scholarly journals Inhibitors of the sodium-glucose transporter type 2 and new possibilities for managing vascular age in patients with type 2 diabetes mellitus

2021 ◽  
pp. 228-236
Author(s):  
I. Sh. Khalimov ◽  
Yu. Ye. Rubtsov ◽  
V. V. Salukhov ◽  
P. V. Agafonov

The article discusses the pathophysiological mechanisms of the development of vascular aging as a combination of the influence on the  body of  genetic, environmental, regulatory, metabolic and other factors causing biochemical, enzymatic and cellular changes in the arterial vascular bed. The concept of “early vascular aging” and “healthy vascular aging” is defined depending on the ratio of the biological and chronological age of the vessels. The role of diabetes mellitus in increasing vascular stiffness, early vascular aging, as well as the  progression of  atherosclerotic cardiovascular diseases and their complications is considered in detail. Approaches to multifactorial management of vascular age in patients with type 2 diabetes (lifestyle modification with strategy of aggressive treatment of modifiers of atherosclerosis, rejection of bad habits, adherence to dietary recommendations and the use of modern organo- and vasoprotective antidiabetic drugs) are revealed. The mechanism of realization of vasoprotective effects of inhibitors of sodium-glucose transporter-2 (iNGLT-2) is described in detail. The results of completed large random ized trials EMPA-REG Outcome and EMPA-REG BP of the most studied representative of the IGLT-2 group, empagliflozin, are presented. It has been shown that due to their glucose and natriuretic effects, the ability to reduce body weight and blood pressure, improve myocardial metabolism and bioenergetics, decrease the activity of the sympathetic nervous system, as well as positive effects on vascular stiffness, NGLT-2 inhibitors are the drugs of choice in patients with type 2 diabetes mellitus (T2DM) and cardiovascular diseases. This makes it possible to widely use this group of drugs for managing the vascular age of patients and represents a new opportunity in the prevention of vascular aging in T2DM. 

2001 ◽  
Vol 86 (5) ◽  
pp. 2181-2186 ◽  
Author(s):  
Ann M. Møller ◽  
Niels M. Jensen ◽  
Julie Pildal ◽  
Thomas Drivsholm ◽  
Knut Borch-Johnsen ◽  
...  

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Alaaeldin Bashier ◽  
Azza Bin Hussain ◽  
Elamin Abdelgadir ◽  
Fatheya Alawadi ◽  
Hani Sabbour ◽  
...  

Abstract The recent American Diabetes Association and the European Association for the Study of Diabetes guideline mentioned glycaemia management in type 2 diabetes mellitus (T2DM) patients with cardiovascular diseases (CVDs); however, it did not cover the treatment approaches for patients with T2DM having a high risk of CVD, and treatment and screening approaches for CVDs in patients with concomitant T2DM. This consensus guideline undertakes the data obtained from all the cardiovascular outcome trials (CVOTs) to propose approaches for the T2DM management in presence of CV comorbidities. For patients at high risk of CVD, metformin is the drug of choice to manage the T2DM to achieve a patient specific HbA1c target. In case of established CVD, a combination of glucagon-like peptide-1 receptor agonist with proven CV benefits is recommended along with metformin, while for chronic kidney disease or heart failure, a sodium–glucose transporter proteins-2 inhibitor with proven benefit is advised. This document also summarises various screening and investigational approaches for the major CV events with their accuracy and specificity along with the treatment guidance to assist the healthcare professionals in selecting the best management strategies for every individual. Since lifestyle modification and management plays an important role in maintaining the effectiveness of the pharmacological therapies, authors of this consensus recommendation have also briefed on the patient-centric non-pharmacological management of T2DM and CVD.


2014 ◽  
Vol 60 (4) ◽  
pp. 60-64
Author(s):  
V G Kadzharyan ◽  
N I Kapshitar’

Insulin is traditionally the main application point on which all methods for the management of type 2 diabetes mellitus are targeted. One of the new strategies for the treatment of this pathology utilizes sodium-dependent glucose transporter-2 (SGLT-2) inhibitors transforms this approach making kidneys the new point of application of antidiabetic therapy. SGLT-2 functions as a tunnel built into the epithelial wall of the initial segment of the proximal tubules in the nephron. When the channel is open, glucose is filtered into primary urine and can be reabsorbed in the proximal tubule. Based on this observation, the pharmaceutical companies began to search for the chemical substances that could be used to close the SGLT-2 tunnels and thereby interfere with the reverse flow of glucose from urine to blood, i.e. stimulate glycosuria. During the last decade, a few alternative molecules have been synthesized capable of selective inhibition of SGLT-2. At present, two of them, dapagliflozin and canagliflozin, are approved for the clinical application.


2020 ◽  
Vol 16 ◽  
Author(s):  
Patricio Lopez-Jaramillo ◽  
Jose Lopez-Lopez ◽  
Daniel Cohen ◽  
Natalia Alarcon-Ariza ◽  
Margarita Mogollon-Zehr

: Hypertension and type 2 diabetes mellitus are two important risk factors that contribute to cardiovascular diseases worldwide. In Latin America hypertension prevalence varies from 30 to 50%. Moreover, the proportion of awareness, treatment and control of hypertension is very low. The prevalence of type 2 diabetes mellitus varies from 8 to 13% and near to 40% are unaware of their condition. In addition, the prevalence of prediabetes varies from 6 to 14% and this condition has been also associated with increased risk of cardiovascular diseases. The principal factors linked to a higher risk of hypertension in Latin America are increased adiposity, low muscle strength, unhealthy diet, low physical activity and low education. Besides being chronic conditions, leading causes of cardiovascular mortality, both hypertension and type 2 diabetes mellitus represent a substantial cost for the weak health systems of Latin American countries. Therefore, is necessary to implement and reinforce public health programs to improve awareness, treatment and control of hypertension and type 2 diabetes mellitus, in order to reach the mandate of the Unit Nations of decrease the premature mortality for CVD.


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