Cai Xiaoling, Yang Wenjia, Gao Xueying, Zhou Lingli, Han Xueyao, Ji Linong
Peking University People's Hospital, Endocrine & Metabolism Department, Beijing, China.
PLoS One. 2016 Dec 9;11(12):e0166625. doi: 10.1371/journal.pone.0166625. eCollection 2016.
The aim of this study is to compare the effects of hypoglycemic treatments in groups of patients categorized according to the mean baseline body mass indexes (BMIs).
Studies were identified by a literature search and all the studies were double blind, placebo-controlled randomized trials in type 2 diabetes patients; study length of ≥12 weeks with the efficacy evaluated by changes in HbA1c from baseline in groups. The electronic search was first conducted in January 2015 and repeated in June 2015.
227 studies were included. Treatment with sulfonylureas was compared with placebo in overweight patients and resulted in a significantly greater change in the HbA1c levels (weighted mean difference (WMD), -1.39%) compared to obese patients (WMD, -0.77%)(p<0.05). Treatment with metformin in overweight patients resulted in a comparable change in the HbA1c levels (WMD, -0.99%) compared to obese patients (WMD, -1.06%)(p>0.05). Treatment with alpha glucosidase inhibitors in normal weight patients was associated with a HbA1c change (WMD, -0.94%) that was comparable that in overweight (WMD, -0.72%) and obese patients (WMD, -0.56%)(p>0.05). Treatment with thiazolidinediones in normal weight patients was associated with a HbA1c change (WMD, -1.04%) that was comparable with that in overweight (WMD, -1.02%) and obese patients (WMD, -0.88%)(p>0.05). Treatment with DPP-4 inhibitors in normal weight patients was associated with a HbA1c change (WMD, -0.93%) that was comparable with that in overweight (WMD, -0.66%) and obese patients (WMD, -0.61%)(p>0.05). In total, of the seven hypoglycemic agents, regression analysis indicated that the mean baseline BMI was not associated with the mean HbA1c changes from baseline.
In each kind of hypoglycemic therapy in type 2 diabetes, the baseline BMI was not associated with the efficacy of HbA1c changes from baseline.
本研究旨在比较根据平均基线体重指数（BMI）分类的患者组中降糖治疗的效果。
通过文献检索确定研究，所有研究均为2型糖尿病患者的双盲、安慰剂对照随机试验；研究时长≥12周，疗效通过各组糖化血红蛋白（HbA1c）相对于基线的变化进行评估。电子检索于2015年1月首次进行，并于2015年6月重复进行。
纳入227项研究。超重患者中，磺脲类药物治疗与安慰剂相比，糖化血红蛋白水平变化显著更大（加权平均差（WMD），-1.39%），而肥胖患者中该变化为（WMD，-0.77%）（p<0.05）。超重患者中，二甲双胍治疗导致的糖化血红蛋白水平变化（WMD，-0.99%）与肥胖患者（WMD，-1.06%）相当（p>0.05）。正常体重患者中，α-葡萄糖苷酶抑制剂治疗导致的糖化血红蛋白变化（WMD，-0.94%）与超重患者（WMD，-0.72%）和肥胖患者（WMD，-0.56%）相当（p>0.05）。正常体重患者中，噻唑烷二酮类药物治疗导致的糖化血红蛋白变化（WMD，-1.04%）与超重患者（WMD，-1.02%）和肥胖患者（WMD，-0.88%）相当（p>0.05）。正常体重患者中，二肽基肽酶-4（DPP-4）抑制剂治疗导致的糖化血红蛋白变化（WMD，-0.93%）与超重患者（WMD，-0.66%）和肥胖患者（WMD，-0.61%）相当（p>0.05）。总体而言，在这七种降糖药物中，回归分析表明平均基线BMI与糖化血红蛋白相对于基线的平均变化无关。
在2型糖尿病的每种降糖治疗中，基线BMI与糖化血红蛋白相对于基线变化的疗效无关。
