Metabolic and functional effects of complex therapy of renal and cardiovascular pathology with sodium-glucose cotransporter type 2 inhibitors in patients with diabetes mellitus and Covid-19 (review)
Background: Studying the mechanisms of development of chronic kidney pathology and concomitant disorders of the cardiovascular system in patients with type 2 diabetes mellitus (DM2) and its combination with Covid-19 remains an urgent problem. Modern methods of treating patients with diabetes recommend the use of a new class of drugs – inhibitors of the activity of sodium-glucose cotransporter-2, as well as those stimulating insulin secretion: glucagon-like peptide agonists, dipeptidyl pentidase-4 inhibitors. The aim of the study:Analysis of literature data on the mechanisms of action of sodium glucose cotransporter inhibitors in the treatment of chronic renal and cardiovascular pathology in patients with DM and Covid-19. Materials and methods: The methodological approaches used in the review to achieve this goal are based on the study of abstract databases: PubMed, Google scholar, E-library literature sources of the last 10 years (more than 135 sources), of which the review included data from 58 articles: 24 original articles, 18 reviews, 6 meta-analyses, 1 letter to the editor, 1 randomized trial, 6 retrospective cohort studies, 2 European and American Association position statements. Results: The mechanisms of action of type 2 SGLT inhibitors are considered in the light of reno- and cardioprotection. The ability of NGLT-2 to have a positive effect on the processes of proximal reabsorption of glucose and sodium, as well as on the glomerular filtration rate (GFR) was revealed. An analysis of the mechanisms of the relationship between diabetes and Covid-19 was carried out. The antioxidant capacity of these drugs was established due to the suppression of LPO activity in the mitochondria of the cells of the proximal tubules of the kidneys. The hypoglycemic effect of NGLT-2, improvement of glycemic control, reduction of body weight and blood pressure has been established. In the group of patients with type 2 diabetes, taking empagliflazine caused a suppression of the incidence of increases in creatinine by 46%, and the need for renal replacement therapy by 55% compared with placebo. Follow-up of patients showed long-term stabilization of renal function, which was reflected in the maintenance of GFR levels and a reduction in deaths by 40%. The mechanisms of action of other drugs were analyzed: metformin and glucocorticoids in diabetes and Covid-19. Conclusion: Epidemiological studies have revealed that diabetes is a risk factor for the development of pathology of the cardiorenal system in combination with Covid-19. The inclusion of SGLT-2 inhibitors in antidiabetic therapy can increase the effectiveness of treatment and their ability to provide nephroprotective and cardioprotective effects
Dzugkoev SG, Dzugkoeva FS, Khubulova AE, et al. Metabolic and functional effects of complex therapy of renal and cardiovascular pathology with sodium-glucose cotransporter type 2 inhibitors in patients with diabetes mellitus and Covid-19 (review). Research Results in Biomedicine. 2025;11(2):286-302. Russian. DOI:10.18413/2658-6533-2025-11-2-0-6
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