Kim Y G, Hahn S, Oh T J, Park K S, Cho Y M
Division of endocrinology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
Diabetes Obes Metab. 2014 Oct;16(10):900-9. doi: 10.1111/dom.12293. Epub 2014 Apr 15.
To compare the HbA1c-lowering efficacy of glucagon-like peptide-1 (GLP-1) analogues between Asians and non-Asians with type 2 diabetes.
We searched randomized controlled trials from MEDLINE, EMBASE, LILACS, CENTRAL and ClinicalTrials.gov. Studies described in English were included if the treatment duration was 12 weeks or more, information about ethnicity and baseline HbA1c values were available and a GLP-1 analogue was compared with a placebo. For the ethnic comparison, we divided the studies into Asian-dominant studies (≥ 50% Asian participants) and non-Asian-dominant studies (<50% Asian participants).
Among the 837 searched studies, 15 trials were included for the meta-analysis. The weighted mean difference of HbA1c with GLP-1 analogues was -1.16% [95% confidence interval (CI) -1.48, -0.85] in the Asian-dominant studies and -0.83% (95% CI -0.97, -0.70) in the non-Asian-dominant studies. The between-group difference was -0.32% (95% CI -0.64, -0.01; p = 0.04). The relative risk (RR) with 95% CIs for achieving the target HbA1c ≤ 7.0% tended to be greater in the Asian-dominant studies [RR 5.7 (3.8, 8.7)] than in the non-Asian-dominant studies [RR 2.8 (2.4, 3.3)]. Body weight changes were similar between the two groups. Hypoglycaemia tended to be more common in Asian-dominant studies (RR 2.8 [2.3, 3.5]) than in non-Asian-dominant studies (RR 1.5 [1.2, 1.8]), but severe hypoglycaemia was very rare in both groups.
GLP-1 analogues lower HbA1c more in Asian-dominant studies than in non-Asian-dominant studies. Further studies are warranted to explore the potential mechanisms of the ethnic difference.
比较亚洲和非亚洲2型糖尿病患者中胰高血糖素样肽-1（GLP-1）类似物降低糖化血红蛋白（HbA1c）的疗效。
我们检索了MEDLINE、EMBASE、LILACS、CENTRAL和ClinicalTrials.gov上的随机对照试验。如果治疗持续时间为12周或更长，有关于种族和基线HbA1c值的信息，并且将GLP-1类似物与安慰剂进行比较，则纳入英文描述的研究。对于种族比较，我们将研究分为亚洲主导型研究（亚洲参与者≥50%）和非亚洲主导型研究（亚洲参与者<50%）。
在检索的837项研究中，15项试验纳入荟萃分析。在亚洲主导型研究中，GLP-1类似物降低HbA1c的加权平均差为-1.16%[95%置信区间（CI）-1.48，-0.85]，在非亚洲主导型研究中为-0.83%（95%CI-0.97，-0.70）。组间差异为-0.32%（95%CI-0.64，-0.01；p=0.04）。亚洲主导型研究中达到目标HbA1c≤7.0%的95%CI相对危险度（RR）[RR 5.7（3.8，8.7）]往往高于非亚洲主导型研究[RR 2.8（2.4，3.3）]。两组体重变化相似。低血糖在亚洲主导型研究（RR 2.8[2.3，3.5]）中往往比在非亚洲主导型研究（RR 1.5[1.2，1.8]）中更常见，但两组严重低血糖都非常罕见。
在亚洲主导型研究中，GLP-1类似物降低HbA1c的效果比非亚洲主导型研究中更显著。有必要进一步研究以探索种族差异的潜在机制。
