Abstract:
OBJECTIVE:To review glucose-lowering efficacy and changes in renal function associated with sodium-glucose co-transporter 2 (SGLT2) inhibitors among patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM). DATA SOURCES:A literature search of MEDLINE and Cochrane databases was performed from 2000 to August 2018 using search terms: SGLT2 inhibitors, sodium glucose co-transporter 2, canagliflozin, empagliflozin, dapagliflozin, ertugliflozin, and chronic kidney disease. References of identified articles were also reviewed. STUDY SELECTION AND DATA EXTRACTION:English-language studies investigating glucose-lowering endpoints and/or changes in renal function with one of four U.S. approved SGLT2 inhibitors were included. A total of 10 studies met inclusion criteria and are included in this review. RESULTS:In patients with T2DM and CKD, SGLT2 inhibitors are modestly effective in lowering hemoglobin A1C and fasting plasma glucose compared to placebo. Small reductions in eGFR are seen shortly after initiating therapy with SGLT2 inhibitors, but return to baseline levels after discontinuation. SGLT2 inhibitors are associated with a substantial reduction in albuminuria and reduced risk of progression to albuminuria. CONCLUSIONS:In patients with T2DM and CKD, SGLT2 inhibitors have a decreased glucose-lowering effect compared to patients without CKD. Renal benefits among patients with CKD are similar to those without CKD and include a significant reduction in albuminuria and reduced incidence of worsening albuminuria. Given that CKD and T2DM are both associated with increased cardiovascular risk, we believe these agents should considered as preferred add-on agents in most patients with uncontrolled T2DM and eGFR >30 ml/min/1.73 m2. Ongoing studies will provide additional information as to whether these agents should be added to the current standard of care for CKD patients, with and without T2DM.
journal_name
Postgrad Medjournal_title
Postgraduate medicineauthors
Kelly MS,Lewis J,Huntsberry AM,Dea L,Portillo Idoi
10.1080/00325481.2019.1549459subject
Has Abstractpub_date
2019-01-01 00:00:00pages
31-42issue
1eissn
0032-5481issn
1941-9260journal_volume
131pub_type
杂志文章,评审abstract::Some patients with severe and chronic pain fail to obtain adequate pain relief with standard pharmacologic treatment agents, including low to moderate dosages of opioids. Understandably, physicians might not believe patients who claim that a standard opioid dosage is an ineffective treatment. These patients may be sev...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2014.996110
更新日期:2015-01-01 00:00:00
abstract::Although a great deal of investigation has led to some novel approaches in treating primary sclerosing cholangitis (PSC) and primary biliary cirrhosis (PBC), no method has been proven to definitively alter the long-term outcome of either disease. In addition, many of the medical regimens reviewed in this article have ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1993-11-01 00:00:00
abstract::HIT is a common, potentially catastrophic syndrome. Awareness and early diagnosis allow effective therapeutic intervention. Ineffective strategies include stopping heparin only and starting warfarin early. Use of alternative anticoagulants is improving patient outcomes. Lepirudin, argatroban, and danaparoid each have ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.2002.09.1307
更新日期:2002-09-01 00:00:00
abstract::Many new, minimally invasive interventional radiology procedures are now viable alternatives to traditional invasive therapy. The radiology procedures can often be performed in the outpatient setting, and although expensive technology may be required, the overall cost to the patient may be lower in the long run. Endov...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2001.06.958
更新日期:2001-06-01 00:00:00
abstract:OBJECTIVE:Laparoscopic adjustable gastric banding (LAGB) is an established bariatric surgical procedure that produces meaningful weight loss and improvements in patients with type 2 diabetes mellitus (T2DM) and a body mass index (BMI) ≥ 30 kg/m2. This study examined the effect of LAGB on T2DM status in severely obese p...
journal_title:Postgraduate medicine
pub_type: 临床试验,杂志文章,多中心研究
doi:10.3810/pgm.2012.11.2590
更新日期:2012-11-01 00:00:00
abstract::Extracorporeal shock wave lithotripsy has become a valuable asset to the urologist and greatly benefits urologic stone patients. Eight years of clinical use have proven its clinical efficacy, with more than 400,000 successfully performed treatments worldwide. In a short period of time, ESWL has completely changed the ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1988.11700265
更新日期:1988-05-01 00:00:00
abstract::Ovulatory dysfunctional uterine bleeding (DUB), a disease prevalent in the latter half of the reproductive years, is diagnosed when organic causes for bleeding have been excluded by clinical, laboratory, and surgical diagnostic means. Disordered prostaglandin metabolism within the endometrium explains most cases of DU...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1985.11698855
更新日期:1985-01-01 00:00:00
abstract::Preview Practical assessment of the functional and support factors affecting quality of life in older patients should be an integral part of medical management. This approach allows physicians to focus on remediable problems that compromise patients' daily functioning and may hinder them from living independently. In ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1996.11946120
更新日期:1996-05-01 00:00:00
abstract::The patient with jaundice may be accurately diagnosed through clinical history, physical findings, and noninvasive laboratory and radiologic examinations available in most community hospitals. Ultrasonography is usually the procedure of choice in initial evaluation, but if acute cholecystitis is suspected, hepatobilia...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:
更新日期:1987-01-01 00:00:00
abstract::The use of opioids for patients with chronic noncancer pain has increased dramatically, and with increasing use there is increasing concern about the potential for abuse and addiction during long-term treatment. Clinicians should avoid viewing formal or subjective risk assessment as a means of classifying patients int...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2014.09.2810
更新日期:2014-09-01 00:00:00
abstract::A high index of suspicion and careful application of diagnostic methods are essential for accurate diagnosis of parasitic bowel diseases. The varied clinical spectrum of giardiasis, amebiasis, and strongyloidiasis emphasizes the need to consider these pathogens when patients present with gastrointestinal complaints. G...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1982.11716069
更新日期:1982-05-01 00:00:00
abstract::Minor burns are common but require early and appropriate care to avoid infection and scarring. Damage can be arrested by immersing the burn in cold water as soon as possible. The goals of care are then to remove dead tissue and protect viable tissue during healing. Very superficial burns require only application of an...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1989.11700548
更新日期:1989-01-01 00:00:00
abstract::An exploratory subgroup analysis of a prospective, randomized, double-blind, forced-titration study comparing the efficacy and safety of once-daily olmesartan medoxomil (OM) and losartan potassium (LOS) in patients with stage 1 or stage 2 hypertension is reported. After a 3- to 4-week placebo run-in period, eligible p...
journal_title:Postgraduate medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.3810/pgm.2012.05.2549
更新日期:2012-05-01 00:00:00
abstract::Reiter's syndrome is an often overlooked and misdiagnosed complex of symptoms. Patients may not present with the classic triad of symptoms, or they may forget to mention other pertinent manifestations. How can you make an accurate diagnosis? And what is an effective approach to management? Dr Kirchner reviews studies ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1995-03-01 00:00:00
abstract::A 29-year-old man had a febrile illness accompanied by chest pain and tachycardia. The ECG suggested either myocarditis or acute ischemia. Heart muscle enzymes were normal, the peripheral blood count showed absolute and relative lymphocytosis, and an echocardiogram disclosed a small pericardial effusion. After deferve...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1989.11700655
更新日期:1989-04-01 00:00:00
abstract::Although uncommon, hypertensive emergencies require prompt recognition and treatment to reduce very high morbidity and mortality rates. Admission to an intensive care unit for treatment and monitoring is essential for optimal care. A Swan-Ganz catheter is often helpful in management. Intravenous nitroprusside sodium (...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1991.11700894
更新日期:1991-04-01 00:00:00
abstract::Amyloidosis occurs in association with many diseases and can also be idiopathic. It is usually a systemic disease with variable presentations. The diagnosis should be suspected in patients with unexplained proteinuria, cardiomyopathy, congestive heart failure, peripheral neuropathy, carpal tunnel syndrome, macroglossi...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1994-10-01 00:00:00
abstract::The dose and dosing interval for leukotriene receptor antagonists montelukast and zafirlukast in adult asthmatic patients were determined by bronchoprovocation with exercise or leukotriene D4 inhalation. Subsequent dose-ranging studies confirmed that once-daily ingestion of a 10-mg dose of montelukast was effective an...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.09.15.2000.suppl7.40
更新日期:2000-09-15 00:00:00
abstract::Elderly patients should be evaluated closely before surgery. Problems commonly found in these patients (ie, hypertension, diabetes, and cardiac and pulmonary disease) should be sought with special care and treated before surgery is undertaken. Also, wound healing may be compromised, drug clearance and metabolism impai...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1992.11701206
更新日期:1992-02-01 00:00:00
abstract::Physicians need to be aware that women and mothers are capable of sexually abusing children and need to watch for signs that a mother may be at risk for perpetrating abuse or that a child may have been abused. Posttraumatic stress disorder, attention-deficit hyperactivity disorder, secondary enuresis and encopresis, n...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1993-07-01 00:00:00
abstract:OBJECTIVES:Naloxone is indicated for reversal of opioid-induced respiratory depression. The objective of this study is to evaluate patterns of naloxone use in hospitalized patients. METHODS:Retrospective chart review at the University of California, San Diego Health. Subjects included adults ≥18 years old who were adm...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.2017.1263139
更新日期:2017-01-01 00:00:00
abstract::Preview Although the early symptoms of Parkinson's disease can be ameliorated, the illness is relentlessly progressive. Studies have therefore been conducted in hopes of finding therapy to delay its disabling course. In this article, Dr Ahlskog examines recent proposals and their application in cases of early and adva...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1994.11945830
更新日期:1994-05-01 00:00:00
abstract::Present evidence suggests that the most important nutritional factor bearing on the risk of development of diabetes mellitus is an excessive caloric intake. Other evidence suggests that both dietary prevention of diabetes and mitigation of hyperglycemia by dietary means can prevent morbidity and mortality from the mic...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1976.11712096
更新日期:1976-09-01 00:00:00
abstract::Recent increases in obesity, diabetes, and hypertension, along with the aging of the US population, are driving a dramatic rise in the prevalence of chronic kidney disease (CKD). Despite this increase, the majority of Americans with early-stage CKD remain unaware of their disease. Primary care physicians are at the fo...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2011.09.2473
更新日期:2011-09-01 00:00:00
abstract::This article on microcytic anemia is the first of several on laboratory investigation of anemia. Microcytic anemia, characterized by a mean corpuscular volume of less than 80 cu mu, is usually due to iron deficiency or chronic disease but may signify thalassemia minor. Exact identification of the cause is important, s...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1979.11715037
更新日期:1979-01-01 00:00:00
abstract::Preview The ultrasensitive third-generation assay for thyrotropin (TSH) is now the "gold standard" for measuring thyroid activity. Who should be screened with it, and what further studies should be done if results are abnormal? Which patients with subclinical disease should receive treatment? Drs Brody and Reichard di...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1995.11946028
更新日期:1995-08-01 00:00:00
abstract::The purpose of this study was to assess the effects of a commercially available weight loss program on weight and glycemic control among obese patients with type 2 diabetes. Participants included 69 patients (49 females, 20 males) with type 2 diabetes who had a mean +/- SD age of 52.2 +/- 9.5 years, a body mass index ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,随机对照试验
doi:10.3810/pgm.2009.09.2046
更新日期:2009-09-01 00:00:00
abstract::Cataracts are the most common treatable form of reduced vision in older adults. Although the incidence of cataracts is high after age 65, careful history taking and clinical examination are essential to establish the diagnosis. Cataract surgery is medically indicated when the view to the retina is obscured or lens-ind...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.1998.05.478
更新日期:1998-05-01 00:00:00
abstract:OBJECTIVE:To evaluate the pharmacokinetics of lisdexamfetamine dimesylate (LDX), a long-acting prodrug stimulant, and mixed amphetamine salts extended-release (MAS XR), alone or with omeprazole, a proton pump inhibitor (PPI). METHODS:This open-label, randomized, 4-period crossover study enrolled healthy adults (18-45 ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,随机对照试验
doi:10.3810/pgm.2009.09.2048
更新日期:2009-09-01 00:00:00
abstract::This article reviews the definition, mechanisms, epidemiology, and clinical sequelae of the metabolic syndrome and explores potential relationships between the metabolic syndrome, type 2 diabetes, and cardiovascular disease. Definitions for the metabolic syndrome proposed by the World Health Organization and the Natio...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.12.2003.suppl31.175
更新日期:2003-12-01 00:00:00