Doosti-Irani Amin, Ostadmohammadi Vahidreza, Mirhosseini Naghmeh, Mansournia Mohammad Ali, Reiter Russel J, Kashanian Maryam, Rahimi Maryam, Razavi Maryamalsadat, Asemi Zatollah
Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
Modeling of Noncommunicable Diseases Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
Horm Metab Res. 2018 Nov;50(11):783-790. doi: 10.1055/a-0752-8462. Epub 2018 Nov 5.
This systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to clarify the effect of melatonin supplementation on glycemic control. Databases including PubMed, MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials were searched until July 30th, 2018. Two reviewers independently assessed study eligibility, extracted data, and evaluated the risk of bias for included trials. Heterogeneity among included studies was assessed using Cochran's Q test and I-square (I) statistic. Data were pooled using random-effect models and standardized mean difference (MD) was considered as the overall effect size. Twelve trials out of 292 selected reports were identified eligible to be included in current meta-analysis. The pooled findings indicated that melatonin supplementation significantly reduced fasting glucose (SMD=-6.34; 95% CI, -12.28, -0.40; p=0.04; I: 65.0) and increased the quantitative insulin sensitivity check index (QUICKI) (SMD=0.01; 95% CI, 0.00, 0.02; p=0.01; I: 0.0). However, melatonin administration did not significantly influence insulin levels (SMD=-1.03; 95% CI, -3.82, 1.77; p=0.47; I: 0.53), homeostasis model assessment of insulin resistance (HOMA-IR) (SMD=-0.34; 95% CI, -1.25, 0.58; p=0.37; I: 0.37) or HbA1c levels (SMD=-0.22; 95% CI, -0.47, 0.03; p=0.08; I: 0.0). In summary, the current meta-analysis showed a promising effect of melatonin supplementation on glycemic control through reducing fasting glucose and increasing QUICKI, yet additional prospective studies are recommended, using higher supplementation doses and longer intervention period, to confirm the impact of melatonin on insulin levels, HOMA-IR and HbA1c.
本系统评价和随机对照试验（RCT）的荟萃分析旨在阐明补充褪黑素对血糖控制的影响。检索了包括PubMed、MEDLINE、EMBASE、科学网和Cochrane对照试验中央注册库在内的数据库，检索截至2018年7月30日。两名评价者独立评估研究的纳入资格、提取数据并评估纳入试验的偏倚风险。使用Cochran's Q检验和I²统计量评估纳入研究之间的异质性。采用随机效应模型合并数据，并将标准化均数差（MD）视为总体效应量。在292篇选定报告中，有12项试验被确定符合纳入当前荟萃分析的条件。汇总结果表明，补充褪黑素可显著降低空腹血糖（SMD=-6.34；95%CI，-12.28，-0.40；p=0.04；I²：65.0）并增加定量胰岛素敏感性检查指数（QUICKI）（SMD=0.01；95%CI，0.00，0.02；p=0.01；I²：0.0）。然而，服用褪黑素对胰岛素水平（SMD=-1.03；95%CI，-3.82，1.77；p=0.47；I²：0.53）、胰岛素抵抗稳态模型评估（HOMA-IR）（SMD=-0.34；95%CI，-1.25，0.58；p=0.37；I²：0.37）或糖化血红蛋白（HbA1c）水平（SMD=-0.22；95%CI，-0.47，0.03；p=0.08；I²：0.0）无显著影响。总之，当前的荟萃分析显示补充褪黑素通过降低空腹血糖和增加QUICKI对血糖控制有显著作用，但建议进行更多前瞻性研究，采用更高的补充剂量和更长的干预期，以确认褪黑素对胰岛素水平、HOMA-IR和HbA1c的影响。
