Hussein Humaira, Zaccardi Francesco, Khunti Kamlesh, Davies Melanie J, Patsko Emily, Dhalwani Nafeesa N, Kloecker David E, Ioannidou Ekaterini, Gray Laura J
Department of Health Sciences, University of Leicester, Leicester, UK.
Diabetes Research Centre, University of Leicester, Leicester, UK.
Diabetes Obes Metab. 2020 Jul;22(7):1035-1046. doi: 10.1111/dom.14008. Epub 2020 Mar 18.
To compare the efficacy and tolerability of sodium-glucose co-transporter 2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) in adults with type 2 diabetes.
Electronic databases were searched from inception to 24 April 2019 for randomized controlled trials reporting change in glycated haemoglobin (HbA1c) at approximately 24 and/or 52 weeks for SGLT-2is and/or GLP-1RAs (classified as short- and long-acting). Bayesian network meta-analyses were conducted to compare within and between SGLT-2i and GLP-1RA classes for cardiometabolic efficacy and adverse events (PROSPERO registration number: CRD42018091306).
Sixty-four trials (53 trials of 24 weeks; seven trials of 52 weeks; four trials of both 24 and 52 weeks), comprising 31 384 participants were identified. Compared with placebo, all treatments improved HbA1c. Long-acting GLP-1RAs reduced HbA1c compared with short-acting GLP-1RAs and SGLT-2is, with semaglutide showing greater reduction compared with placebo [24 weeks: -1.49% (95% credible interval: -1.76, -1.22); 52 weeks: -1.38% (-2.05, -0.71)] and all other treatments. Long-acting GLP-1RAs showed benefits in body weight and waist circumference reduction, while SGLT-2is reduced blood pressure. SGLT-2is showed increased risk of genital infection in comparison with long-acting GLP-1RAs [odds ratio (95% credible interval): 5.26 (1.45, 25.00)], while GLP-1RAs showed increased risk of diarrhoea in comparison with SGLT-2is [short-acting GLP-1RAs: 1.65 (1.09, 2.49); long-acting GLP-1RAs: 2.23 (1.51, 3.28)]. No other differences were found between SGLT-2is and GLP-1RAs in adverse events.
Long-acting GLP-1RAs showed superiority in reducing HbA1c levels, body weight and waist circumference. SGLT-2is showed reductions in blood pressure levels. This review provides essential evidence to guide treatment recommendations in the management of type 2 diabetes.
比较钠-葡萄糖协同转运蛋白2抑制剂（SGLT-2i）和胰高血糖素样肽-1受体激动剂（GLP-1RA）在成年2型糖尿病患者中的疗效和耐受性。
检索电子数据库，时间范围从建库至2019年4月24日，查找关于SGLT-2i和/或GLP-1RA（分为短效和长效）在约24周和/或52周时糖化血红蛋白（HbA1c）变化的随机对照试验。进行贝叶斯网络荟萃分析，以比较SGLT-2i和GLP-1RA类别内及类别间的心脏代谢疗效和不良事件（PROSPERO注册号：CRD42018091306）。
共纳入64项试验（24周的试验53项；52周的试验7项；24周和52周的试验均有的4项），涉及31384名参与者。与安慰剂相比，所有治疗均能改善HbA1c。长效GLP-1RA与短效GLP-1RA和SGLT-2i相比，可降低HbA1c，其中司美格鲁肽与安慰剂相比降低幅度更大[24周：-1.49%（95%可信区间：-1.76，-1.22）；52周：-1.38%（-2.05，-0.71）]，且优于所有其他治疗。长效GLP-1RA在减轻体重和减小腰围方面有优势，而SGLT-2i可降低血压。与长效GLP-1RA相比，SGLT-2i发生生殖器感染的风险增加[比值比（95%可信区间）：5.26（1.45，25.00）]，而与SGLT-2i相比，GLP-1RA发生腹泻的风险增加[短效GLP-1RA：1.65（1.09，2.49）；长效GLP-1RA：2.23（1.51，3.28）]。在不良事件方面，SGLT-2i和GLP-1RA之间未发现其他差异。
长效GLP-1RA在降低HbA1c水平、体重和腰围方面表现出优越性。SGLT-2i可降低血压水平。本综述为指导2型糖尿病管理中的治疗推荐提供了重要证据。
