Department of Geriatric Endocrinology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
Department of Endocrinology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China.
J Diabetes Investig. 2019 Mar;10(2):446-457. doi: 10.1111/jdi.12876. Epub 2018 Jul 26.
AIMS/INTRODUCTION: In the present meta-analysis, we aimed to determine the effects of sodium-glucose cotransporter 2 inhibitor (SGLT-2i) in addition to insulin therapy on cardiovascular risk factors in type 2 diabetes patients.
Randomized controlled trials were identified by searching the PubMed, Embase and Cochrane Library databases published before September 2017. The intervention group received SGLT-2i as add-on treatment to insulin therapy, and the control group received placebos in addition to insulin. We assessed pooled data, including weighted mean differences and 95% confidence intervals (CIs) using a random-effects model.
A total of 10 randomized controlled trials (n = 5,159) were eligible. The weighted mean differences for systolic blood pressure and diastolic blood pressure were -3.17 mmHg (95% CI -4.53, -1.80, I = 0%) and -1.60 mmHg (95% CI -2.52, -0.69, I = 0%) in the intervention groups. Glycosylated hemoglobin, fasting plasma glucose, postprandial glucose and daily insulin were also lower in the intervention groups, with relative weighted mean differences of -0.49% (95% CI -0.71, -0.28%, I = 92%), -1.10 mmol/L (95% CI -1.69, -0.51 mmol/L, I = 84%), -3.63 mmol/L (95% CI -4.36, -2.89, I = 0%) and -5.42 IU/day (95% CI -8.12, -2.72, I = 93%). The transformations of uric acid and bodyweight were -26.16 μmol/L (95% CI -42.14, -10.17, I = 80%) and -2.13 kg (95% CI -2.66, -1.60, I = 83%). The relative risk of hypoglycemia was 1.09 (95% CI 1.02, 1.17, P < 0.01). The relative risks of urinary tract and genital infection were 1.29 (95% CI 1.03, 1.62, P = 0.03) and 5.25 (95% CI 3.55, 7.74, P < 0.01).
The results showed that in the intervention group, greater reductions were achieved for blood pressure, glucose control, uric acid and bodyweight. This treatment regimen might therefore provide beneficial effects on the occurrence and development of cardiovascular events.
目的/引言：本荟萃分析旨在确定钠-葡萄糖共转运蛋白 2 抑制剂（SGLT-2i）联合胰岛素治疗对 2 型糖尿病患者心血管风险因素的影响。
通过检索 PubMed、Embase 和 Cochrane 图书馆数据库，确定了随机对照试验，检索时间截至 2017 年 9 月前。干预组接受 SGLT-2i 作为胰岛素治疗的附加治疗，对照组在接受胰岛素治疗的同时给予安慰剂。我们采用随机效应模型评估了包括加权均数差值和 95%置信区间（CI）在内的汇总数据。
共有 10 项随机对照试验（n=5159）符合纳入标准。干预组的收缩压和舒张压的加权均数差值分别为-3.17mmHg（95%CI-4.53，-1.80，I=0%）和-1.60mmHg（95%CI-2.52，-0.69，I=0%）。干预组的糖化血红蛋白、空腹血糖、餐后血糖和每日胰岛素用量也较低，相对加权均数差值分别为-0.49%（95%CI-0.71，-0.28%，I=92%）、-1.10mmol/L（95%CI-1.69，-0.51mmol/L，I=84%）、-3.63mmol/L（95%CI-4.36，-2.89，I=0%）和-5.42IU/天（95%CI-8.12，-2.72，I=93%）。尿酸和体重的变化分别为-26.16μmol/L（95%CI-42.14，-10.17，I=80%）和-2.13kg（95%CI-2.66，-1.60，I=83%）。低血糖的相对风险为 1.09（95%CI1.02，1.17，P<0.01）。尿路感染和生殖道感染的相对风险分别为 1.29（95%CI1.03，1.62，P=0.03）和 5.25（95%CI3.55，7.74，P<0.01）。
结果表明，在干预组中，血压、血糖控制、尿酸和体重的降低更为显著。因此，这种治疗方案可能对心血管事件的发生和发展具有有益影响。
