Dai Danping, Mao Yiyang, Jin Haiying, Zhang Wei
Department of Pharmacy, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, Zhejiang, China.
Medicine (Baltimore). 2019 Sep;98(36):e17081. doi: 10.1097/MD.0000000000017081.
The purpose of this study was to assess the efficacy and hypoglycemic risk of sitagliptin versus that of GLP-1 receptor agonists in the management of obese/overweight patients with T2DM.
EMBASE, PubMed, Cochrane Library, and ClinicalTrials.gov were searched; randomized controlled trials comparing the efficacy of sitagliptin versus that of GLP-1 receptor agonists in obese/overweight patients with T2DM were included. The mean BMI of participants for each study was ≥30 kg/m. We conducted a meta-analysis according to the methods specified in the Cochrane Handbook for Systematic Reviews of Interventions. RevMan 5.1 software was used to perform the meta-analysis. The Cochrane Q test and I statistics were used to estimate the heterogeneity among studies. The results are expressed as the mean difference (MD) or risk ratio (RR) with 95% confidence intervals.
A total of 8 eligible studies were included in our meta-analysis. Compared with GLP-1 receptor agonists, sitagliptin was less effective at reducing HbA1c (0.42 [0.27, 0.56]), FPG (0.78 [0.36, 1.19]), PPG (2.61 [1.35, 3.87]), and body weight (1.42 [0.71, 2.14]). Conversely, there were no significant differences in SBP reduction (0.38 [-1.14, 1.89]), DBP reduction (-0.30 [-1.00, 0.39]), and hypoglycemic risk (1.09 [0.50, 2.35]).
For obese/overweight patients, sitagliptin may exert a less potent effect on HbA1C, FPG, PPG, and weight reduction than GLP-1 receptor agonists, but these drugs had a similar efficacy in reducing blood pressure; furthermore, there was no significant difference in hypoglycemic risk.
本研究旨在评估西他列汀与胰高血糖素样肽-1（GLP-1）受体激动剂在治疗肥胖/超重2型糖尿病（T2DM）患者时的疗效及低血糖风险。
检索了EMBASE、PubMed、Cochrane图书馆和ClinicalTrials.gov；纳入比较西他列汀与GLP-1受体激动剂治疗肥胖/超重T2DM患者疗效的随机对照试验。每项研究参与者的平均体重指数（BMI）≥30kg/m²。我们根据《Cochrane干预措施系统评价手册》中规定的方法进行了荟萃分析。使用RevMan 5.1软件进行荟萃分析。采用Cochrane Q检验和I²统计量估计研究间的异质性。结果以平均差（MD）或风险比（RR）及95%置信区间表示。
我们的荟萃分析共纳入8项符合条件的研究。与GLP-1受体激动剂相比，西他列汀在降低糖化血红蛋白（HbA1c）（0.42 [0.27, 0.56]）、空腹血糖（FPG）（0.78 [0.36, 1.19]）、餐后血糖（PPG）（2.61 [1.35, 3.87]）和体重（1.42 [0.71, 2.14]）方面效果较差。相反，在收缩压降低（0.38 [-1.14, 1.89]）、舒张压降低（-0.30 [-1.00, 0.39]）和低血糖风险（1.09 [0.50, 2.35]）方面无显著差异。
对于肥胖/超重患者，西他列汀在降低HbA1c、FPG、PPG和减轻体重方面的效果可能不如GLP-1受体激动剂，但这些药物在降低血压方面疗效相似；此外，低血糖风险无显著差异。
