Hou Liqiong, Zhao Tieyun, Liu Yunhui, Zhang Yiyi
Department of Endocrinology and Metabolism, West China Hospital of Sichuan University, Chengdu, Sichuan 610000, P.R. China.
Exp Ther Med. 2015 Apr;9(4):1528-1536. doi: 10.3892/etm.2015.2277. Epub 2015 Feb 9.
Previous randomized controlled trials (RCTs) have reported conflicting results for the efficacy of sitagliptin and sulfonylurea therapy in patients with type 2 diabetes mellitus showing inadequate glycemic control with metformin monotherapy. To clarify these findings, a meta-analysis was conducted of the outcomes of all published RCTs comparing sitagliptin with sulfonylureas in the treatment of type 2 diabetes mellitus. Standard medical databases were searched to identify relevant English- and Chinese-language RCTs. RCT results were compared regarding the mean change in glycated hemoglobin (HbA1c) level; the proportion achieving <7% HbAlc; and a change in body weight. No significant differences were found between the metformin plus sitagliptin and metformin plus sulfonylurea groups regarding HbAlc or the proportion achieving <7% HbAlc, while the metformin plus sitagliptin group experienced fewer hypoglycemic events (P<0.00001) and a greater reduction in body weight (P<0.00001). Metformin plus sitagliptin therapy may decrease HbAlc values in patients with type 2 diabetes mellitus who are not achieving their glycemic targets with metformin monotherapy in a manner similar to metformin plus sulfonylurea therapy, whilst posing a lower risk of hypoglycemia, and yielding a more beneficial effect on body weight.
既往随机对照试验（RCT）报告了西他列汀与磺脲类药物治疗二甲双胍单药治疗血糖控制不佳的2型糖尿病患者疗效的相互矛盾的结果。为了阐明这些发现，对所有已发表的比较西他列汀与磺脲类药物治疗2型糖尿病的RCT结果进行了荟萃分析。检索了标准医学数据库以识别相关的英文和中文RCT。比较了RCT结果中糖化血红蛋白（HbA1c）水平的平均变化、HbA1c<7%的比例以及体重变化。二甲双胍加西他列汀组与二甲双胍加磺脲类药物组在HbA1c或HbA1c<7%的比例方面未发现显著差异，而二甲双胍加西他列汀组发生低血糖事件较少（P<0.00001）且体重下降幅度更大（P<0.00001）。对于二甲双胍单药治疗未达到血糖目标的2型糖尿病患者，二甲双胍加西他列汀治疗可能以类似于二甲双胍加磺脲类药物治疗的方式降低HbA1c值，同时低血糖风险较低，且对体重产生更有益的影响。
