diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM12864diaendo-12864Research ArticleОбзорыReviewАктуализация позиций глифлозинов в алгоритмах лечения пациентов с сахарным диабетом 2 типа и хронической болезнью почек: новые патогенетические механизмы и данные субанализов крупных рандомизированных контролируемых исследованийGliflozins position update in the treatment algorithms for patients with type 2 diabetes mellitus and chronic kidney disease: new pathogenetic mechanisms and data from subanalyses of the large randomised control trailshttps://orcid.org/0000-0002-3443-7206СухареваО. Ю.SukharevaO. Y.

Сухарева Ольга Юрьевна, к.м.н.

SPIN: 5650-4416

117036, Москва, ул. Дм. Ульянова, д. 11

Olga Y. Sukhareva, MD, PhD

SPIN: 5650-4416

11 Dm. Ulyanova str., Moscow, 117036

olgasukhareva@mail.ruhttps://orcid.org/0000-0001-6953-6928ЗураеваЗ. Т.ZuraevaZ. T.

Зураева Замира Тотразовна, к.м.н.

SPIN: 6002-0455

Москва

Zamira T. Zuraeva, MD, PhD

SPIN: 6002-0455

Moscow

zuraeva_zamira@mail.ruhttps://orcid.org/0000-0002-3433-0142ШамхаловаМ. Ш.ShamhalovaM. S.

Шамхалова Минара Шамхаловна, д.м.н.

SPIN: 4942-5481

Москва

Minara S. Shamhalova, MD, PhD

SPIN: 4942-5481

Moscow

shamkhalova@mail.ruНациональный медицинский исследовательский центр эндокринологииEndocrinology Research Centre202122012022246553564Copyright © Сухарева О.Ю., Зураева З.Т., Шамхалова М.Ш., 20222022Сухарева О.Ю., Зураева З.Т., Шамхалова М.Ш.Sukhareva O.Y., Zuraeva Z.T., Shamhalova M.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/12864

Результаты ряда крупных международных исследований по оценке влияния ингибиторов натрийглюкозного котранспортера 2-го типа (SGLT2) на сердечно-сосудистый риск продемонстрировали нефропротективный потенциал этих препаратов. Канаглифлозин в исследовании CREDENCE, которое было первым исследованием с первичным фокусом на оценке нефропротективных свойств глифлозинов, убедительно показал возможность замедления прогрессирования почечной патологии. В статье обобщены результаты последовавших субанализов CREDENCE: эффективность канаглифлозина в зависимости от исходного уровня расчетной скорости клубочковой фильтрации (рСКФ); эффекты у лиц с рСКФ <30 мл/мин/1,73 м2 ; влияние на развитие и течение анемии; влияние на уровень калия в крови; эффекты в отношении сердечной недостаточности и сердечно-сосудистой смертности. С учетом доказанных преимуществ современные алгоритмы лечения пациентов с сахарным диабетом 2 типа и хронической болезнью почек отдают приоритет использованию глифлозинов. Канаглифлозин является препаратом с относительно низким соотношением селективности к SGLT1/SGLT2. Описаны механизмы, опосредованные ингибированием SGLT1 транспорта в почке и в кишечнике, что, помимо уменьшения постпрандиальной гликемии, возможно, имеет дополнительный потенциал для нефропротекции.

The series of the cardiovascular outcome trails have demonstrated the nephroprotective properties of the gliflozins. Canagliflozin in the CREDENCE, which was the first study with a primary focus on the evaluation of the nephroprotective properties of gliflozin, have demonstrated the possibility to slow the progression of the renal disease. The paper summarizes the additional data from the CREDENCE trail: assessment of the efficacy of canagliflozin by initial eGFR; efficacy in individuals with GFR <30 ml/min/1.73 m2 ; long-term effects of canagliflozin on anaemia-related outcomes; effects of canagliflozin on serum potassium; effects on heart failure and cardiovascular mortality. There are discussed the current treatment algorithms for patients with type 2 diabetes and CKD where using of gliflozins is a priority option. Canagliflozin is a drug with a relatively low ratio of SGLT1/SGLT2 selectivity. The effects of the inhibition of SGLT1 transport in the kidney and in the intestine are described and their additional influence on reducing of the postprandial glycemia and additional nephroprotection.

сахарный диабет 2 типахроническая болезнь почекSGLT1SGLT2SGLT2 ингибиторыглифлозиныканаглифлозинCREDENCEнефропротекцияtype 2 diabetes mellituschronic kidney diseaseSGLT1SGLT2SGLT2 inhibitorsgliflozinscanagliflozinCREDENCEnephroprotectionReferencesSchwartz SS, Epstein S, Corkey BE, et al. A Unified Pathophysiological Construct of Diabetes and its Complications. Trends Endocrinol Metab. 2017;28(9):645-655. doi: https://doi.org/10.1016/j.tem.2017.05.005Schwartz SS, Epstein S, Corkey BE, et al. A Unified Pathophysiological Construct of Diabetes and its Complications. Trends Endocrinol Metab. 2017;28(9):645-655. doi: https://doi.org/10.1016/j.tem.2017.05.005Gerich JE, Meyer C, Woerle HJ, Stumvoll M. Renal Gluconeogenesis. Diabetes Care. 2001;24(2):382-391. doi: https://doi.org/10.2337/diacare.24.2.382Gerich JE, Meyer C, Woerle HJ, Stumvoll M. Renal Gluconeogenesis. Diabetes Care. 2001;24(2):382-391. doi: https://doi.org/10.2337/diacare.24.2.382Bergman H, Drury DR. The relationship of kidney function to the glucose utilization of the extra abdominal tissues. Am J Physiol Content. 1938;124(2):279-284. doi: https://doi.org/10.1152/ajplegacy.1938.124.2.279Bergman H, Drury DR. The relationship of kidney function to the glucose utilization of the extra abdominal tissues. Am J Physiol Content. 1938;124(2):279-284. doi: https://doi.org/10.1152/ajplegacy.1938.124.2.279Meyer C, Stumvoll M, Nadkarni V, et al. Abnormal renal and hepatic glucose metabolism in type 2 diabetes mellitus. J Clin Invest. 1998;102(3):619-624. doi: https://doi.org/10.1172/JCI2415Meyer C, Stumvoll M, Nadkarni V, et al. Abnormal renal and hepatic glucose metabolism in type 2 diabetes mellitus. J Clin Invest. 1998;102(3):619-624. doi: https://doi.org/10.1172/JCI2415Bays H. From victim to ally: the kidney as an emerging target for the treatment of diabetes mellitus. Curr Med Res Opin. 2009;25(3):671-681. doi: https://doi.org/10.1185/03007990802710422Bays H. From victim to ally: the kidney as an emerging target for the treatment of diabetes mellitus. Curr Med Res Opin. 2009;25(3):671-681. doi: https://doi.org/10.1185/03007990802710422Onyango AN. Mechanisms of the Regulation and Dysregulation of Glucagon Secretion. Oxid Med Cell Longev. 2020;2020:1-9. doi: https://doi.org/10.1155/2020/3089139Onyango AN. Mechanisms of the Regulation and Dysregulation of Glucagon Secretion. Oxid Med Cell Longev. 2020;2020:1-9. doi: https://doi.org/10.1155/2020/3089139McGuire DK, Shih WJ, Cosentino F, et al. Association of SGLT2 Inhibitors With Cardiovascular and Kidney Outcomes in Patients With Type 2 Diabetes. JAMA Cardiol. 2021;6(2):148. doi: https://doi.org/10.1001/jamacardio.2020.4511McGuire DK, Shih WJ, Cosentino F, et al. Association of SGLT2 Inhibitors With Cardiovascular and Kidney Outcomes in Patients With Type 2 Diabetes. JAMA Cardiol. 2021;6(2):148. doi: https://doi.org/10.1001/jamacardio.2020.4511Zhang J, Wei J, Jiang S, et al. Macula Densa SGLT1-NOS1- Tubuloglomerular Feedback Pathway, a New Mechanism for Glomerular Hyperfiltration during Hyperglycemia. J Am Soc Nephrol. 2019;30(4):578-593. doi: https://doi.org/10.1681/ASN.2018080844Zhang J, Wei J, Jiang S, et al. Macula Densa SGLT1-NOS1- Tubuloglomerular Feedback Pathway, a New Mechanism for Glomerular Hyperfiltration during Hyperglycemia. J Am Soc Nephrol. 2019;30(4):578-593. doi: https://doi.org/10.1681/ASN.2018080844Carlström M. The Other Glucose Transporter, SGLT1 – Also a Potential Trouble Maker in Diabetes? J Am Soc Nephrol. 2019;30(4):519-521. doi: https://doi.org/10.1681/ASN.2019020171Carlström M. The Other Glucose Transporter, SGLT1 – Also a Potential Trouble Maker in Diabetes? J Am Soc Nephrol. 2019;30(4):519-521. doi: https://doi.org/10.1681/ASN.2019020171Cinti F, Moffa S, Impronta F, et al. Spotlight on ertugliflozin and its potential in the treatment of type 2 diabetes: evidence to date. Drug Des Devel Ther. 2017;11:2905-2919. doi: https://doi.org/10.2147/DDDT.S114932Cinti F, Moffa S, Impronta F, et al. Spotlight on ertugliflozin and its potential in the treatment of type 2 diabetes: evidence to date. Drug Des Devel Ther. 2017;11:2905-2919. doi: https://doi.org/10.2147/DDDT.S114932Kashiwagi A, Maegawa H. Metabolic and hemodynamic effects of sodium-dependent glucose cotransporter 2 inhibitors on cardio-renal protection in the treatment of patients with type 2 diabetes mellitus. J Diabetes Investig. 2017;8(4):416-427. doi: https://doi.org/10.1111/jdi.12644Kashiwagi A, Maegawa H. Metabolic and hemodynamic effects of sodium-dependent glucose cotransporter 2 inhibitors on cardio-renal protection in the treatment of patients with type 2 diabetes mellitus. J Diabetes Investig. 2017;8(4):416-427. doi: https://doi.org/10.1111/jdi.12644Thomas MC, Cherney DZI. The actions of SGLT2 inhibitors on metabolism, renal function and blood pressure. Diabetologia. 2018;61(10):2098-2107. doi: https://doi.org/10.1007/s00125-018-4669-0Thomas MC, Cherney DZI. The actions of SGLT2 inhibitors on metabolism, renal function and blood pressure. Diabetologia. 2018;61(10):2098-2107. doi: https://doi.org/10.1007/s00125-018-4669-0Zelniker TA, Braunwald E. Cardiac and Renal Effects of SodiumGlucose Co-Transporter 2 Inhibitors in Diabetes. J Am Coll Cardiol. 2018;72(15):1845-1855. doi: https://doi.org/10.1016/j.jacc.2018.06.040Zelniker TA, Braunwald E. Cardiac and Renal Effects of SodiumGlucose Co-Transporter 2 Inhibitors in Diabetes. J Am Coll Cardiol. 2018;72(15):1845-1855. doi: https://doi.org/10.1016/j.jacc.2018.06.040Heerspink HJL, Kosiborod M, Inzucchi SE, Cherney DZI. Renoprotective effects of sodium-glucose cotransporter-2 inhibitors. Kidney Int. 2018;94(1):26-39. doi: https://doi.org/10.1016/j.kint.2017.12.027Heerspink HJL, Kosiborod M, Inzucchi SE, Cherney DZI. Renoprotective effects of sodium-glucose cotransporter-2 inhibitors. Kidney Int. 2018;94(1):26-39. doi: https://doi.org/10.1016/j.kint.2017.12.027Салухов В.В., Халимов Ю.Ш., Шустов С.Б., Попов С.И. Ингибиторы SGLT2 и почки: механизмы и основные эффекты у больных сахарным диабетом 2 типа // Сахарный диабет. — 2020. — Т. 23. — № 5. — С. 475-491. doi: https://doi.org/10.14341/DM12123Salukhov V V, Khalimov YS, Shustov SB, Popov SI. SGLT2 inhibitors and kidneys: mechanisms and main effects in diabetes mellitus patients. Diabetes mellitus. 2021;23(5):475-491. (In Russ.). doi: https://doi.org/10.14341/DM12123Шестакова М.В., Сухарева О.Ю. Глифлозины: особенности сахароснижающего действия и негликемические эффекты нового класса препаратов // Клиническая фармакология и терапия. — 2016. — Т. 25. — № 2. — С. 65-71.Shestakova MV, Sukhareva OYu. Gliflozins: glucose-lowering and nonglycemic effects of new class of antidiabetic medications. Clin. Pharmacol. Ther. 2016;25(2):65-71. (In Russ.).Cherney DZI, Perkins BA, Soleymanlou N, et al. Renal Hemodynamic Effect of Sodium-Glucose Cotransporter 2 Inhibition in Patients With Type 1 Diabetes Mellitus. Circulation. 2014;129(5):587-597. doi: https://doi.org/10.1161/CIRCULATIONAHA.113.005081Cherney DZI, Perkins BA, Soleymanlou N, et al. Renal Hemodynamic Effect of Sodium-Glucose Cotransporter 2 Inhibition in Patients With Type 1 Diabetes Mellitus. Circulation. 2014;129(5):587-597. doi: https://doi.org/10.1161/CIRCULATIONAHA.113.005081Heerspink HJL, Desai M, Jardine M, et al. Canagliflozin Slows Progression of Renal Function Decline Independently of Glycemic Effects. J Am Soc Nephrol. 2017;28(1):368-375. doi: https://doi.org/10.1681/ASN.2016030278Heerspink HJL, Desai M, Jardine M, et al. Canagliflozin Slows Progression of Renal Function Decline Independently of Glycemic Effects. J Am Soc Nephrol. 2017;28(1):368-375. doi: https://doi.org/10.1681/ASN.2016030278Yaribeygi H, Butler AE, Atkin SL, et al. Sodium–glucose cotransporter 2 inhibitors and inflammation in chronic kidney disease: Possible molecular pathways. J Cell Physiol. 2019;234(1):223-230. doi: https://doi.org/10.1002/jcp.26851Yaribeygi H, Butler AE, Atkin SL, et al. Sodium–glucose cotransporter 2 inhibitors and inflammation in chronic kidney disease: Possible molecular pathways. J Cell Physiol. 2019;234(1):223-230. doi: https://doi.org/10.1002/jcp.26851Tonneijck L, Muskiet MH, Smits MM, et al. Glomerular Hyperfiltration in Diabetes: Mechanisms, Clinical Significance, and Treatment. J Am Soc Nephrol. 2017;28(4):1023-1039. doi: https://doi.org/10.1681/ASN.2016060666Tonneijck L, Muskiet MH, Smits MM, et al. Glomerular Hyperfiltration in Diabetes: Mechanisms, Clinical Significance, and Treatment. J Am Soc Nephrol. 2017;28(4):1023-1039. doi: https://doi.org/10.1681/ASN.2016060666Wanner C, Inzucchi SE, Lachin JM, et al. Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes. N Engl J Med. 2016;375(4):323-334. doi: https://doi.org/10.1056/NEJMoa1515920Wanner C, Inzucchi SE, Lachin JM, et al. Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes. N Engl J Med. 2016;375(4):323-334. doi: https://doi.org/10.1056/NEJMoa1515920Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015;373(22):2117-2128. doi: https://doi.org/10.1056/NEJMoa1504720Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015;373(22):2117-2128. doi: https://doi.org/10.1056/NEJMoa1504720Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med. 2017;377(7):644-657. doi: https://doi.org/10.1056/NEJMoa1611925Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med. 2017;377(7):644-657. doi: https://doi.org/10.1056/NEJMoa1611925Wiviott SD, Raz I, Bonaca MP, et al. Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2019;380(4):347-357. doi: https://doi.org/10.1056/NEJMoa1812389Wiviott SD, Raz I, Bonaca MP, et al. Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2019;380(4):347-357. doi: https://doi.org/10.1056/NEJMoa1812389Cherney DZI, Charbonnel B, Cosentino F, et al. Effects of ertugliflozin on kidney composite outcomes, renal function and albuminuria in patients with type 2 diabetes mellitus: an analysis from the randomised VERTIS CV trial. Diabetologia. 2021;64(6):1256-1267. doi: https://doi.org/10.1007/s00125-021-05407-5Cherney DZI, Charbonnel B, Cosentino F, et al. Effects of ertugliflozin on kidney composite outcomes, renal function and albuminuria in patients with type 2 diabetes mellitus: an analysis from the randomised VERTIS CV trial. Diabetologia. 2021;64(6):1256-1267. doi: https://doi.org/10.1007/s00125-021-05407-5Zelniker TA, Wiviott SD, Raz I, et al. SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet. 2019;393(10166):31-39. doi: https://doi.org/10.1016/S0140-6736(18)32590-XZelniker TA, Wiviott SD, Raz I, et al. SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet. 2019;393(10166):31-39. doi: https://doi.org/10.1016/S0140-6736(18)32590-XPerkovic V, Jardine MJ, Neal B, et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019;380:2295-2306. doi: https://doi.org/10.1056/NEJMoa1811744Perkovic V, Jardine MJ, Neal B, et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy. N Engl J Med. 2019;380:2295-2306. doi: https://doi.org/10.1056/NEJMoa1811744Brenner BM, Cooper ME, de Zeeuw D, et al. RENAAL Study Investigators. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001;345(12):861-869. doi: https://doi.org/10.1056/NEJMoa011161Brenner BM, Cooper ME, de Zeeuw D, et al. RENAAL Study Investigators. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001;345(12):861-869. doi: https://doi.org/10.1056/NEJMoa011161Lewis EJ, Hunsicker LG, Clarke WR, et al. Collaborative Study Group. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med. 2001;345(12):851-860. doi: https://doi.org/10.1056/NEJMoa011303Lewis EJ, Hunsicker LG, Clarke WR, et al. Collaborative Study Group. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med. 2001;345(12):851-860. doi: https://doi.org/10.1056/NEJMoa011303Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al. DAPA-CKD Trial Committees and Investigators. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2020;383(15):1436-1446. doi: https://doi.org/10.1056/NEJMoa2024816Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al. DAPA-CKD Trial Committees and Investigators. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2020;383(15):1436-1446. doi: https://doi.org/10.1056/NEJMoa2024816Jardine MJ, Zhou Z, Mahaffey KW, et al. CREDENCE Study Investigators. Renal, Cardiovascular, and Safety Outcomes of Canagliflozin by Baseline Kidney Function: A Secondary Analysis of the CREDENCE Randomized Trial. J Am Soc Nephrol. 2020;31(5):1128-1139. doi: https://doi.org/10.1681/ASN.2019111168Jardine MJ, Zhou Z, Mahaffey KW, et al. CREDENCE Study Investigators. Renal, Cardiovascular, and Safety Outcomes of Canagliflozin by Baseline Kidney Function: A Secondary Analysis of the CREDENCE Randomized Trial. J Am Soc Nephrol. 2020;31(5):1128-1139. doi: https://doi.org/10.1681/ASN.2019111168Bakris G, Oshima M, Mahaffey KW, et al. Effects of Canagliflozin in Patients with Baseline eGFR <30 ml/min per 1.73 m(2): Subgroup Analysis of the Randomized CREDENCE Trial. Clin J Am Soc Nephrol. 2020;15(12):1705-1714. doi: https://doi.org/10.2215/CJN.10140620Bakris G, Oshima M, Mahaffey KW, et al. Effects of Canagliflozin in Patients with Baseline eGFR <30 ml/min per 1.73 m(2): Subgroup Analysis of the Randomized CREDENCE Trial. Clin J Am Soc Nephrol. 2020;15(12):1705-1714. doi: https://doi.org/10.2215/CJN.10140620Herat LY, Magno AL, Rudnicka C, et al. SGLT2 Inhibitor–Induced Sympathoinhibition. JACC Basic to Transl Sci. 2020;5(2):169-179. doi: https://doi.org/10.1016/j.jacbts.2019.11.007Herat LY, Magno AL, Rudnicka C, et al. SGLT2 Inhibitor–Induced Sympathoinhibition. JACC Basic to Transl Sci. 2020;5(2):169-179. doi: https://doi.org/10.1016/j.jacbts.2019.11.007El-Achkar TM, Ohmit SE, Mccullough PA, et al. Higher prevalence of anemia with diabetes mellitus in moderate kidney insufficiency: The Kidney Early Evaluation Program. Kidney Int. 2005;67(4):1483-1488. doi: https://doi.org/10.1111/j.1523-1755.2005.00226.xEl-Achkar TM, Ohmit SE, Mccullough PA, et al. Higher prevalence of anemia with diabetes mellitus in moderate kidney insufficiency: The Kidney Early Evaluation Program. Kidney Int. 2005;67(4):1483-1488. doi: https://doi.org/10.1111/j.1523-1755.2005.00226.xLambers Heerspink HJ, de Zeeuw D, Wie L, et al. Dapagliflozin a glucose-regulating drug with diuretic properties in subjects with type 2 diabetes. Diabetes Obes Metab. 2013;15(9):853-862. doi: https://doi.org/10.1111/dom.12127Lambers Heerspink HJ, de Zeeuw D, Wie L, et al. Dapagliflozin a glucose-regulating drug with diuretic properties in subjects with type 2 diabetes. Diabetes Obes Metab. 2013;15(9):853-862. doi: https://doi.org/10.1111/dom.12127Oshima M, Neuen BL, Jardine MJ, et al. Effects of canagliflozin on anaemia in patients with type 2 diabetes and chronic kidney disease: a post-hoc analysis from the CREDENCE trial. Lancet Diabetes Endocrinol. 2020;8(11):903-914. doi: https://doi.org/10.1016/S2213-8587(20)30300-4Oshima M, Neuen BL, Jardine MJ, et al. Effects of canagliflozin on anaemia in patients with type 2 diabetes and chronic kidney disease: a post-hoc analysis from the CREDENCE trial. Lancet Diabetes Endocrinol. 2020;8(11):903-914. doi: https://doi.org/10.1016/S2213-8587(20)30300-4Inzucchi SE, Zinman B, Fitchett D, et al. How Does Empagliflozin Reduce Cardiovascular Mortality? Insights From a Mediation Analysis of the EMPA-REG OUTCOME Trial. Diabetes Care. 2018;41(2):356-363. doi: https://doi.org/10.2337/dc17-1096Inzucchi SE, Zinman B, Fitchett D, et al. How Does Empagliflozin Reduce Cardiovascular Mortality? Insights From a Mediation Analysis of the EMPA-REG OUTCOME Trial. Diabetes Care. 2018;41(2):356-363. doi: https://doi.org/10.2337/dc17-1096Li J, Neal B, Perkovic V, et al. Mediators of the effects of canagliflozin on kidney protection in patients with type 2 diabetes. Kidney Int. 2020;98(3):769-777. doi: https://doi.org/10.1016/j.kint.2020.04.051Li J, Neal B, Perkovic V, et al. Mediators of the effects of canagliflozin on kidney protection in patients with type 2 diabetes. Kidney Int. 2020;98(3):769-777. doi: https://doi.org/10.1016/j.kint.2020.04.051Neuen BL, Oshima M, Perkovic V, et al. Effects of canagliflozin on serum potassium in people with diabetes and chronic kidney disease: the CREDENCE trial. Eur Heart J. 2021;42(48):4891-4901. doi: https://doi.org/10.1093/eurheartj/ehab497Neuen BL, Oshima M, Perkovic V, et al. Effects of canagliflozin on serum potassium in people with diabetes and chronic kidney disease: the CREDENCE trial. Eur Heart J. 2021;42(48):4891-4901. doi: https://doi.org/10.1093/eurheartj/ehab497Arnott C, Li JW, Cannon CP, et al. The effects of canagliflozin on heart failure and cardiovascular death by baseline participant characteristics: Analysis of the CREDENCE trial. Diabetes Obes Metab. 2021;23(7):1652-1659. doi: https://doi.org/10.1111/dom.14386Arnott C, Li JW, Cannon CP, et al. The effects of canagliflozin on heart failure and cardiovascular death by baseline participant characteristics: Analysis of the CREDENCE trial. Diabetes Obes Metab. 2021;23(7):1652-1659. doi: https://doi.org/10.1111/dom.14386Mahaffey KW, Jardine MJ, Bompoint S, et al. Canagliflozin and Cardiovascular and Renal Outcomes in Type 2 Diabetes Mellitus and Chronic Kidney Disease in Primary and Secondary Cardiovascular Prevention Groups. Circulation. 2019;140(9):739-750. doi: https://doi.org/10.1161/CIRCULATIONAHA.119.042007Mahaffey KW, Jardine MJ, Bompoint S, et al. Canagliflozin and Cardiovascular and Renal Outcomes in Type 2 Diabetes Mellitus and Chronic Kidney Disease in Primary and Secondary Cardiovascular Prevention Groups. Circulation. 2019;140(9):739-750. doi: https://doi.org/10.1161/CIRCULATIONAHA.119.042007Дедов И.И., Шестакова М.В., Майоров А.Ю., и др. Алгоритмы специализированной медицинской помощи больным сахарным диабетом. 10-й выпуск (дополненный). — М.: 2021. Доступно по: https://www.endocrincentr.ru/sites/default/files/specialists/science/clinicrecomendations/algoritmy_sd_kniga_10-y_vypusk_dopolnennyy.pdfDedov II, Shestakova MV, Maiorov AYu, et al. Algoritmy spetsializirovannoi meditsinskoi pomoshchi bol’nym sakharnym diabetom. 10-i vypusk (dopolnennyi). Moscow: 2021. (In Russ.). Доступно по: https://www.endocrincentr.ru/sites/default/files/specialists/science/clinicrecomendations/algoritmy_sd_kniga_10-y_vypusk_dopolnennyy.pdfAmerican Diabetes Association. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2021. Diabetes Care. 2021;44(S1):S111-124. doi: https://doi.org/10.2337/dc21-S009American Diabetes Association. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2021. Diabetes Care. 2021;44(S1):S111-124. doi: https://doi.org/10.2337/dc21-S009Polidori D, Sha S, Mudaliar S, et al. Canagliflozin lowers postprandial glucose and insulin by delaying intestinal glucose absorption in addition to increasing urinary glucose excretion: results of a randomized, placebo-controlled study. Diabetes Care. 2013;36(8):2154-2161. doi: https://doi.org/10.2337/dc12-2391Polidori D, Sha S, Mudaliar S, et al. Canagliflozin lowers postprandial glucose and insulin by delaying intestinal glucose absorption in addition to increasing urinary glucose excretion: results of a randomized, placebo-controlled study. Diabetes Care. 2013;36(8):2154-2161. doi: https://doi.org/10.2337/dc12-2391Zaccardi F, Webb DR, Htike ZZ, et al. Efficacy and safety of sodium-glucose co-transporter-2 inhibitors in type 2 diabetes mellitus: systematic review and network meta-analysis. Diabetes Obes Metab. 2016;18(8):783-794. doi: https://doi.org/10.1111/dom.12670Zaccardi F, Webb DR, Htike ZZ, et al. Efficacy and safety of sodium-glucose co-transporter-2 inhibitors in type 2 diabetes mellitus: systematic review and network meta-analysis. Diabetes Obes Metab. 2016;18(8):783-794. doi: https://doi.org/10.1111/dom.12670See RM, Teo YN, Teo YH, et al. Effects of Sodium-Glucose Cotransporter 2 on Amputation Events: A Systematic Review and Meta-Analysis of Randomized-Controlled Trials. Pharmacology. 2021:1-8. doi: https://doi.org/10.1159/000520903See RM, Teo YN, Teo YH, et al. Effects of Sodium-Glucose Cotransporter 2 on Amputation Events: A Systematic Review and Meta-Analysis of Randomized-Controlled Trials. Pharmacology. 2021:1-8. doi: https://doi.org/10.1159/000520903Дедов И.И., Шестакова М.В., Майоров А.Ю. и др. Алгоритмы специализированной медицинской помощи больным сахарным диабетом: Клинические рекомендации (Вып. 9) // Сахарный диабет. — 2019. — Т. 22. — №S1. — С.1-144. doi: https://doi.org/10.14341/DM221S1Dedov II, Shestakova MV, Mayorov AYu, et al. Standards of specialized diabetes care. Diabetes Mellitus. 2019;22(S1):1-144 (In Russ.). doi: https://doi.org/10.14341/DM221S1Buse JB, Wexler DJ, Tsapas A, et al. 2019 Update to: Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2020;43(2):487-493. doi: https://doi.org/10.2337/dci19-0066Buse JB, Wexler DJ, Tsapas A, et al. 2019 Update to: Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2020;43(2):487-493. doi: https://doi.org/10.2337/dci19-0066Garber AJ, Handelsman Y, Grunberger G, et al. Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Comprehensive Type 2 Diabetes Management Algorithm — 2020 Executive Summary. Endocr Pract. 2020;26(1):107-139. doi: https://doi.org/10.4158/CS-2019-0472Garber AJ, Handelsman Y, Grunberger G, et al. Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Comprehensive Type 2 Diabetes Management Algorithm — 2020 Executive Summary. Endocr Pract. 2020;26(1):107-139. doi: https://doi.org/10.4158/CS-2019-0472Durkin M, Blais J. Linear Projection of Estimated Glomerular Filtration Rate Decline with Canagliflozin and Implications for Dialysis Utilization and Cost in Diabetic Nephropathy. Diabetes Ther. 202112(2):499–508. doi: https://doi.org/10.1007/s13300-020-00953-4Durkin M, Blais J. Linear Projection of Estimated Glomerular Filtration Rate Decline with Canagliflozin and Implications for Dialysis Utilization and Cost in Diabetic Nephropathy. Diabetes Ther. 202112(2):499–508. doi: https://doi.org/10.1007/s13300-020-00953-4

The authors declare that there are no conflicts of interest present.