Baker IDI Heart and Diabetes Institute, Clinical Diabetes and Epidemiology, Melbourne, Australia; Department of Endocrinology, Diabetology and Metabolic Disease, Avicenne Hospital, SMBH, Paris 13, Bobigny, France; UMR U557 Inserm/U1125 Inra/CNAM/Université Paris 13, Sorbonne Paris Cité, Bobigny, France.
Baker IDI Heart and Diabetes Institute, Clinical Diabetes and Epidemiology, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Victoria, Australia.
Diabetes Res Clin Pract. 2016 Nov;121:27-34. doi: 10.1016/j.diabres.2016.08.011. Epub 2016 Aug 26.
To identify the determinants of efficacy of glucagon-like peptide-1 receptor agonists (GLP-1A) and dipeptidyl peptidase-4 inhibitors (DPP-4I).
MEDLINE and EMBASE were searched between 01/01/2011 and 15/08/2014 for randomized controlled trials of 12-52weeks' duration, which reported the change in glycated hemoglobin (HbA1c) from baseline as the primary end point, and reported data about predictors of efficacy of incretins.
Among 4172 studies found, 77 studies reported data on baseline HbA1c, age, sex, ethnicity, body mass index (BMI), and history of diabetes in relation to change in HbA1c. For DPP-4I, 37 out of 47 studies reported a greater decrease in HbA1c among patients with higher baseline HbA1c. Most DPP-4I studies reported no variation in efficacy in regard to demographic characteristics or BMI. Among 17 studies reporting on GLP-1A, baseline higher HbA1c was reported as predictive of a greater response in 7 out of 9 studies; 13 studies reported data about other factors, without consistent findings.
Current evidence suggests that higher baseline HbA1c is associated with a greater efficacy of both DPP-4I and GLP-1A therapies in lowering HbA1c. The roles of other potential predictors are less consistent across studies and require further investigation.
确定胰高血糖素样肽-1 受体激动剂（GLP-1A）和二肽基肽酶-4 抑制剂（DPP-4I）疗效的决定因素。
在 2011 年 1 月 1 日至 2014 年 8 月 15 日期间，通过 MEDLINE 和 EMBASE 检索了 12-52 周随机对照试验，这些试验以糖化血红蛋白（HbA1c）从基线的变化作为主要终点，并报告了关于肠降血糖素疗效预测因素的数据。
在 4172 项研究中，有 77 项研究报告了基线 HbA1c、年龄、性别、种族、体重指数（BMI）和糖尿病史与 HbA1c 变化的关系数据。对于 DPP-4I，47 项研究中有 37 项研究报告称，基线 HbA1c 较高的患者 HbA1c 下降幅度更大。大多数 DPP-4I 研究报告称，在人口统计学特征或 BMI 方面，疗效没有差异。在报告 GLP-1A 的 17 项研究中，有 7 项研究报告称，基线 HbA1c 较高与更大的反应相关；13 项研究报告了其他因素的数据，但没有一致的发现。
目前的证据表明，较高的基线 HbA1c 与 DPP-4I 和 GLP-1A 治疗降低 HbA1c 的疗效更大相关。其他潜在预测因素的作用在不同研究中不太一致，需要进一步研究。
