Department of Diabetology, Careggi Hospital and University of Florence, Florence, Italy.
Cardiovascular Department, Ospedale San Donato, Arezzo, Italy.
Diabetes Obes Metab. 2018 May;20(5):1213-1222. doi: 10.1111/dom.13221. Epub 2018 Feb 11.
Sodium glucose co-transport-2 (SGLT-2) inhibitors reduce tubular glucose reabsorption, producing a reduction of blood glucose without stimulating insulin release. The aim of this meta-analysis was the systematic collection of available data from randomized trials, in order to establish the durability of the efficacy of SGLT-2 inhibitors on glycaemic control and body mass index.
A meta-analysis was performed, including all trials with a duration of at least 12 weeks, comparing SGLT-2 inhibitors with non-SGLT-2 inhibitor agents in type 2 diabetes. The principal outcome was the effect of SGLT-2 inhibitors on hemoglobin A1c (HbA1c) at 12, 24, 52 and 104 weeks. Data on body mass index at the same time points were also collected.
Among 66 randomized trials, HbA1c reduction at 12, 24, 52 and 104 weeks was 0.63% (0.57; 0.68, 0.63% (0.57; 0.70), 0.66% (0.57; 0.74) and 0.60% (0.40; 0.81), respectively. SGLT-2 inhibitors showed a greater efficacy than dipeptidyl-peptidase-4 inhibitors (DPP-4i). Sulfonylureas appeared to be superior to SGLT-2 inhibitors at 12 weeks, but not at 24 and 52 weeks; SGLT-2 inhibitors produced a greater reduction in HbA1c than did sulfonylureas at 104 weeks. SGLT-2 inhibitor-induced weight loss in placebo-controlled trials appeared to increase progressively with the duration of treatment.
SGLT-2 inhibitors showed a good persistence of efficacy, at least up to 2 years, with a small but significant superiority over DPP-4i. Sulfonylureas are more effective in the very short term, but less effective in the longer term.
钠-葡萄糖协同转运蛋白 2（SGLT-2）抑制剂可减少肾小管对葡萄糖的重吸收，从而在不刺激胰岛素释放的情况下降低血糖。本荟萃分析的目的是系统收集来自随机试验的可用数据，以确定 SGLT-2 抑制剂在血糖控制和体重指数方面的疗效持久性。
进行了一项荟萃分析，纳入了至少持续 12 周的比较 SGLT-2 抑制剂与 2 型糖尿病非 SGLT-2 抑制剂的所有试验。主要结局是 SGLT-2 抑制剂对糖化血红蛋白（HbA1c）的影响，时间点为 12、24、52 和 104 周。还收集了同一时间点体重指数的数据。
在 66 项随机试验中，SGLT-2 抑制剂在 12、24、52 和 104 周时的 HbA1c 降低分别为 0.63%（0.57；0.68）、0.60%（0.57；0.70）、0.66%（0.57；0.74）和 0.60%（0.40；0.81）。SGLT-2 抑制剂的疗效优于二肽基肽酶-4 抑制剂（DPP-4i）。磺酰脲类药物在 12 周时似乎优于 SGLT-2 抑制剂，但在 24 和 52 周时则不然；SGLT-2 抑制剂在 104 周时使 HbA1c 降低的效果优于磺酰脲类药物。在安慰剂对照试验中，SGLT-2 抑制剂引起的体重减轻似乎随着治疗时间的延长而逐渐增加。
SGLT-2 抑制剂至少在 2 年内疗效持久，与 DPP-4i 相比具有较小但显著的优势。磺酰脲类药物在短期内效果更好，但在长期内效果较差。
