Wilkinson Samantha V, Tomlinson Laurie A, Iwagami Masao, Stirnadel-Farrant Heide A, Smeeth Liam, Douglas Ian
Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
RWD & Epidemiology, GSK R&D, Stevenage, SG1 2NY, UK.
Wellcome Open Res. 2018 Jun 19;3:74. doi: 10.12688/wellcomeopenres.14660.1. eCollection 2018.
: The development of kidney disease is a serious complication among people with type 2 diabetes mellitus, associated with substantially increased morbidity and mortality. We aimed to summarise the current evidence for the relationship between treatments for type 2 diabetes and long-term kidney outcomes, by conducting a systematic search and review of relevant studies. : We searched Medline, Embase and Web of Science, between 1st January 1980 and 15th May 2018 for published clinical trials and observational studies comparing two or more classes of oral therapy for type 2 diabetes. We included people receiving oral antidiabetic drugs. Studies were eligible that; (i) compared two or more classes of oral therapy for type 2 diabetes; (ii) reported kidney outcomes as primary or secondary outcomes; (iii) included more than 100 participants; and (iv) followed up participants for 48 weeks or more. Kidney-related outcome measures included were Incidence of chronic kidney disease, reduced eGFR, increased creatinine, 'micro' and 'macro' albuminuria. We identified 15 eligible studies, seven of which were randomised controlled trials and eight were observational studies. Reporting of specific renal outcomes varied widely. Due to variability of comparisons and outcomes meta-analysis was not possible. The majority of comparisons between treatment with metformin or sulfonylurea indicated that metformin was associated with better renal outcomes. Little evidence was available for recently introduced treatments or commonly prescribed combination therapies. : Comparative evidence for the effect of treatments for type 2 diabetes on renal outcomes, either as monotherapy or in combination is sparse.
在2型糖尿病患者中，肾脏疾病的发展是一种严重的并发症，与发病率和死亡率的大幅上升相关。我们旨在通过对相关研究进行系统检索和综述，总结2型糖尿病治疗方法与长期肾脏结局之间关系的现有证据。我们检索了1980年1月1日至2018年5月15日期间的Medline、Embase和科学网，以查找比较两种或更多类2型糖尿病口服治疗方法的已发表临床试验和观察性研究。我们纳入了接受口服抗糖尿病药物的人群。符合条件的研究需满足：（i）比较两种或更多类2型糖尿病口服治疗方法；（ii）将肾脏结局报告为主要或次要结局；（iii）纳入超过100名参与者；（iv）对参与者进行48周或更长时间的随访。纳入的与肾脏相关的结局指标包括慢性肾脏病的发病率、估算肾小球滤过率降低、肌酐升高、“微量”和“大量”白蛋白尿。我们确定了15项符合条件的研究，其中7项为随机对照试验，8项为观察性研究。特定肾脏结局的报告差异很大。由于比较和结局的变异性，无法进行荟萃分析。二甲双胍或磺脲类药物治疗之间的大多数比较表明，二甲双胍与更好的肾脏结局相关。对于最近引入的治疗方法或常用的联合治疗方法，几乎没有证据。关于2型糖尿病治疗方法作为单一疗法或联合疗法对肾脏结局影响比较的证据很少。
