porozendoОстеопороз и остеопатииOsteoporosis and Bone Diseases2072-26802311-0716Endocrinology Research Centre10.14341/osteo12718porozendo-12718Research ArticleОригинальное исследованиеOriginal studyВлияние эмпаглифлозина на фосфорно-кальциевый метаболизм у больных сахарным диабетом 2 типа с сохранной функцией почекEffect of empagliflozin on phosphorus and calcium metabolism in patients with type 2 diabetes mellitus with preserved kidney functionhttps://orcid.org/0000-0003-1808-1331ЛебедевД. А.LebedevD. A.

Лебедев Денис Андреевич. eLibrary SPIN: 3588-2999

Институт эндокринологии

194156, Санкт-Петербург, пр. Пархоменко, д. 15

Denis A. Lebedev. eLibrary SPIN: 3588-2999

Institute of Endocrinology

15 Parkhomenko street, St. Petersburg, 194156

doctorlebedev11@gmail.comhttps://orcid.org/0000-0001-9836-5427ТимкинаН. В.TimkinaN. V.

Тимкина Наталья Владимировна. eLibrary SPIN: 6259-7745

Институт эндокринологии

Санкт-Петербург

Natalia V. Timkina. eLibrary SPIN: 6259-7745

Institute of Endocrinology

St. Petersburg

n.timkina2014@yandex.ruhttps://orcid.org/0000-0002-1547-0123КароноваТ. Л.KaronovaT. L.

Каронова Татьяна Леонидовна, д.м.н., профессор. eLibrary SPIN: 3337-4071

Институт эндокринологии

Санкт-Петербург

Tatiana L. Karonova , MD, PhD, professor. eLibrary SPIN: 3337-4071

Institute of Endocrinology

St. Petersburg

karonova@mail.ruhttps://orcid.org/0000-0002-4878-6909АндрееваА. Т.AndreevaA. T.

Андреева Алена Тимуровна. eLibrary SPIN: 6051-7214

Институт эндокринологии

Санкт-Петербург

Alena T. Andreeva. eLibrary SPIN: 6051-7214

Institute of Endocrinology

St. Petersburg

arabicaa@gmail.comhttps://orcid.org/0000-0002-2882-9406КокинаМ. А.KokinaM. A.

Кокина Мария Александровна

Институт эндокринологии

Санкт-Петербург

Maria A. Kokina

Institute of Endocrinology

St. Petersburg

mapillika@yandex.ruhttps://orcid.org/0000-0003-0888-8991ГригорьеваА. Л.GrigorievaA. L.

Григорьева Александра Леонидовна

Санкт-Петербург

Alexandra L. Grigorieva

St. Petersburg

alexagri@mail.ruhttps://orcid.org/0000-0002-0559-697XБабенкоА. Ю.BabenkoA. Yu.

Бабенко Алина Юрьевна, д.м.н., профессор. eLibrary SPIN: 9388-1077

Институт эндокринологии

Санкт-Петербург

Alina Yu. Babenko, MD, PhD, professor. eLibrary SPIN: 9388-1077

Institute of Endocrinology

St. Petersburg

alina_babenko@mail.ruГриневаЕ. Н.GrinevaE. N.

Гринева Елена Николаевна, д.м.н., профессор. eLibrary SPIN: 2703-0841

Институт эндокринологии

Санкт-Петербург

Elena N. Grineva, MD, PhD, professor. eLibrary SPIN: 2703-0841

Institute of Endocrinology

St. Petersburg

grineva_e@mail.ruНациональный медицинский исследовательский центр им. А.А. АлмазоваРоссияAlmazov National Medical Research CentreRussian FederationКлиническая ревматологическая больница №25РоссияClinical Rheumatological Hospital № 25Russian Federation20212408202124149Copyright © Лебедев Д.А., Тимкина Н.В., Каронова Т.Л., Андреева А.Т., Кокина М.А., Григорьева А.Л., Бабенко А.Ю., Гринева Е.Н., 20212021Лебедев Д.А., Тимкина Н.В., Каронова Т.Л., Андреева А.Т., Кокина М.А., Григорьева А.Л., Бабенко А.Ю., Гринева Е.Н.Lebedev D.A., Timkina N.V., Karonova T.L., Andreeva A.T., Kokina M.A., Grigorieva A.L., Babenko A.Y., Grineva E.N.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.osteo-endojournals.ru/jour/article/view/12718Обоснование

Обоснование. Ингибиторы натрий-глюкозного ко-транспортера 2 типа (ИНГТ2) являются сахароснижающими препаратами и зарегистрированы для лечения сахарного диабета 2 типа (СД2). В ходе клинических исследований данных препаратов были получены доказательства повышенного риска переломов и влияния на уровни фосфора, витамина D и паратиреоидного гормона (ПТГ).

Цель

Цель. В связи с этим целью данного исследования было изучить влияние наиболее селективного ИНГТ2 эмпаглифлозина на параметры фосфорно-кальциевого обмена у пациентов с СД2 и сохранной функцией почек.

Материалы и методы

Материалы и методы. Тридцать девять пациентов с СД2 получали эмпаглифлозин в дозе 10 мг в дополнение к сахароснижающим препаратам в течение 12 нед. Перед началом лечения была проведена двухэнергетическая рентгеновская абсорбциометрия (DXA) с оценкой трабекулярного костного индекса (ТКИ). В начале и в конце исследования оценивали концентрацию фосфора (P), общего (оСа) и ионизированного кальция (Са++), фактора роста фибробластов-23 (ФРФ-23), 25(OH)D и ПТГ.

Результаты

Результаты. По результатам DXA только у 2 пациентов имел место остеопороз, у 10 (25,6%) пациентов показатели минеральной плотности кости (МПК) были ниже 1,35 г/см2 по шкале ТКИ. На фоне лечения эмпаглифлозином в течение 12 нед было получено значимое увеличение ФРФ-23. По сравнению с исходным уровнем не было получено статистически значимых различий в концентрациях P, оСа, Са++, ПТГ и 25(ОН)D через 12 нед лечения. Уровень ФРФ-23 не коррелировал с уровнем скорости клубочковой фильтрации ни до, ни после лечения (r=0,31, р=0,27 и r=0,39, p=0,55 соответственно). Кроме того, исходный уровень МПК с поправкой на ТКИ и исходный уровень 25(OH)D не коррелировали с концентрациями Са, Р, ФРФ-23 и ПТГ (p>0,05).

Заключение

Заключение. Таким образом, результаты исследования продемонстрировали влияние эмпаглифлозина на увеличение уровня ФРФ-23 без значительного изменения концентрации фосфора, кальция, 25(OH)D и ПТГ после 12 нед лечения у пациентов с СД2 и сохраненной функцией почек. Полученные данные подтвердили необходимость оценки ТКИ у больных СД2 для получения дополнительной информации о качестве костной ткани.

Background

Background: Sodium glucose co-transporter type 2 inhibitors (iSGLT2) are antihyperglycemic drugs approved for the treatment of type 2 diabetes mellitus (T2DM). Clinical trials with these drugs have shown evidence of an increased risk of fractures and an effect on phosphorus, vitamin D and parathyroid hormone (PTH) levels.

Aim

Aim: The aim of this study was to investigate the effect of the most selective iSGLT2 empagliflozin on the calcium and phosphorus metabolism in patients with T2DM and preserved kidney function.

Materials and methods

Materials and methods: Thirty-nine T2DM patients were received empagliflozin 10 mg in addition to their antihyperglycemic drugs for 12 weeks. Before starting treatment, a dual-energy X-ray absorptiometry (DXA) with an assessment of the trabecular bone score (TBS) was performed. The concentration of phosphorus (P), total (tCa) and ionized calcium (Ca++), fibroblast growth factor 23 (FGF-23), 25(OH)D and PTH were assessed.

Results

Results: According to the DXA results, only 2 patients had osteoporosis, 10 (25.6%) patients had bone mineral density (BMD) values below 1.35 g /cm2 on the TCI scale. Treatment with empagliflozin for 12 weeks was lead to significant increase in FGF-23. Compared to the baseline level, there were no statistically significant differences in the concentrations of P, oCa, Ca++, PTH and 25(OH)D after 12 weeks of treatment. The level of FGF-23 did not correlate with the level of glomerular filtration rate either before or after treatment (r = 0.31, p = 0.27 and r = 0.39, p = 0.55, respectively). In addition, baseline BMD adjusted for TBS and baseline 25(OH)D did not correlate with Ca, F, FGF-23, and PTH concentrations (p>0.05).

Conclusion

Conclusion: Thus, empagliflozin has increased the level of FGF-23 without significant changes in the concentration of phosphorus, calcium, 25 (OH) D, and PTH after 12 weeks of treatment in patients with T2DM and preserved renal function. The obtained data confirmed the necessity to assess the TBS in patients with T2DM, because it’s provide additional information on the quality of bone tissue.

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