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他汀类药物治疗 2 型糖尿病患者的血糖控制:荟萃分析。

Statin therapy on glycaemic control in type 2 diabetes: a meta-analysis.

机构信息

The Affiliated ZhongDa Hospital of Southeast University, Department of Endocrinology, No. 87 DingJiaQiao Road, Nanjing, 210009, PR China.

出版信息

Expert Opin Pharmacother. 2013 Aug;14(12):1575-84. doi: 10.1517/14656566.2013.810210. Epub 2013 Jul 5.

Abstract

OBJECTIVE

Randomised controlled trials (RCTs) indicate that statin therapy has cardiovascular benefit among patients with type 2 diabetes. Recently, statins were reported to increase risk of diabetes by 9%. The aim was to investigate by a meta-analysis whether statins deteriorate glycaemic control in type 2 diabetes.

METHODS

Medline, EMBASE and Cochrane Central Register of Controlled Trials from 1966 to 2012 were searched for RCTs of statins. Included were only trials with type 2 diabetes.

MAIN OUTCOME MEASURES

The I(2) statistic was used to measure heterogeneity between trials and calculated mean differences for glycaemic parameters with random-effect meta-analysis.

RESULTS

26 eligible studies were identified with 3232 participants. Statin therapy had no remarkable influence on HbA1c (WMD 0.04%, 95% CI -0.08 to 0.16, I² = 45.7%, n = 3070), FPG (2.25 mg/dl, 95% CI -3.50 to 7.99, I² = 46%, n = 1176), BMI, fasting insulin or HOMA-IR. However, subgroup analysis showed significant, detrimental effect of atorvastatin on HbA1c, whereas simvastatin presented an ameliorative effect. Meta-regression presented that neither baseline age nor relative reduction in LDL-cholesterol concentrations accounted for residual heterogeneity.

CONCLUSION

Statin therapy showed non-significant effect on glycaemic control in type 2 diabetes. Statin therapy need not change among them with moderate or high cardiovascular risk or existing cardiovascular disease.

摘要

目的

随机对照试验(RCT)表明,他汀类药物治疗对 2 型糖尿病患者具有心血管益处。最近,有报道称他汀类药物会使糖尿病风险增加 9%。本研究旨在通过荟萃分析来研究他汀类药物是否会使 2 型糖尿病患者的血糖控制恶化。

方法

检索了 1966 年至 2012 年期间的 Medline、EMBASE 和 Cochrane 对照试验中心注册库,以寻找他汀类药物的 RCT。仅纳入了针对 2 型糖尿病的试验。

主要观察指标

采用 I² 统计量来衡量试验间的异质性,并采用随机效应荟萃分析计算血糖参数的平均差异。

结果

确定了 26 项符合条件的研究,共纳入了 3232 名参与者。他汀类药物治疗对 HbA1c(WMD 0.04%,95%CI-0.08 至 0.16,I²=45.7%,n=3070)、FPG(2.25mg/dl,95%CI-3.50 至 7.99,I²=46%,n=1176)、BMI、空腹胰岛素或 HOMA-IR 无明显影响。然而,亚组分析显示阿托伐他汀对 HbA1c 有显著的不良影响,而辛伐他汀则有改善作用。Meta 回归分析表明,基线年龄或 LDL-胆固醇浓度的相对降低均不能解释残留的异质性。

结论

他汀类药物治疗对 2 型糖尿病患者的血糖控制无显著影响。对于中高危心血管风险或已有心血管疾病的患者,他汀类药物的治疗无需改变。

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