ภาวะน้ำหนักลดจากยายับยั้ง Sodium-glucose co-transporter 2

ผู้แต่ง

  • สรวิเชษฐ์ รัตนชัยวงศ์ สาขาวิชาโภชนวิทยาคลินิก ภาควิชาอายุรศาสตร์ คณะแพทยศาสตร์ มหาวิทยาลัยขอนแก่น

คำสำคัญ:

ภาวะน้ำหนักลด, ยายับยั้ง sodium-glucose co-transporter 2, โรคอ้วน, โรคเบาหวาน, ยาลดความอ้วน

บทคัดย่อ

ยายับยั้ง sodium-glucose co-transporter 2 (sodium-glucose co-transporter 2 inhibitor, SGLT2-i) เป็นยาลดระดับน้ำตาลที่มีผลข้างเคียงที่ทำให้ผู้ป่วยโรคเบาหวานสามารถลดน้ำหนักได้ โดยยา SGLT2-i จะทำให้ผู้ป่วยมีการสูญเสียกลูโคสออกไปทางปัสสาวะเพิ่มขึ้น ทำให้สมดุลพลังงานของผู้ป่วยเป็นลบและมีน้ำหนักลดลงได้ กลไกอื่น ๆ ที่อาจเกี่ยวข้องในการลดน้ำหนักของยา SGLT2-i ได้แก่ การทำให้ร่างกายสูญเสียน้ำนอกเซลล์ออกไปทางปัสสาวะมากขึ้นชั่วคราว กระตุ้นการใช้ไขมันในร่างกายเป็นแหล่งพลังงานมากขึ้น และอาจช่วยเพิ่มเมตาบอลิสมในร่างกายโดยการเพิ่มเนื้อเยื่อไขมันสีน้ำตาล (brown adipose tissue, BAT) ผู้ป่วยที่ได้รับยา SGLT-2i มักมีน้ำหนักลดลงอยู่ในช่วง 1-3 กิโลกรัม โดยน้ำหนักจะลดลงเร็วในช่วง 1-6 เดือนแรก หลังจากนั้นจะค่อย ๆ ลดลงอย่างช้า ๆ จนน้ำหนักเริ่มคงที่ที่ 6 เดือนถึง 1 ปีหลังใช้ยา โดยน้ำหนักที่หายไปส่วนใหญ่เป็นน้ำหนักของไขมันในร่างกาย ในขณะที่มวลกล้ามเนื้อและมวลกระดูกค่อนข้างคงที่ การแนะนำให้ผู้ป่วยควบคุมอาหารอย่างต่อเนื่อง พิจารณาเพิ่มขนาดของยา SGLT2-i หรือใช้ร่วมกับ glucagon-like peptide-1 receptor agonist (GLP-1 RA) อาจช่วยให้ผู้ป่วยลดน้ำหนักได้มากขึ้น ปัจจุบันยา SGLT2-i ยังไม่มีข้อบ่งชี้ในการใช้เป็นยาลดน้ำหนักในผู้ป่วยที่ไม่ได้เป็นโรคเบาหวาน

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2021-12-29

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