Domecq Juan Pablo, Prutsky Gabriela, Elraiyah Tarig, Wang Zhen, Mauck Karen F, Brito Juan Pablo, Undavalli Chaitanya, Sundaresh Vishnu, Prokop Larry J, Montori Victor M, Murad M Hassan
Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota.
Division of Nephrology, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.
J Clin Endocrinol Metab. 2019 Sep 1;104(9):3986-3995. doi: 10.1210/jc.2019-01269.
The extent to which some pharmacological interventions reduce or increase the risk of biochemical conversion to type 2 diabetes mellitus (T2DM) in at-risk individuals is unclear.
We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, and Scopus through 24 August 2017 for randomized controlled trials evaluating the effect of drugs suspected to modify the risk of biochemical conversion to T2DM.
We included 43 trials with 192,156 subjects (mean age, 60 years; 56% men; mean body mass index, 30.4 kg/m2). α-Glucosidase inhibitors, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, metformin, orlistat, phentermine/topiramate, and pioglitazone significantly reduced the risk of biochemical conversion to T2DM, whereas statins and nateglinide increased the risk. There was insufficient direct evidence regarding the effects of sulfonylureas, glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, and sodium-glucose cotransporter-2 inhibitors. Most trials were brief and evaluated this outcome during treatment without a withdrawal or washout period.
Several drugs modify the risk of biochemical conversation to T2DM, although whether this effect is persistent and clinically relevant is unclear. Future studies need to focus on cardiovascular disease prevention, mortality, and patient-important outcomes instead of biochemical conversion to T2DM.
某些药物干预措施在高危个体中降低或增加生化转化为2型糖尿病（T2DM）风险的程度尚不清楚。
我们检索了截至2017年8月24日的MEDLINE、Embase、Cochrane对照试验中心注册库、Cochrane系统评价数据库和Scopus，以查找评估怀疑可改变生化转化为T2DM风险的药物效果的随机对照试验。
我们纳入了43项试验，涉及192,156名受试者（平均年龄60岁；56%为男性；平均体重指数30.4kg/m²）。α-葡萄糖苷酶抑制剂、血管紧张素转换酶抑制剂、血管紧张素II受体阻滞剂、二甲双胍、奥利司他、芬特明/托吡酯和吡格列酮显著降低了生化转化为T2DM的风险，而他汀类药物和那格列奈则增加了风险。关于磺脲类药物、胰高血糖素样肽-1受体激动剂、二肽基肽酶-4抑制剂和钠-葡萄糖协同转运蛋白-2抑制剂的效果，没有足够的直接证据。大多数试验时间较短，且在治疗期间评估这一结果，没有撤药或洗脱期。
几种药物可改变生化转化为T2DM的风险，尽管这种效果是否持续以及是否具有临床相关性尚不清楚。未来的研究需要关注心血管疾病预防、死亡率和对患者重要的结局，而非生化转化为T2DM。
