胰高血糖素样肽-1 受体激动剂与基础胰岛素联合治疗 2 型糖尿病的系统评价和荟萃分析。
Glucagon-like peptide-1 receptor agonist and basal insulin combination treatment for the management of type 2 diabetes: a systematic review and meta-analysis.
机构信息
Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON, Canada.
Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON, Canada; Division of Endocrinology, University of Toronto, Toronto, ON, Canada.
出版信息
Lancet. 2014 Dec 20;384(9961):2228-34. doi: 10.1016/S0140-6736(14)61335-0. Epub 2014 Sep 11.
BACKGROUND
Combination treatment with a glucagon-like peptide-1 (GLP-1) agonist and basal insulin has been proposed as a treatment strategy for type 2 diabetes that could provide robust glucose-lowering capability with low risk of hypoglycaemia or weight gain. We thus did a systematic review and meta-analysis of randomised controlled trials to assess the effect of this combination treatment on glycaemic control, hypoglycaemia, and weight gain in patients with type 2 diabetes.
METHODS
We systematically searched PubMed, Embase, Cochrane, Web of Knowledge, FDA.gov, and ClinicalTrials.gov for randomised controlled trials (published between Jan 1, 1950, and July 29, 2014; no language restrictions) comparing GLP-1 agonist and basal insulin combination treatment to other anti-diabetic treatments. Our main endpoints were glycaemic control, hypoglycaemia, and change in weight. We assessed pooled data by use of a random-effects model.
FINDINGS
Of 2905 identified studies, 15 were eligible and were included in our analysis (N=4348 participants). Compared with other anti-diabetic treatments, GLP-1 agonist and basal insulin combination treatment yielded an improved mean reduction in glycated haemoglobin (HbA1c) of -0·44% (95% CI -0·60 to -0·29), an improved likelihood of achieving the target HbA1c of 7·0% or lower (relative risk [RR] 1·92; 95% CI 1·43 to 2·56), no increased relative risk of hypoglycaemia (0·99; 0·76 to 1·29), and a mean reduction in weight of -3·22 kg (-4·90 to -1·54). Furthermore, compared with basal-bolus insulin regimens, the combination treatment yielded a mean reduction in HbA1c of -0·1% (-0·17 to -0·02), with lower relative risk of hypoglycaemia (0·67, 0·56 to 0·80), and reduction in mean weight (-5·66 kg; -9·8 to -1·51).
INTERPRETATION
GLP-1 agonist and basal insulin combination treatment can enable achievement of the ideal trifecta in diabetic treatment: robust glycaemic control with no increased hypoglycaemia or weight gain. This combination is thus a potential therapeutic strategy that could improve the management of patients with type 2 diabetes.
FUNDING
None.
背景
胰高血糖素样肽-1（GLP-1）激动剂和基础胰岛素的联合治疗已被提议作为 2 型糖尿病的治疗策略，它可以提供强大的降糖能力，同时低血糖或体重增加的风险较低。因此，我们进行了一项系统评价和荟萃分析，以评估这种联合治疗对 2 型糖尿病患者血糖控制、低血糖和体重增加的影响。
方法
我们系统地检索了 PubMed、Embase、Cochrane、Web of Knowledge、FDA.gov 和 ClinicalTrials.gov，以查找 1950 年 1 月 1 日至 2014 年 7 月 29 日期间发表的（无语言限制）比较 GLP-1 激动剂和基础胰岛素联合治疗与其他抗糖尿病治疗的随机对照试验。我们的主要终点是血糖控制、低血糖和体重变化。我们使用随机效应模型评估汇总数据。
结果
在 2905 项确定的研究中，有 15 项符合条件并纳入了我们的分析（N=4348 名参与者）。与其他抗糖尿病治疗相比，GLP-1 激动剂和基础胰岛素联合治疗可显著降低糖化血红蛋白（HbA1c）均值-0.44%（95%CI-0.60 至-0.29），显著提高达到 7.0%或更低目标 HbA1c 的可能性（相对风险[RR]1.92；95%CI 1.43 至 2.56），低血糖的相对风险无增加（0.99；0.76 至 1.29），体重均值降低-3.22kg（-4.90 至-1.54）。此外，与基础-餐时胰岛素方案相比，联合治疗可使 HbA1c 均值降低-0.1%（-0.17 至-0.02），低血糖的相对风险更低（0.67，0.56 至 0.80），体重均值降低（-5.66kg；-9.8 至-1.51）。
解释
GLP-1 激动剂和基础胰岛素联合治疗可以实现糖尿病治疗的理想三重奏：强大的血糖控制，无增加的低血糖或体重增加。因此，这种联合治疗是一种潜在的治疗策略，可以改善 2 型糖尿病患者的管理。
资金
无。
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