Department of Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
| | - Rajesh Saxena
- Department of Clinical Research, Max Super Specialty Hospital, New Delhi, India
| | - Nidhi
- Department of Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, India
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Lin R, Yan W, He M, Liu B, Su X, Yi M, Zhang Y. The benefits of hypoglycemic therapy for patients with obstructive sleep apnea. Sleep Breath 2024; 28:1355-1363. [PMID: 38489146 DOI: 10.1007/s11325-024-03015-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is often associated with glycemic abnormalities. This study is conducted to investigate the effects of hypoglycemic therapy on OSA-related indicators. METHOD We systematically searched Web of Science, PubMed, Embase, and the Cochrane Library for articles on OSA patients receiving any hypoglycemic drugs, published until December 25, 2022. Seven original studies were finally included. The proposal was registered with PROSPERO (CRD42022351206). RESULTS In summary, in addition to reduced glycosylated hemoglobin A1c (HbA1c), we found that hypoglycemic treatment can lower the apnea-hypopnea index (AHI) by 7.07/h (p = 0.0001). Although long-term treatment (> 12 weeks) achieved a more significant reduction in HbA1c (- 1.57% vs. - 0.30%) compared to short-term treatment (≤ 12 weeks), there was no significant difference between the two in terms of AHI (intergroup p-value = 0.27). We also found that patients using sodium glucose cotransporter 2 inhibitors (SGLT2i) experienced a greater reduction in AHI (- 11.00/h, p < 0.00001). Additionally, hypoglycemic treatment also showed certain improvements in related indicators like Epworth Sleepiness Scale, body mass index, and blood pressure. CONCLUSIONS Our results affirm the benefits of hypoglycemic treatment for OSA patients and highlight the notable effect of SGLT2i. Further researches are needed to help doctors gain a comprehensive understanding of the interaction between OSA and glycemic abnormalities.
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Affiliation(s)
- Ruihan Lin
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Xiangya Medical School, Central South University, Changsha, China
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wenjie Yan
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Xiangya Medical School, Central South University, Changsha, China
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Meng He
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Bin Liu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoli Su
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
| | - Minhan Yi
- School of Life Sciences, Central South University, Changsha, China.
| | - Yuan Zhang
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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Mondal S, Pramanik S, Khare VR, Fernandez CJ, Pappachan JM. Sodium glucose cotransporter-2 inhibitors and heart disease: Current perspectives. World J Cardiol 2024; 16:240-259. [PMID: 38817648 PMCID: PMC11135334 DOI: 10.4330/wjc.v16.i5.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 04/08/2024] [Accepted: 04/28/2024] [Indexed: 05/23/2024] Open
Abstract
Sodium glucose cotransporter-2 inhibitors (SGLT-2i) are antidiabetic medications with remarkable cardiovascular (CV) benefits proven by multiple randomised controlled trials and real-world data. These drugs are also useful in the prevention of CV disease (CVD) in patients with diabetes mellitus (DM). Although DM as such is a huge risk factor for CVD, the CV benefits of SGLT-2i are not just because of antidiabetic effects. These molecules have proven beneficial roles in prevention and management of nondiabetic CVD and renal disease as well. There are various molecular mechanisms for the organ protective effects of SGLT-2i which are still being elucidated. Proper understanding of the role of SGLT-2i in prevention and management of CVD is important not only for the cardiologists but also for other specialists caring for various illnesses which can directly or indirectly impact care of heart diseases. This clinical review compiles the current evidence on the rational use of SGLT-2i in clinical practice.
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Affiliation(s)
- Sunetra Mondal
- Department of Endocrinology, NRS Medical College, Kolkata 700020, West Bengal, India
| | - Subhodip Pramanik
- Department of Endocrinology, Neotia Getwel Multispecialty Hospitals, Siliguri 734010, West Bengal, India
| | - Vibhu Ranjan Khare
- Department of Endocrinology, NRS Medical College, Kolkata 700020, West Bengal, India
| | - Cornelius James Fernandez
- Department of Endocrinology and Metabolism, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston PE21 9QS, United Kingdom
| | - Joseph M Pappachan
- Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
- Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
- Faculty of Biology, Medicine & Health, The University of Manchester, Manchester M13 9PL, United Kingdom.
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4
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Xie L, Li S, Yu X, Wei Q, Yu F, Tong J. DAHOS Study: Efficacy of dapagliflozin in treating heart failure with reduced ejection fraction and obstructive sleep apnea syndrome - A 3-month, multicenter, randomized controlled clinical trial. Eur J Clin Pharmacol 2024; 80:771-780. [PMID: 38386021 DOI: 10.1007/s00228-024-03643-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 02/02/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND The recent discovery of new therapeutic approaches to heart failure with reduced ejection fraction (HFrEF), including sodium-glucose cotransporter-2 (SGLT-2) inhibitors, as well as improved treatment of co-morbidities has provided much needed help to HFrEF. In addition, dapagliflozin, one of the SGLT-2 inhibitors, serves as a promising candidate in treating obstructive sleep apnea (OSA) of HFrEF patients due to its likely mechanism of countering the pathophysiology of OSA of HFrEF. METHODS This 3-month multicenter, prospective, randomized controlled trial enrolled participants with left ventricular ejection fraction (LVEF) less than 40% and apnea-hypopnea index (AHI) greater than 15. Participants were randomized into two groups: the treatment group received optimized heart failure treatment and standard-dose dapagliflozin, while the control group only received optimized heart failure treatment. The primary endpoint was the difference in AHI before and after treatment between the two groups. Secondary endpoints included oxygen desaturation index (ODI), minimum oxygen saturation, longest apnea duration, inflammatory factors (CRP, IL-6), quality of life score, and LVEF. RESULTS A total of 107 patients were included in the final analysis. AHI, LVEF and other baseline data were similar for the dapagliflozin and control groups. After 12 weeks of dapagliflozin treatment, the dapagliflozin group showed significant improvements in sleep parameters including AHI, HI, longest pause time, ODI, time spent with SpO2 < 90%, and average SpO2. Meanwhile, the control group showed no significant changes in sleep parameters, but did demonstrate significant improvements in left ventricular end-diastolic diameter, LVEF, and NT-proBNP levels at 12 weeks. In the experimental group, BMI was significantly reduced, and there were improvements in ESS score, MLHFQ score, and EQ-5D-3L score, as well as significant reductions in CRP and IL-6 levels, while the CRP and IL-6 levels were not improved in the control group. The decrease in LVEF was more significant in the experimental group compared to the control group. There were no significant differences in the magnitude of the decreases between the two groups. CONCLUSIONS Dapagliflozin may be an effective treatment for heart failure complicated with OSA, and could be considered as a potential new treatment for OSA. (Trial registration www.chictr.org.cn , ChiCTR2100049834. Registered 10 August 2021).
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Affiliation(s)
- Liang Xie
- Department of Cardiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Shengnan Li
- School of Medicine, Southeast University, Nanjing, China
| | - Xiaojin Yu
- School of Medicine, Southeast University, Nanjing, China
| | - Qin Wei
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Fuchao Yu
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jiayi Tong
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
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Armentaro G, Pelaia C, Condoleo V, Severini G, Crudo G, De Marco M, Pastura CA, Tallarico V, Pezzella R, Aiello D, Miceli S, Maio R, Savarese G, Rosano GMC, Sciacqua A. Effect of SGLT2-Inhibitors on Polygraphic Parameters in Elderly Patients Affected by Heart Failure, Type 2 Diabetes Mellitus, and Sleep Apnea. Biomedicines 2024; 12:937. [PMID: 38790899 PMCID: PMC11117816 DOI: 10.3390/biomedicines12050937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/12/2024] [Accepted: 04/17/2024] [Indexed: 05/26/2024] Open
Abstract
Obstructive sleep apneas (OSAs) and central sleep apneas (CSAs) are the most common comorbidities in Heart Failure (HF) that are strongly associated with all-cause mortality. Several therapeutic approaches have been used to treat CSA and OSA, but none have been shown to significantly improve HF prognosis. Our study evaluated the effects of a 3-months treatment with sodium-glucose cotransporter type 2 inhibitor (SGLT2i) on polygraphic parameters in patients with sleep apnea (SA) and HF, across the spectrum of ejection fraction, not treated with continuous positive air pressure (CPAP). A group of 514 consecutive elderly outpatients with HF, type 2 diabetes mellitus (T2DM) and SA, eligible for treatment with SGLT2i, were included in the investigation before starting any CPAP therapy. The two groups were compared with the t-test and Mann-Whitney test for unpaired data when appropriate. Then, a simple logistic regression model was built using 50% reduction in AHI as the dependent variable and other variables as covariates. A multivariate stepwise logistic regression model was constructed using the variables that linked with the dependent variable to calculate the odds ratio (OR) for the independent predictors associated with the reduction of 50% in AHI. The treated group experienced significant improvements in polygraphic parameters between baseline values and follow-up with reduction in AHI (28.4 ± 12.9 e/h vs. 15.2 ± 6.5 e/h; p < 0.0001), ODI (15.4 ± 3.3 e/h vs. 11.1 ± 2.6 e/h; p < 0.0001), and TC90 (14.1 ± 4.2% vs. 8.2 ± 2.0%; p < 0.0001), while mean SpO2 improved (91. 3 ± 2.3 vs. 93.8 ± 2.5); p < 0.0001. These benefits were not seen in the untreated population. The use of SGLT2i in patients suffering from HF and mixed-type SA not on CPAP therapy significantly contributes to improving polygraphic parameters.
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Affiliation(s)
- Giuseppe Armentaro
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Campus Universitario “S. Venuta”, Viale Europa—Località Germaneto, 88100 Catanzaro, Italy; (G.A.); (C.P.); (V.C.); (G.S.); (G.C.); (M.D.M.); (C.A.P.); (S.M.); (R.M.)
| | - Corrado Pelaia
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Campus Universitario “S. Venuta”, Viale Europa—Località Germaneto, 88100 Catanzaro, Italy; (G.A.); (C.P.); (V.C.); (G.S.); (G.C.); (M.D.M.); (C.A.P.); (S.M.); (R.M.)
| | - Valentino Condoleo
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Campus Universitario “S. Venuta”, Viale Europa—Località Germaneto, 88100 Catanzaro, Italy; (G.A.); (C.P.); (V.C.); (G.S.); (G.C.); (M.D.M.); (C.A.P.); (S.M.); (R.M.)
| | - Giandomenico Severini
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Campus Universitario “S. Venuta”, Viale Europa—Località Germaneto, 88100 Catanzaro, Italy; (G.A.); (C.P.); (V.C.); (G.S.); (G.C.); (M.D.M.); (C.A.P.); (S.M.); (R.M.)
| | - Giulia Crudo
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Campus Universitario “S. Venuta”, Viale Europa—Località Germaneto, 88100 Catanzaro, Italy; (G.A.); (C.P.); (V.C.); (G.S.); (G.C.); (M.D.M.); (C.A.P.); (S.M.); (R.M.)
| | - Mario De Marco
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Campus Universitario “S. Venuta”, Viale Europa—Località Germaneto, 88100 Catanzaro, Italy; (G.A.); (C.P.); (V.C.); (G.S.); (G.C.); (M.D.M.); (C.A.P.); (S.M.); (R.M.)
| | - Carlo Alberto Pastura
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Campus Universitario “S. Venuta”, Viale Europa—Località Germaneto, 88100 Catanzaro, Italy; (G.A.); (C.P.); (V.C.); (G.S.); (G.C.); (M.D.M.); (C.A.P.); (S.M.); (R.M.)
| | | | - Rita Pezzella
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy;
| | - Domenico Aiello
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, 88100 Catanzaro, Italy;
| | - Sofia Miceli
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Campus Universitario “S. Venuta”, Viale Europa—Località Germaneto, 88100 Catanzaro, Italy; (G.A.); (C.P.); (V.C.); (G.S.); (G.C.); (M.D.M.); (C.A.P.); (S.M.); (R.M.)
| | - Raffaele Maio
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Campus Universitario “S. Venuta”, Viale Europa—Località Germaneto, 88100 Catanzaro, Italy; (G.A.); (C.P.); (V.C.); (G.S.); (G.C.); (M.D.M.); (C.A.P.); (S.M.); (R.M.)
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden;
| | - Giuseppe M. C. Rosano
- Department of Human Sciences and Promotion of Quality of Life, Chair of Pharmacology, San Raffaele University of Rome, 00166 Rome, Italy;
- Cardiology, San Raffaele Cassino Hospital, 03043 Cassino, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University “Magna Græcia” of Catanzaro, Campus Universitario “S. Venuta”, Viale Europa—Località Germaneto, 88100 Catanzaro, Italy; (G.A.); (C.P.); (V.C.); (G.S.); (G.C.); (M.D.M.); (C.A.P.); (S.M.); (R.M.)
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Polecka A, Olszewska N, Danielski Ł, Olszewska E. Association between Obstructive Sleep Apnea and Heart Failure in Adults-A Systematic Review. J Clin Med 2023; 12:6139. [PMID: 37834783 PMCID: PMC10573908 DOI: 10.3390/jcm12196139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Heart failure (HF) patients commonly experience obstructive sleep apnea (OSA), which may worsen their condition. We reviewed a diverse range of studies to investigate the prevalence of OSA in HF patients, the effects of positive airway pressure (PAP) treatment, and the potential impact of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and sacubitril/valsartan on OSA outcomes. METHODS We analyzed case-control, observational studies, and randomized controlled trials. Prevalence rates, PAP treatment, and HF pharmacotherapy were assessed. RESULTS Numerous studies revealed a high prevalence of OSA in HF patients, particularly with preserved ejection fraction. PAP treatment consistently improved an apnea-hypopnea index, left ventricular ejection fraction, oxygen saturation, and overall quality of life. Emerging evidence suggests that SGLT2i and sacubitril/valsartan might influence OSA outcomes through weight loss, improved metabolic profiles, and potential direct effects on upper airway muscles. CONCLUSIONS The complex interplay between OSA and HF necessitates a multifaceted approach. PAP treatment has shown promising results in improving OSA symptoms and HF parameters. Additionally, recent investigations into the effects of HF pharmacotherapy on OSA suggest their potential as adjunctive therapy. This review provides insights for clinicians and researchers, highlighting the importance of addressing OSA and HF in patient management strategies.
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Affiliation(s)
- Agnieszka Polecka
- Doctoral School of the Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Natalia Olszewska
- Student Research Group, Department of Otolaryngology, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Łukasz Danielski
- Student Research Group, Department of Otolaryngology, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Ewa Olszewska
- Sleep Apnea Surgery Center, Department of Otolaryngology, Medical University of Bialystok, 15-089 Bialystok, Poland
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Salmen T, Rizvi AA, Rizzo M, Pietrosel VA, Bica IC, Diaconu CT, Potcovaru CG, Salmen BM, Coman OA, Bobircă A, Stoica RA, Pantea Stoian A. Antidiabetic Molecule Efficacy in Patients with Type 2 Diabetes Mellitus-A Real-Life Clinical Practice Study. Biomedicines 2023; 11:2455. [PMID: 37760896 PMCID: PMC10525559 DOI: 10.3390/biomedicines11092455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/25/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
In this paper, we aim to evaluate the efficacy of antidiabetic cardioprotective molecules such as Sodium-Glucose Cotransporter-2 Inhibitors (SGLT-2i) and Glucagon-like Peptide 1 Receptor Agonists (GLP-1 RAs) when used with other glucose-lowering drugs, lipid-lowering, and blood pressure (BP)-lowering drugs in a real-life setting. A retrospective, observational study on 477 patients admitted consecutively in 2019 to the outpatient clinic of a tertiary care unit for Diabetes Mellitus was conducted. Body mass index (BMI), blood pressure (BP) (both systolic and diastolic), and metabolic parameters, as well as A1c hemoglobin, fasting glycaemia and lipid profile, including total cholesterol (C), HDL-C, LDL-C and triglycerides), were evaluated at baseline and two follow-up visits were scheduled (6 months and 12 months) in order to assess the antidiabetic medication efficacy. Both SGLT-2i and GLP-1 RAs were efficient in terms of weight control reflected by BMI; metabolic control suggested by fasting glycaemia and A1c; and the diastolic component of BP control when comparing the data from the 6 and 12-month visits to the baseline, and when comparing the 12-month visit to the 6-month visit. Moreover, when comparing SGLT-2i and GLP-1 RAs with metformin, there are efficacy data for SGLT-2i at baseline in terms of BMI, fasting glycaemia, and HbA1c. In this retrospective study, both classes of cardioprotective molecules, when used in conjunction with other glucose-lowering, antihypertensive, and lipid-lowering medications, appeared to be efficient in a real-life setting for the management of T2DM.
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Affiliation(s)
- Teodor Salmen
- Doctoral School of Carol Davila, University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Ali Abbas Rizvi
- Department of Medicine, University of Central Florida College of Medicine, Orlando, FL 32827, USA
| | - Manfredi Rizzo
- School of Medicine, Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (Promise), University of Palermo, 90133 Palermo, Italy
| | - Valeria-Anca Pietrosel
- Department of Diabetes, Nutrition and Metabolic Diseases, “Prof. Dr N.C. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, 030167 Bucharest, Romania
| | - Ioana-Cristina Bica
- Doctoral School of Carol Davila, University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | | | | | - Bianca-Margareta Salmen
- Doctoral School of Carol Davila, University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Oana Andreia Coman
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Anca Bobircă
- Internal Medicine and Rheumatology Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Roxana-Adriana Stoica
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Anca Pantea Stoian
- Department of Diabetes, Nutrition and Metabolic Diseases, “Prof. Dr N.C. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, 030167 Bucharest, Romania
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Cacciapuoti F, D'Onofrio A, Tarquinio LG, Capone V, Mauro C, Marfella R, Cacciapuoti F. Sleep-disordered breathing and heart failure: a vicious cycle of cardiovascular risk. Monaldi Arch Chest Dis 2023; 94. [PMID: 37667884 DOI: 10.4081/monaldi.2023.2660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/10/2023] [Indexed: 09/06/2023] Open
Abstract
Sleep-disordered breathing (SDB) represents an important cardiovascular risk factor that is still often underestimated and not always optimally treated. Such breathing disorders can induce several harmful effects on the heart, also favoring the development of arrhythmias, ischemic heart disease, and left ventricular remodeling. Obstructive sleep apnea syndrome (OSA) is more frequent in heart failure patients than in the general population, promoting the worsening of left ventricular dysfunction. Both sleep apnea and heart failure have common clinical manifestations but also similar neurohormonal characteristics, contributing to the development and progression of heart failure and resulting in increased mortality. The pathophysiological mechanisms underlying left ventricular dysfunction associated with SDB will be analyzed, and the potential therapeutic effects of gliflozins on OSA in heart failure patients will be discussed.
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Affiliation(s)
| | | | | | | | - Ciro Mauro
- Department of Cardiology, "A. Cardarelli" Hospital, Naples.
| | - Raffaele Marfella
- Department of Internal Medicine, "L. Vanvitelli" University, Naples.
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9
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Xie L, Song S, Li S, Wei Q, Liu H, Zhao C, Yu F, Tong J. Efficacy of dapagliflozin in the treatment of HFrEF with obstructive sleep apnea syndrome (DAHOS study): study protocol for a multicentric, prospective, randomized controlled clinical trial. Trials 2023; 24:318. [PMID: 37158922 PMCID: PMC10169325 DOI: 10.1186/s13063-023-07332-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 04/28/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Heart failure with reduced ejection fraction (HFrEF) is associated with sleep dyspnea (SDB), which plays an adverse role in the pathophysiology of the condition. SDB management in HFrEF, however, remains controversial. HFrEF's medical management has recently made significant progress with the discovery of new therapeutic avenues, namely sodia-glucose cotransporter-2 (SGLT-2) inhibitors, and better treatment of co-morbidities. Dapagliflozin, one of the SGLT-2 inhibitors, is a good candidate for correcting SDB of HFrEF patients because their known mechanisms of action are likely to counteract the pathophysiology of SDB in HFrEF. METHODS/DESIGN The trial is a 3-month, multicentric, prospective, randomized controlled clinical study. Patients (i.e., adults with left ventricular ejection fraction ≤ 40%, Apnoea-Hypopnoea Index ≥ 15) will be randomized to receive optimized heart failure therapy plus a standard dose of dapagliflozin, while the control group will receive only optimized heart failure therapy. Patients will be evaluated before and after 3 months (nocturnal ventilatory polygraphy, echocardiography, laboratory testing, and quality-of-life and SDB questionnaires). The primary outcome is the change in the Apnoea-Hypopnoea Index, before and after 3 months of treatment. TRIAL REGISTRATION www.chictr.org.cn , ChiCTR2100049834. Registered 10 August 2021.
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Affiliation(s)
- Liang Xie
- School of Medicine, Southeast University, Nanjing, China
- Department of Cardiology, Jinling Hospitial, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Songsong Song
- Department of Cardiology, Zhongda Hospital, Nanjing, China
| | - Shengnan Li
- School of Medicine, Southeast University, Nanjing, China
| | - Qin Wei
- Department of Cardiology, Zhongda Hospital, Nanjing, China
| | - Hong Liu
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Chao Zhao
- State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing, China
| | - Fuchao Yu
- Department of Cardiology, Zhongda Hospital, Nanjing, China
| | - Jiayi Tong
- Department of Cardiology, Zhongda Hospital, Nanjing, China.
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10
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Wojeck BS, Inzucchi SE, Neeland IJ, Mancuso JP, Frederich R, Masiukiewicz U, Cater NB, McGuire DK, Cannon CP, Yaggi HK. Ertugliflozin and incident obstructive sleep apnea: an analysis from the VERTIS CV trial. Sleep Breath 2023; 27:669-672. [PMID: 35596030 PMCID: PMC10212814 DOI: 10.1007/s11325-022-02594-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/01/2022] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The sodium-glucose transporter 2 inhibitor (SGLT2i) empagliflozin may reduce the incidence of obstructive sleep apnea (OSA) in patients with type 2 diabetes (T2D) and cardiovascular (CV) disease. This analysis of VERTIS CV, the CV outcome trial for the SGLT2i ertugliflozin conducted in a similar group of patients, explored the effects of ertugliflozin on reported incident OSA. METHODS In VERTIS CV, patients ≥ 40 years with T2D and atherosclerotic CV disease (ASCVD) were randomized to ertugliflozin 5 or 15 mg or placebo. The primary endpoint was the composite of major adverse CV events. This exploratory analysis evaluated the impact of ertugliflozin (5 and 15 mg pooled) on incident OSA. Patients with prevalent OSA were excluded. Incident OSA events were based on investigator-reported events using the MedDRA SMQ term "sleep apnea syndrome." A multivariable Cox proportional hazards regression model was constructed to assess the association between ertugliflozin and incident OSA. RESULTS Of 8246 patients enrolled, 7697 (93.3%) were without baseline OSA (placebo, n = 2561; ertugliflozin, n = 5136; mean age 64.4 years; BMI 31.7 kg/m2; HbA1c, 8.2%; 69.2% male; 88.3% White). The OSA incidence rate was 1.44 per 1000 person-years versus 2.61 per 1000 person-years among patients treated with ertugliflozin versus placebo, respectively, corresponding to a 48% relative risk reduction (HR 0.52; 95% CI 0.28-0.96; P = 0.04). CONCLUSIONS In VERTIS CV, ertugliflozin reduced by nearly half the incidence of OSA in patients with T2D and ASCVD. These data contribute to the literature that SGLT2is may have a significant beneficial impact on OSA. TRIAL REGISTRATION CLINICALTRIALS gov identifier: NCT01986881.
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Affiliation(s)
- Brian S Wojeck
- Section of Endocrinology, Yale School of Medicine, 33 Cedar Street, P.O. Box 208020, New Haven, CT, 06520, USA.
| | - Silvio E Inzucchi
- Section of Endocrinology, Yale School of Medicine, 33 Cedar Street, P.O. Box 208020, New Haven, CT, 06520, USA
| | - Ian J Neeland
- Harrington Heart and Vascular Institute University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | | | - Urszula Masiukiewicz
- Section of Endocrinology, Yale School of Medicine, 33 Cedar Street, P.O. Box 208020, New Haven, CT, 06520, USA
- Pfizer Inc, Groton, CT, USA
| | | | - Darren K McGuire
- University of Texas Southwestern Medical Center and Parkland Health and Hospital System, Dallas, TX, USA
| | - Christopher P Cannon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Henry Klar Yaggi
- Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
- The VA CT Clinical Epidemiology Research Center, West Haven, CT, USA
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11
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Severino P, D'Amato A, Prosperi S, Costi B, Angotti D, Birtolo LI, Chimenti C, Lavalle C, Maestrini V, Mancone M, Fedele F. Sodium-glucose cotransporter 2 inhibitors and heart failure: the best timing for the right patient. Heart Fail Rev 2023; 28:709-721. [PMID: 34654997 PMCID: PMC10140096 DOI: 10.1007/s10741-021-10170-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 12/17/2022]
Abstract
Sodium-glucose cotransporter 2 inhibitors (SGLT2i), initially born as anti-diabetic drugs, have shown many beneficial effects on the cardiovascular system, in particular against heart failure (HF). HF is a complex and multifaceted disease that requires a comprehensive approach. It should not be considered as a simplistic cardiac disease, but a systemic disease that leads to multisystemic organ failure and death. Exploiting their pleiotropic effects, SGLT2i are a very valid tool for HF treatment. Beyond the indication to reduce HF hospitalization and death risk, in patients with diabetes mellitus at high cardiovascular risk or with established cardiovascular event, SGLT2i administration reported beneficial effects regarding the wide spectrum of HF manifestations and stages, independently by diabetes mellitus presence. Recent evidence focuses on HF rehospitalization, cardiac and all-cause death reduction, as well as symptoms and quality of life improvement, in patients with chronic HF or with a recent HF decompensation episode. Given the recent finding about the SGLT2i usefulness in HF patients, further studies are needed to define the best administration timing to maximize the SGLT2i-derived beneficial effects.
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Affiliation(s)
- Paolo Severino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy.
| | - Andrea D'Amato
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Silvia Prosperi
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Bettina Costi
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Danilo Angotti
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Lucia Ilaria Birtolo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Cristina Chimenti
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Carlo Lavalle
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Francesco Fedele
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
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12
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Potential Use of SGLT-2 Inhibitors in Obstructive Sleep Apnea: A new treatment on the horizon. Sleep Breath 2023; 27:77-89. [PMID: 35378662 DOI: 10.1007/s11325-022-02606-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/20/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is characterized by hypoxic episodes due to collapse of the airway during sleep and is frequently associated with obesity, type 2 diabetes mellitus (T2DM) and cardiovascular diseases (CVD). There is currently no pharmacological agent approved for the treatment of OSA. Sodium-glucose cotransporter-2 (SGLT2) inhibitors have the potential to both increase life expectancy and quality of life of these patients making them promising agents for this role. There are relatively few studies investigating this possible beneficial relationship between these drugs and OSA. METHOD We aimed to increase awareness on the potential benefits of SGLT2 inhibitors in OSA patients by describing the current evidence on the effectiveness of these inhibitors in both overall and cardiovascular morbidity and mortality. We performed a literature search for articles reporting on the use of SGLT2 inhibitors in patients with OSA and T2DM. RESULTS We identified 4 manuscripts studying the use of SGLT2 inhibitors in 475 OSA patients with T2DM. Among them, 332 patients were administered SGLT2 inhibitors, and 143 patients were in a control group. SGLT2 inhibitors have many potential positive impacts on OSA patients by targeting various mechanisms involved in OSA pathogenesis. CONCLUSION SGLT2 inhibitors are prime pharmacological candidates for the treatment of OSA, and additional studies are needed to better explore mechanisms and outcomes unique to this population. Additionally, patients with OSA often have multiple comorbidities that are clinical indications for SGLT2 inhibitor therapy. Physicians should recognize and encourage the use of these agents in such patients.
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13
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Matsumoto T, Murase K, Tabara Y, Minami T, Kanai O, Takeyama H, Sunadome H, Nagasaki T, Takahashi N, Nakatsuka Y, Hamada S, Handa T, Tanizawa K, Nakamoto I, Wakamura T, Komenami N, Setoh K, Kawaguchi T, Tsutsumi T, Morita S, Takahashi Y, Nakayama T, Sato S, Hirai T, Matsuda F, Chin K. Sleep disordered breathing and haemoglobin A1c levels within or over normal range and ageing or sex differences: the Nagahama study. J Sleep Res 2022; 32:e13795. [PMID: 36437403 DOI: 10.1111/jsr.13795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/12/2022] [Accepted: 11/10/2022] [Indexed: 11/29/2022]
Abstract
Recently an association between blood glucose dysregulation and sleep disruption was suggested. The association between sleep disordered breathing, most of which is due to obstructive sleep apnea (OSA) in the general population, and diabetic severity, as well as the impact of antidiabetic treatment, remains unclear. This study aimed to investigate these associations as well as age and sex differences. This cross-sectional study evaluated 7,680 community participants as the main cohort (population-based cohort). OSA was assessed by the 3% oxygen desaturation index from pulse oximetry, which was corrected for sleep duration obtained by wrist actigraphy. For arguing the limitations for using pulse oximetry, 597 hospitalised patients, who were assessed by the apnea-hypopnea index from attended polysomnography, were also evaluated as the validation cohort (hospital-based cohort). Moderate-to-severe OSA was more prevalent as haemoglobin A1c (HbA1c) levels increased (<5.6%/5.6%-<6.5%/6.5%-<7.5%/≥7.5%, respectively) in both cohorts (p < 0.001), but only in those without antidiabetic treatment. The HbA1c level was an independent factor for moderate-to-severe OSA (population-based cohort, odds ratio [OR] 1.26, 95% confidence interval [CI] 1.10-1.45; hospital-based cohort, OR 1.69, 95% CI 1.22-2.33, per 1% increase). These associations were more prominent in the middle-aged (aged <60 years) than in the elderly (aged ≥60 years) and in women than in men in both cohorts. The prevalence of moderate-to-severe OSA in patients with antidiabetic treatment in the hospital-based cohort was ≥75% regardless of HbA1c levels. In conclusion, an association between the prevalence of OSA and HbA1c level even within or over the normal range was found only in patients without antidiabetic treatment and was more prominent in the middle-aged and in women.
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Affiliation(s)
- Takeshi Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
- Department of Respiratory Medicine Saiseikai‐Noe Hospital Osaka Japan
| | - Kimihiko Murase
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Yasuharu Tabara
- Center for Genomic Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
- Graduate School of Public Health Shizuoka Graduate University of Public Health Shizuoka Japan
| | - Takuma Minami
- Department of Primary Care and Emergency Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Osamu Kanai
- Department of Respiratory Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Hirofumi Takeyama
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Hironobu Sunadome
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Tadao Nagasaki
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Naomi Takahashi
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Yoshinari Nakatsuka
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Satoshi Hamada
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Tomohiro Handa
- Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Kiminobu Tanizawa
- Department of Respiratory Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Isuzu Nakamoto
- Nursing Science, Human Health Sciences, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Tomoko Wakamura
- Nursing Science, Human Health Sciences, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Naoko Komenami
- Department of Food and Nutrition Kyoto Women's University Kyoto Japan
| | - Kazuya Setoh
- Center for Genomic Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Takahisa Kawaguchi
- Center for Genomic Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Takanobu Tsutsumi
- Center for Genomic Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Yoshimitsu Takahashi
- Department of Health Informatics Kyoto University School of Public Health Kyoto Japan
| | - Takeo Nakayama
- Department of Health Informatics Kyoto University School of Public Health Kyoto Japan
| | - Susumu Sato
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
| | - Kazuo Chin
- Center for Genomic Medicine, Graduate School of Medicine Kyoto University Kyoto Japan
- Department of Sleep Medicine and Respiratory Care, Division of Sleep Medicine Nihon University of Medicine Tokyo Japan
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14
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Bellido V, Martínez J, Calvo F, Villarroel A, Lecumberri E, Moreno J, Morillas C, Rodrigo S, Izarra A, Lecube A. Beyond the Glycaemic Control of Dapagliflozin: Microangiopathy and Non-classical Complications. Diabetes Ther 2022; 13:873-888. [PMID: 35338446 PMCID: PMC9076778 DOI: 10.1007/s13300-022-01237-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Abstract
Dapagliflozin is a selective sodium-glucose cotransporter 2 inhibitor (SGLT2i) indicated for the treatment of type 2 diabetes mellitus (T2DM), heart failure (HF) with reduced ejection fraction (EF) and chronic kidney disease (CKD). In monotherapy or as an additive therapy, dapagliflozin aids glycaemic control, is associated with reductions in blood pressure and weight, and promotes a favourable lipid profile. In this review, we address the impact of dapagliflozin on cardiovascular risk factors and common microangiopathic complications such as kidney disease and retinopathy in patients with T2DM. Furthermore, we evaluate its potential beneficial effects on other less frequent complications of diabetes, such as macular oedema, cognitive impairment, non-alcoholic fatty liver disease and respiratory disorders during sleep. Moreover, the underuse of SGLT2i in clinical practice is discussed. Our goal is to help translate this evidence into clinical practice.
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Affiliation(s)
- Virginia Bellido
- Endocrinology and Nutrition Department, Virgen del Rocío University Hospital, Sevilla, Spain
| | | | - Fernando Calvo
- Endocrinology and Nutrition Department, "Lozano Blesa" Clinical Hospital, Zaragoza, Spain
| | | | - Edurne Lecumberri
- Endocrinology and Nutrition Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Juan Moreno
- Medical Department, AstraZeneca Spain, Madrid, Spain
| | - Carlos Morillas
- Endocrinology and Nutrition Department, Dr Peset University Hospital of Valencia, Valencia, Spain
| | | | | | - Albert Lecube
- Research Group On Obesity, Diabetes and Metabolism (ODIM), Institute of Biomedical Research of Lleida (IRBLleida), Endocrinology and Nutrition Department, Arnau de Vilanova University Hospital, Lleida, University of Lleida, Avda. Rovira Roure 80, 25198, Lleida, Spain.
- Biomedical Research Networking Center in Diabetes and Associated Metabolic Disorders (CIBERDEM), Carlos III Health Institute, Madrid, Spain.
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15
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Sinha B, Ghosal S. A Meta-Analysis of the Effect of Sodium Glucose Cotransporter-2 Inhibitors on Metabolic Parameters in Patients With Polycystic Ovary Syndrome. Front Endocrinol (Lausanne) 2022; 13:830401. [PMID: 35265039 PMCID: PMC8900375 DOI: 10.3389/fendo.2022.830401] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/17/2022] [Indexed: 11/28/2022] Open
Abstract
Objective Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among women of childbearing age and is associated with multiple morbidities. However, treatment for this condition is mainly applied for symptomatic relief and does not address the complex pathophysiology of this condition. This meta-analysis was conducted on the usage of sodium-glucose cotransporter 2 inhibitors (SGLT-2is) in PCOS because this group of drugs presents an attractive strategy to address the metabolic and hormonal defects by managing the pathophysiological defects observed in this syndrome. Methods We included prospective trials that enrolled patients with established PCOS and compared an SGLT-2i group versus a control group with at least 2 weeks of follow-up. The standardized mean difference (SMD) was used for effect size estimation from individual studies and was pooled using the fixed effect model. Results We included four trials with a pooled population of 158 patients with documented PCOS who received either an SGLT-2i or standard management. From a metabolic perspective, significant improvements were observed in the reduction in body weight (SMD: -0.68, 95% CI -1.16 to -0.19, <0.01), fasting plasma glucose (FPG) (SMD: -0.59, 95% CI -0.99 to -0.19, P<0.01), and insulin resistance as assessed with the HOMA-IR (SMD: -0.39, 95% CI -0.76 to -0.03, P=0.03). In addition, a significant improvement was noted in dehydroepiandrosterone sulphate (DHEAS) levels (SMD: -0.55, 95% CI -0.94 to -0.16, P<0.01). Conclusion SGLT-2i use is associated with salutary outcomes of metabolic and anthropometric markers of PCOS and likely favourable hormonal effects. Clinical Trial Registration [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021268564], PROSPERO 2021 CRD42021268564.
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Affiliation(s)
- Binayak Sinha
- Department of Endocrinology, AMRI Hospitals, Kolkata, India
| | - Samit Ghosal
- Department of Endocrinology, Nightingale Hospital, Kolkata, India
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16
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Are high- or low-dose SGLT2 inhibitors associated with cardiovascular and respiratory adverse events? A meta-analysis. J Cardiovasc Pharmacol 2022; 79:655-662. [DOI: 10.1097/fjc.0000000000001222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022]
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17
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Abstract
Obstructive sleep apnea (OSA) is characterized by upper airway collapse during sleep. Chronic intermittent hypoxia, sleep fragmentation, and inflammatory activation are the main pathophysiological mechanisms of OSA. OSA is highly prevalent in obese patients and may contribute to cardiometabolic risk by exerting detrimental effects on adipose tissue metabolism and potentiating the adipose tissue dysfunction typically found in obesity. This chapter will provide an update on: (a) the epidemiological studies linking obesity and OSA; (b) the studies exploring the effects of intermittent hypoxia and sleep fragmentation on the adipose tissue; (c) the effects of OSA treatment with continuous positive airway pressure (CPAP) on metabolic derangements; and (d) current research on new anti-diabetic drugs that could be useful in the treatment of obese OSA patients.
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Affiliation(s)
- Maria R Bonsignore
- Sleep Disordered Breathing and Chronic Respiratory Failure Clinic, PROMISE Department, University of Palermo, Palermo, Italy.
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), Palermo, Italy.
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18
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Kusunoki M, Hisano F, Wakazono N, Tsutsumi K, Oshida Y, Miyata T. Effect of Treatment With Sodium-Glucose Cotransporter 2 Inhibitor on the Initiation of Continuous Positive Airway Pressure Therapy in Type 2 Diabetic Patients With Obstructive Sleep Apnea Syndrome. J Clin Med Res 2021; 13:497-501. [PMID: 34925660 PMCID: PMC8670768 DOI: 10.14740/jocmr4626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/09/2021] [Indexed: 11/11/2022] Open
Abstract
Background Obese patients with type 2 diabetes mellitus often develop obstructive sleep apnea syndrome (OSAS). In this study, continuous positive airway pressure (CPAP) was initiated in Japanese patients with type 2 diabetes mellitus who developed OSAS during treatment with a sodium-glucose cotransporter 2 (SGLT2) inhibitor, and the effect of the SGLT2 inhibitor therapy on the patients was investigated. Methods The study was conducted in outpatients with type 2 diabetes mellitus with serum hemoglobin A1c (HbA1c) values of ≥ 6.5% who developed OSAS. The patients were divided into two groups according to whether they were receiving treatment with an SGLT2 inhibitor or with other oral hypoglycemic agents: the SGLT2 inhibitor group (n = 9) and non-SGLT2 inhibitor group (n = 7). The patients in the former group were under treatment with one of the following three SGLT2 inhibitors: luseogliflozin (2.5 mg/day), dapagliflozin (5 mg/day) and empagliflozin (10 mg/day). The patients took the drugs once daily, before or after breakfast. The patients were initiated on CPAP therapy for OSAS, and their weight, body mass index (BMI), serum HbA1c level, lipid profile, liver function parameters, serum uric acid, and apnea-hypopnea index (AHI) measured before the initiation of CPAP therapy (baseline) were compared with the values measured 3 months after the start of CPAP therapy. Results The AHI decreased significantly after 3 months of CPAP therapy, as compared to that at the baseline, in both the SGLT2 inhibitor and non-SGLT2 inhibitor groups. There was no significant change in the serum HbA1c value after 3 months of CPAP therapy as compared to that at the baseline in either group. The body weight and BMI increased significantly after 3 months of CPAP therapy in the SGLT2 inhibitor group, but not in the non-SGLT2 inhibitor group. Conclusion The body weight and BMI increased significantly after 3 months of CPAP therapy initiated for OSAS in the type 2 diabetic patients who were receiving SGLT2 inhibitor therapy. Thus, when CPAP therapy is adopted for an obese diabetic patient with OSAS, it should be borne in mind that the body weight may increase if the patient is receiving SGLT2 inhibitor treatment.
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Affiliation(s)
- Masataka Kusunoki
- Department of Diabetes, Motor Function and Metabolism, Research Center of Health, Physical Fitness and Sports, Nagoya University, Nagoya, Japan
| | - Fumiya Hisano
- Graduate School of Medicine, Department of Integrated Health Sciences, Nagoya University, Nagoya, Japan
| | - Naomi Wakazono
- Department of Diabetes, Motor Function and Metabolism, Research Center of Health, Physical Fitness and Sports, Nagoya University, Nagoya, Japan
| | | | | | - Tetsuro Miyata
- Office of Medical Education, School of Medicine, International University of Health and Welfare, Chiba, Japan
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19
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Possible Preventative/Rehabilitative Role of Gliflozins in OSA and T2DM. A Systematic Literature Review-Based Hypothesis. Adv Ther 2021; 38:4195-4214. [PMID: 34273093 PMCID: PMC8342338 DOI: 10.1007/s12325-021-01791-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/13/2021] [Indexed: 02/07/2023]
Abstract
Obstructive sleep apnoea (OSA) is characterized by frequent apnoea episodes during sleep due to upper airway obstruction. The present review summarizes current knowledge on inter-relationships between OSA and type 2 diabetes mellitus (T2DM) and suggests the former as a possible target for sodium-glucose co-transporter-2 inhibitors (SGLT-2i). Based on pathophysiological mechanisms underlying OSA onset and renal SGLT-2 effects, we suggest that SGLT-2i indications might expand beyond current ones, including glucose, lipids, uric acid, blood pressure, and body weight control as well as chronic heart failure and kidney disease prevention.
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20
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Kario K, Williams B. Nocturnal Hypertension and Heart Failure: Mechanisms, Evidence, and New Treatments. Hypertension 2021; 78:564-577. [PMID: 34225469 DOI: 10.1161/hypertensionaha.121.17440] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Heart failure (HF) is a common condition with an increasing prevalence. Despite a variety of evidence-based treatments for patients with HF with reduced ejection fraction, morbidity and mortality rates remain high. Furthermore, there are currently no treatments that have yet been shown to reduce complication and death rates in patients who have HF with preserved ejection fraction. Hypertension is a common comorbidity in patients with HF, contributing to disease development and prognosis. For example, hypertension is closely associated with the development of left ventricular hypertrophy, which an important precursor of HF. In particular, nighttime blood pressure (BP) appears to be an important, modifiable risk factor. Both nighttime BP and an abnormal circadian pattern of nighttime BP dipping have been shown to predict development of HF and the occurrence of cardiovascular events, independent of office BP. Key mechanisms for this association include sodium handling/salt sensitivity and increased sympathetic activation. These pathogenic mechanisms are targeted by several new treatment options, including sodium-glucose cotransporter 2 inhibitors, angiotensin receptor neprilysin inhibitors, mineralocorticoid receptor antagonists, and renal denervation. All of these could form part of antihypertensive strategies designed to control nighttime BP and contribute to the goal of achieving perfect 24-hour BP management. Nevertheless, additional research is needed to determine the effects of reducing nighttime BP and improving the circadian BP profile on the rate of HF, other cardiovascular events, and mortality.
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Affiliation(s)
- Kazuomi Kario
- From the Jichi Medical University School of Medicine, Tochigi, Japan (K.K.)
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London and National Institute for Health Research University College London Biomedical Research Centre, United Kingdom (B.W.)
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21
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Qiu M, Ding LL, Zhan ZL, Liu SY. Use of SGLT2 inhibitors and occurrence of noninfectious respiratory disorders: a meta-analysis of large randomized trials of SGLT2 inhibitors. Endocrine 2021; 73:31-36. [PMID: 33559806 DOI: 10.1007/s12020-021-02644-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/21/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE The impact of use of sodium-glucose transporter 2 (SGLT2) inhibitors on occurrence of various kinds of respiratory disorders has not been established. We aimed at evaluating the relationship between use of SGLT2 inhibitors and occurrence of 9 kinds of noninfectious respiratory disorders. METHODS Large randomized controlled trials (RCTs) of SGLT2 inhibitors were included in this study. We conducted fixed-effects meta-analysis to synthesize risk ratios (RRs) and 95% confidence intervals (CIs). We did subgroup analysis respectively stratified by type of underlying diseases and type of SGLT2 inhibitors. RESULTS Nine Large RCTs were included for analysis. Compared with placebo, SGLT2 inhibitors significantly reduced the occurrence of overall respiratory disorders (RR 0.75, 95% CI 0.62-0.91), acute pulmonary oedema (RR 0.51, 95% CI 0.29-0.88), asthma (RR 0.57, 95% CI 0.33-0.995), and sleep apnoea syndrome (RR 0.35, 95% CI 0.12-0.99). SGLT2 inhibitors showed the reduced trends in the risks of chronic obstructive pulmonary disease (COPD) (RR 0.79, 95% CI 0.61-1.02; P = 0.073) and pulmonary hypertension (RR 0.43, 95% CI 0.16-1.17; P = 0.098). SGLT2 inhibitors had no significant effects on three other respiratory disorders. These effects exhibited by SGLT2 inhibitors were consistent across different underlying diseases (Psubgroup ≥0.209) and different SGLT2 inhibitors (Psubgroup ≥0.192). CONCLUSIONS SGLT2 inhibitors can significantly reduce the occurrence of acute pulmonary oedema, asthma, and sleep apnoea syndrome; and produce the reduced trends in the risks of COPD and pulmonary hypertension. These findings will prompt further investigation on SGLT2 inhibitors for primary and secondary prevention of various respiratory disorders.
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Affiliation(s)
- Mei Qiu
- Department of General Medicine, Shenzhen Longhua District Central Hospital, Shenzhen, China.
| | - Liang-Liang Ding
- Department of Endocrinology, First Affiliated Hospital of Yangtze University, Jingzhou, China
| | - Ze-Lin Zhan
- Class 3, Clinical Medicine, Grade 2019, The Second Clinical Medical College, Southern Medical University, Guangzhou, China
| | - Shu-Yan Liu
- Department of Endocrinology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
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Empagliflozin therapy and insulin resistance-associated disorders: effects and promises beyond a diabetic state. ACTA ACUST UNITED AC 2021; 6:e57-e78. [PMID: 34027215 PMCID: PMC8117073 DOI: 10.5114/amsad.2021.105314] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/21/2021] [Indexed: 12/21/2022]
Abstract
Empagliflozin is a SGLT2 inhibitor that has shown remarkable cardiovascular and renal activities in patients with type 2 diabetes (T2D). Preclinical and clinical studies of empagliflozin in T2D population have demonstrated significant improvements in body weight, waist circumference, insulin sensitivity, and blood pressure – effects beyond its antihyperglycaemic control. Moreover, several studies suggested that this drug possesses significant anti-inflammatory and antioxidative stress properties. This paper explores extensively the main preclinical and clinical evidence of empagliflozin administration in insulin resistance-related disorders beyond a diabetic state. It also discusses its future perspectives, as a therapeutic approach, in this high cardiovascular-risk population.
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23
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Schütz SG, Dunn A, Braley TJ, Pitt B, Shelgikar AV. New frontiers in pharmacologic obstructive sleep apnea treatment: A narrative review. Sleep Med Rev 2021; 57:101473. [PMID: 33853035 DOI: 10.1016/j.smrv.2021.101473] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 12/22/2022]
Abstract
Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing characterized by intermittent partial or complete closure of the upper airway during sleep. If left untreated, OSA is associated with adverse cardiovascular outcomes such as hypertension, coronary heart disease, heart failure, cardiac arrhythmia, stroke, and death. Positive airway pressure (PAP) is often considered the first-line treatment for OSA. While PAP can be very effective in reducing the number of obstructive apneas and hypopneas, its impact on prevention of adverse cardiovascular consequences remains controversial, and treatment adherence is often poor. Hence, the necessity for novel treatment options to help those who cannot adhere to positive airway pressure treatment. Different classes of medications have been tested with regards to their effect on OSA severity. This review 1) provides an update on the epidemiology and pathophysiology of OSA, 2) outlines the mechanistic rationale for medication classes tested as OSA treatment and 3) discusses the effects of these medications on OSA. Several wake-promoting medications are approved for management of persistent sleepiness despite OSA treatment; discussion of these symptomatic treatments is outside the scope of this review. Herein, the authors review the current evidence for pharmacological management of OSA and provide future directions.
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Affiliation(s)
- Sonja G Schütz
- Department of Neurology Sleep Disorders Center, University of Michigan Ann Arbor, MI, USA.
| | - Abbey Dunn
- Department of Neurology Sleep Disorders Center, University of Michigan Ann Arbor, MI, USA
| | - Tiffany J Braley
- Department of Neurology Multiple Sclerosis and Sleep Disorders Center, University of Michigan, Ann Arbor, MI, USA
| | - Bertram Pitt
- Department of Internal Medicine Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Anita V Shelgikar
- Department of Neurology Sleep Disorders Center, University of Michigan Ann Arbor, MI, USA
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24
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SGLT2 inhibitors and sleep apnea; how helpful are the medications: A meta-analysis. ENDOCRINE AND METABOLIC SCIENCE 2021. [DOI: 10.1016/j.endmts.2021.100084] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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25
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Khorasani ZM, Ravan VR, Hejazi S. Evaluation of the Prevalence of Sleep Disorder Among Patients with Type 2 Diabetes Mellitus Referring to Ghaem Hospital from 2016 to 2017. Curr Diabetes Rev 2021; 17:214-221. [PMID: 32459608 DOI: 10.2174/1573399816666200527140340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Diabetes is the most common metabolic disease in primary health care. The prevalence and severity of diabetes can be influenced through lifestyle modification. This study was aimed to identify the prevalence of sleep disorders as a modifiable lifestyle factor among diabetic patients. MATERIALS AND METHODS This cross-sectional study was conducted on 190 patients with type 2 diabetes mellitus who referred to the Internal Medicine Clinic of the Ghaem Hospital, Mashhad, Iran from 2016 to 2017. A demographic questionnaire and the Pittsburgh Sleep Quality Assessment questionnaire (with sleep disorder defined as scores higher than 5) was filled for each subject. Blood tests including haemoglobin A1 C (Hb A1C), fasting blood sugar (FBS) and 2 hour post prandial glucose as well as the assessment of blood pressure and body mass index (BMI) were performed for all patients. Data were analysed using the statistical package for social sciences (SPSS) version 16. RESULTS Age of the patients (with male to female ratio being 71/119s) was 56.31 ± 7.37 years. BMI of more than 25 kg/m2was observed in 145 (76.3%) of patients. Mean Pittsburgh Sleep Quality Assessment score was 7.48 ± 4.11. Fifty-one (26.8%) patients were good sleepers and 139 (73.2%) were poor sleepers. There was a significant relationship between sleep disorder and age (p=0.019) and female gender (p=0.017), but no other variables which included level of education, occupation, HbA1 C, FBS, 2-hour post prandial glucose, systolic and diastolic blood pressure. CONCLUSION Sleep disorders are common among type 2 diabetic patients especially women. It is recommended that sleep disorders should be screened in diabetic patients. Treatment and prevention of sleep disorders through sleep hygiene education including recommendation to have normal nocturnal sleep should be focused by practitioners in type 2 diabetic patients, especially women. Appropriate measures should be taken to manage sleep disorders by weight control in this population.
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Affiliation(s)
- Zahra M Khorasani
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vahid R Ravan
- Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sepideh Hejazi
- Lung Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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26
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Bossi AC, Forloni F, Colombelli PL. A Response To: Sodium-Glucose Cotransporter 2 Inhibitors and Major COVID-19 Outcomes: Promising Mechanisms, Conflicting Data, and Intriguing Clinical Decisions. Diabetes Ther 2020; 11:3007-3009. [PMID: 33052537 PMCID: PMC7556550 DOI: 10.1007/s13300-020-00943-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/03/2020] [Indexed: 01/14/2023] Open
Affiliation(s)
- Antonio C Bossi
- Endocrine Unit-Diabetes Regional Center, Treviglio, BG, Italy.
| | - Franco Forloni
- Endocrine Unit-Diabetes Regional Center, Treviglio, BG, Italy
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27
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Control of 24-hour blood pressure with SGLT2 inhibitors to prevent cardiovascular disease. Prog Cardiovasc Dis 2020; 63:249-262. [PMID: 32275926 DOI: 10.1016/j.pcad.2020.04.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/06/2020] [Indexed: 02/07/2023]
Abstract
The presence of hypertension (HTN) in patients with diabetes mellitus (DM) further worsens cardiovascular disease (CVD) prognosis. In addition, masked HTN and abnormal circadian blood pressure (BP) variability are common among patients with DM. Clinical trial data show that sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve CVD prognosis and prevent progression of renal dysfunction in high-risk patients with type 2 DM (T2DM). Consistent reductions in 24-hour, daytime and nocturnal BP have been documented during treatment with SGLT2i in patients with DM and HTN, and these reductions are of a magnitude that is likely to be clinically significant. SGLT2i agents also appear to have beneficial effects on morning, evening and nocturnal home BP. Greater reductions in BP during treatment with SGLT2i have been reported in patient subgroups with higher body mass index, and in those with higher baseline BP. Other documented beneficial effects of SGLT2i include reductions in arterial stiffness and the potential to decrease the apnea-hypopnea index in patients with DM and obstructive sleep apnea. Recent guidelines highlight the important role of SGLT2i as part of the pharmacological management of patients with DM and HTN, and recommend consideration of SGLT2i early in the clinical course to reduce all-cause and CVD mortality in patients with T2DM and CVD. Overall, available data support a role for SGLT2i as effective BP-lowering agents in patients with T2DM and poorly controlled HTN, irrespective of baseline glucose control status. Sustained improvements in 24-hour BP and the 24-hour BP profile are likely to contribute to the CVD benefits of SGLT2i treatment.
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Kalra S, Shetty KK, Nagarajan VB, Ved JK. Basic and Clinical Pharmaco-Therapeutics of SGLT2 Inhibitors: A Contemporary Update. Diabetes Ther 2020; 11:813-833. [PMID: 32130664 PMCID: PMC7136386 DOI: 10.1007/s13300-020-00789-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Indexed: 12/11/2022] Open
Abstract
Clinical relevance of sodium/glucose cotransporter 2 (SGLT2) inhibitors has been rapidly evolving across several therapy areas, apart from type 2 diabetes mellitus. While some of these developments are based on recognized scientific explanations, unexpected study findings have also shaped much of our present understanding. As the role of these agents evolves in various facets of cardiology, nephrology, hepatology and endocrinology, their optimum clinical value propositions should be realized in line with the principles of personalized medicine. An updated pharmaco-ergonomic qualification tool, based on the present evidence with these agents, would be a step in this direction. This review describes the present evidence on diverse pharmacological and therapeutic aspects for various SGLT2 inhibitors, as an attempt to provide useful guidance for optimum application in clinical practice.
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Pugliese G, Barrea L, Laudisio D, Salzano C, Aprano S, Colao A, Savastano S, Muscogiuri G. Sleep Apnea, Obesity, and Disturbed Glucose Homeostasis: Epidemiologic Evidence, Biologic Insights, and Therapeutic Strategies. Curr Obes Rep 2020; 9:30-38. [PMID: 31970714 DOI: 10.1007/s13679-020-00369-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE OF REVIEW Obstructive sleep apnea (OSA), obesity, and disturbed glucose homeostasis are usually considered distinct clinical condition, although they are tightly related to each other. The aim of our manuscript is to provide an overview of the current evidence on OSA, obesity, and disturbed glucose homeostasis providing epidemiologic evidence, biological insights, and therapeutic strategies. RECENT FINDINGS The mechanisms hypothesized to be involved in this complex interplay are the following: (1) "direct weight-dependent" mechanisms, according to which fat excess compromises respiratory mechanics, and (2) "indirect weight-dependent" mechanisms such as hyperglycemia, insulin resistance and secondary hyperinsulinemia, leptin resistance and other hormonal dysregulations frequently found in subjects with obesity, type 2 diabetes, and/or sleep disorders. Moreover, the treatment of each of these clinical conditions, through weight loss induced by diet or bariatric surgery, the use of anti-obesity or antidiabetic drugs, and continuous positive airway pressure (CPAP), seems to positively influence the others. These recent data suggest not only that there are multiple connections among these diseases but also that treating one of them may result in an improvement of the others.
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Affiliation(s)
- Gabriella Pugliese
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, via Sergio Pansini 5, 80131, Naples, Italy
| | - Luigi Barrea
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, via Sergio Pansini 5, 80131, Naples, Italy
| | - Daniela Laudisio
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, via Sergio Pansini 5, 80131, Naples, Italy
| | - Ciro Salzano
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, via Sergio Pansini 5, 80131, Naples, Italy
| | - Sara Aprano
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, via Sergio Pansini 5, 80131, Naples, Italy
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, via Sergio Pansini 5, 80131, Naples, Italy
| | - Silvia Savastano
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, via Sergio Pansini 5, 80131, Naples, Italy
| | - Giovanna Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, via Sergio Pansini 5, 80131, Naples, Italy.
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30
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Lajara R. Combination therapy with SGLT-2 inhibitors and GLP-1 receptor agonists as complementary agents that address multi-organ defects in type 2 diabetes. Postgrad Med 2019; 131:555-565. [PMID: 31580737 DOI: 10.1080/00325481.2019.1670017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Type 2 diabetes (T2D) has a complex pathophysiology composed of multiple underlying defects that lead to impaired glucose homeostasis and the development of macrovascular and microvascular complications. Of the currently available glucose-lowering therapies, sodium-glucose cotransporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) both provide effective glycemic control and have been shown to reduce cardiovascular (CV) events in patients with T2D and a high CV risk or established CV disease. Because these agents have complementary mechanisms of action, they are able to act on multiple defects of T2D when used in combination. This review discusses the rationale for and potential benefits of SGLT-2i plus GLP-1RA combination therapy in patients with T2D. A search of the PubMed database was conducted for studies and reviews describing the combined use of SGLT-2is and GLP-1RAs, with a specific focus on identifying clinical studies of combination therapy in patients with T2D. In clinical studies, glycated hemoglobin (A1c) was significantly reduced over 28-52 weeks with SGLT-2i plus GLP-1RA therapy versus the individual agents or baseline. Several CV risk factors, including body weight, blood pressure, and lipid parameters, were also improved. SGLT-2i plus GLP-1RA therapy was generally well tolerated, with a low risk of hypoglycemia and no unexpected findings. Taken together with results from large CV outcomes trials of SGLT-2is and GLP-1RAs, combination therapy with these agents potentially provides effective durable glycemic control and CV benefits due to their complementary actions on the defects of T2D.
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