Wang Weihao, Liu Hongyan, Xiao Shumin, Liu Shuaihui, Li Xin, Yu Pei
Key Laboratory of Hormones and Development (Ministry of Health), Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China.
Department of Nephrology and Dialysis, Medical University of Tianjin, Tianjin, China.
Diabetes Ther. 2017 Aug;8(4):727-738. doi: 10.1007/s13300-017-0282-3. Epub 2017 Jun 14.
Combination therapy with insulin and glucagon-like peptide-1 receptor agonists (GLP-1RAs) has already been proven an efficient treatment option for type 2 diabetes. This combination can effectively improve glycated hemoglobin levels, cause weight loss and reduce the dosage of insulin. In addition, it can also reduce the risk of hypoglycemia. Several randomized controlled trials have confirmed that this treatment may be just as effective for type 1 diabetes mellitus (T1DM) patients. The objective of this meta-analysis was to assess the effects and efficacy of the treatment on glycemic changes, weight loss and insulin dosage in type 1 diabetes mellitus patients.
We searched Embase, PubMed and Cochrane for randomized controlled trials (no time restrictions) that investigated combined insulin and GLP-1 treatment. The main endpoints were measurements of glycated hemoglobin and changes in the weight and the dosage of insulin.
In total, 1093 were studies identified, and 7 studies were included in our meta-analysis. GLP-1 agonist and insulin combination therapy led to greater reductions in HbA1c levels [P = 0.03; mean difference -0.21; 95% confidence intervals (CI) (-0.40, 0.02)] and weight [P < 0.05; -3.53 (-4.86, 2.19)] compared to control treatments. The combination therapy did not significantly influence the daily weight-adjusted total insulin dose [P = 0.05; -0.11 (-0.23, 0)], but it did reduce the daily weight-adjusted bolus insulin dose [P = 0.001; -0.06 (-0.1, 0.02)].
Our meta-analysis supports the use of a combined therapeutic regimen of insulin and GLP-1RAs for treating patients with T1DM. Combination therapy with GLP-1 and insulin could achieve an ideal treatment effect on glycemic control, weight loss and bolus insulin dose in patients with T1DM.
胰岛素与胰高血糖素样肽-1受体激动剂（GLP-1RAs）联合治疗已被证明是2型糖尿病的一种有效治疗选择。这种联合治疗可有效改善糖化血红蛋白水平、导致体重减轻并减少胰岛素剂量。此外，它还可降低低血糖风险。多项随机对照试验已证实，这种治疗对1型糖尿病（T1DM）患者可能同样有效。本荟萃分析的目的是评估该治疗对1型糖尿病患者血糖变化、体重减轻和胰岛素剂量的影响及疗效。
我们在Embase、PubMed和Cochrane中检索了调查胰岛素与GLP-1联合治疗的随机对照试验（无时间限制）。主要终点是糖化血红蛋白的测量值以及体重和胰岛素剂量的变化。
总共识别出1093项研究，7项研究纳入了我们的荟萃分析。与对照治疗相比，GLP-1激动剂与胰岛素联合治疗使糖化血红蛋白水平降低幅度更大[P = 0.03；平均差值-0.21；95%置信区间（CI）（-0.40，0.02）]，体重降低幅度更大[P < 0.05；-3.53（-4.86，2.19）]。联合治疗对每日体重调整后的总胰岛素剂量没有显著影响[P = 0.05；-0.11（-0.23，0）]，但确实降低了每日体重调整后的速效胰岛素剂量[P = 0.001；-0.06（-0.1，0.02）]。
我们的荟萃分析支持使用胰岛素与GLP-1RAs联合治疗方案来治疗T1DM患者。GLP-1与胰岛素联合治疗可在T1DM患者的血糖控制、体重减轻和速效胰岛素剂量方面取得理想的治疗效果。
