medicina59巻12号

2022年11月発行

特集 避けて通れない心不全診療—総合内科力・循環器力を鍛えよう！ 心不全発症予防

糖尿病患者における心不全ステージA・Bの治療およびステージCにさせない方法を教えてください

著者： 遠藤慶太¹ 鈴木利彦¹

所属機関： ¹東京ベイ・浦安市川医療センター腎臓・内分泌・糖尿病内科

ページ範囲：P.2272 - P.2278

Point
◎糖尿病は心不全のリスクであり，心不全は糖尿病のリスクである．
◎糖尿病は高血糖，インスリン抵抗性，高インスリン血症を背景として多彩な機序で心不全を起こす．
◎糖尿病治療では，心不全発症予防（ステージA，B）という観点でのエビデンスは限られている．
◎心不全における，新規糖尿病治療薬の有効性が期待される．

参考文献

1）Dunlay SM, et al：Type 2 diabetes mellitus and heart failure；A scientific statement from the American Heart Association and the Heart Failure Society of America；This statement does not represent an update of the 2017 ACC/AHA/HFSA heart failure guideline update. Circulation 140：e294-e324, 2019

2）日本循環器学会/日本心不全学会：2017年改訂版　急性・慢性心不全診療ガイドライン，2018　https://www.j-circ.or.jp/cms/wp-content/uploads/2017/06/JCS2017_tsutsui_h.pdf（2022年8月閲覧）

3）Marwick TH, et al：Implications of underlying mechanisms for the recognition and management of diabetic cardiomyopathy. J Am Coll Cardiol 71：339-351, 2018

4）Tate M, et al：Insulin replacement limits progression of diabetic cardiomyopathy in the low-dose streptozotocin-induced diabetic rat. Diab Vasc Dis Res 14：423-433, 2017

5）Iribarren C, et al：Glycemic control and heart failure among adult patients with diabetes. Circulation 103：2668-2673, 2001

6）Preiss D, et al：Predictors of development of diabetes in patients with chronic heart failure in the Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity（CHARM）program. Diabetes Care 32：915-920, 2009

7）Preiss D, et al：Eplerenone and new-onset diabetes in patients with mild heart failure；Results from the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure（EMPHASIS-HF）. Eur J Heart Fail 14：909-915, 2012

8）Sato A：The necessity and effectiveness of mineralocorticoid receptor antagonist in the treatment of diabetic nephropathy. Hypertens Res 38：367-374, 2015

9）Oellgaard J, et al：Reduced risk of heart failure with intensified multifactorial intervention in individuals with type 2 diabetes and microalbuminuria；21 years of follow-up in the randomised Steno-2 study. Diabetologia 61：1724-1733, 2018

10）Wright AK, et al：Primary prevention of cardiovascular and heart failure events with SGLT2 inhibitors, GLP-1 receptor agonists, and their combination in type 2 diabetes. Diabetes Care 45：909-918, 2022

11）Packer M：SGLT2 inhibitors produce cardiorenal benefits by promoting adaptive cellular reprogramming to induce a state of fasting mimicry；A paradigm shift in understanding their mechanism of action. Diabetes Care 43：508-511, 2020

12）Lopaschuk GD, Verma S：Mechanisms of cardiovascular benefits of Sodium Glucose Co-Transporter 2（SGLT2）inhibitors；A state-of-the-art review. JACC Basic Transl Sci 5：632-644, 2020

13）Zelniker TA, 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 393：31-39, 2019

14）Carraro-Lacroix LR, et al：Regulation of Na＋/H＋ exchanger NHE3 by glucagon-like peptide 1 receptor agonist exendin-4 in renal proximal tubule cells. Am J Physiol Renal Physiol 297：F1647-1655, 2009

15）Marso SP, et al：Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med 375：311-322, 2016

16）Gerstein HC, et al：Dulaglutide and cardiovascular outcomes in type 2 diabetes（REWIND）A double-blind, randomised placebo-controlled trial. Lancet 394：121-130, 2019

17）American Diabetes Association Professional Practice Committee：9. Pharmacologic approaches to glycemic treatment；Standards of medical care in diabetes-2022. Diabetes Care 45（Suppl 1）：S125-S143, 2022

18）Filippatos G, et al：Finerenone reduces risk of incident heart failure in patients with chronic kidney disease and type 2 diabetes；Analyses from the FIGARO-DKD Trial. Circulation 145：437-447, 2022

19）Triggle CR, et al：Metformin;Is it a drug for all reasons and diseases? Metabolism 133：155223, 2022

20）Holman RR, et al：10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 359：1577-1589, 2008

21）Crowley MJ, et al：Clinical outcomes of metformin use in populations with chronic kidney disease, congestive heart failure, or chronic liver disease；A systematic review. Ann Intern Med 166：191-200, 2017