Purpose

In patients with type 2 diabetes mellitus (T2DM), both sodium-glucose cotransporter 2 inhibitors (SGLT2is) and glucagon-like peptide receptor agonists (GLP-1 RAs) have demonstrated significant improvements in cardiovascular and kidney outcomes independent of their glycemic benefits. This paper will briefly compare the effect of SGLT2is and GLP-1 RAs to that of the SGLT1/2 inhibitor sotagliflozin on the incidence of myocardial infarction (MI) and stroke in patients with T2DM and further postulate mechanisms to account for these findings.

Methods and Results

Thus far, the results from SCORED and SOLOIST (trials studying the SGLT1/2 inhibitor sotagliflozin) suggest that an increase in SGLT1 inhibition when added to SGLT2 inhibition may contribute to reductions in MI and stroke in patients with T2DM. This benefit is beyond what SGLT2is alone can accomplish and at least similar to GLP-1 RAs but with the added benefit of a reduction in hospitalizations and urgent visits for HF. Larger and longer studies are required to confirm the effectiveness of SGLT1/SGLT2 inhibition in reducing MI and stroke in patients with T2DM and elucidate the mechanisms associated with this finding.

Conclusions

The role of SGLT1/2 inhibition as an addition to GLP-1 RAs in patients with and without T2DM at increased risk for MI and stroke requires further study. Regardless, the finding that a relative increase in SGLT1/2 inhibition reduces the risk of MI and stroke as well as hospitalizations and urgent visits for heart failure could improve quality of life and reduce the healthcare burden associated with T2DM.

中文翻译：

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联合抑制 SGLT1/SGLT2 在降低 2 型糖尿病患者卒中和心肌梗死发生率中的作用

目的

在 2 型糖尿病 (T2DM) 患者中，钠-葡萄糖协同转运蛋白 2 抑制剂 (SGLT2is) 和胰高血糖素样肽受体激动剂 (GLP-1 RAs) 都显示出心血管和肾脏结局的显着改善，与其血糖益处无关。本文将简要比较 SGLT2is 和 GLP-1 RA 与 SGLT1/2 抑制剂 sotagliflozin 对 T2DM 患者心肌梗死 (MI) 和卒中发病率的影响，并进一步假设解释这些发现的机制。

方法和结果

迄今为止，来自 SCORED 和 SOLOIST（研究 SGLT1/2 抑制剂 sotagliflozin 的试验）的结果表明，在 SGLT2 抑制的基础上增加 SGLT1 抑制可能有助于减少 T2DM 患者的 MI 和卒中。这种益处超出了单独 SGLT2is 所能达到的范围，至少与 GLP-1 RA 相似，但具有减少 HF 住院和紧急就诊的额外益处。需要更大规模和更长时间的研究来证实 SGLT1/SGLT2 抑制在减少 T2DM 患者的 MI 和卒中方面的有效性，并阐明与这一发现相关的机制。

结论

SGLT1/2 抑制作为 GLP-1 RA 的补充，在患有和不患有 MI 和卒中风险增加的 T2DM 患者中的作用需要进一步研究。无论如何，SGLT1/2 抑制的相对增加降低了 MI 和中风的风险以及因心力衰竭住院和紧急就诊的发现可以改善生活质量并减轻与 T2DM 相关的医疗保健负担。