基于特定临床情况的 2 型糖尿病患者为中心的管理：系统评价、荟萃分析和试验序贯分析。
Patient-centered Management of Type 2 Diabetes Mellitus Based on Specific Clinical Scenarios: Systematic Review, Meta-analysis and Trial Sequential Analysis.
机构信息
Internal Medicine Department, Post-graduate Program in Medical Sciences: Endocrinology, Universidade Federal do Rio Grande do Sul, Endocrine Division, Hospital de Clínicas de Porto Alegre, Endocrine Division, Ramiro Barcelos, Porto Alegre, Brazil.
Mount Sinai Hospital, University of Toronto, Toronto, Canada.
出版信息
J Clin Endocrinol Metab. 2020 Nov 1;105(11). doi: 10.1210/clinem/dgaa534.
INTRODUCTION
New antihyperglycemic medications have been proven to have cardiovascular (CV) and renal benefits in type 2 diabetes mellitus (T2DM); however, an evidence-based decision tree in specific clinical scenarios is lacking.
MATERIALS AND METHODS
Systematic review and meta-analysis of randomized controlled trials (RCTs), with trial sequential analysis (TSA). Randomized controlled trial inclusion criteria were patients with T2DM from 1 of these subgroups: elderly, obese, previous atherosclerotic CV disease (ASCVD), previous coronary heart disease (CHD), previous heart failure (HF), or previous chronic kidney disease (CKD). Randomized controlled trials describing those subgroups with at least 48 weeks of follow-up were included. Outcomes: 3-point major adverse cardiovascular events (MACE), CV death, hospitalization due to HF, and renal outcomes. We performed direct meta-analysis with the number of events in the intervention and control groups in each subset, and the relative risk of the events was calculated.
RESULTS
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) were the only antihyperglycemic agents related to a reduction in CV events in different populations. For obese and elderly populations, GLP-1 RA were associated with benefits in 3-point MACE; for patients with ASCVD, both SGLT2i and GLP-1 RA had benefits in 3-point MACE, while for patients with CHD, only SGLT2i were beneficial.
CONCLUSIONS
SGLT2i and GLP-1 RA reduced CV events in selected populations: SGLT2i led to a reduction in events in patients with previous CHD, ASCVD, and HF. GLP-1 RA led to a reduction in CV events in patients with ASCVD, elderly patients, and patients with obesity. Trial sequential analysis shows that these findings are conclusive. This review opens a pathway towards evidence-based, personalized treatment of T2DM.
REGISTRATION
PROSPERO CRD42019132807.
简介
新的抗高血糖药物已被证明在 2 型糖尿病（T2DM）中有心血管（CV）和肾脏获益；然而，在特定临床情况下缺乏基于证据的决策树。
材料和方法
系统评价和随机对照试验（RCT）的荟萃分析，结合试验序贯分析（TSA）。RCT 的纳入标准为来自以下亚组之一的 T2DM 患者：老年人、肥胖、既往动脉粥样硬化性心血管疾病（ASCVD）、既往冠心病（CHD）、既往心力衰竭（HF）或既往慢性肾脏病（CKD）。包括至少随访 48 周的描述这些亚组的随机对照试验。结局：3 点主要不良心血管事件（MACE）、CV 死亡、HF 住院和肾脏结局。我们对每个亚组的干预组和对照组中的事件数量进行了直接荟萃分析，并计算了事件的相对风险。
结果
钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）和胰高血糖素样肽 1 受体激动剂（GLP-1 RA）是唯一与不同人群 CV 事件减少相关的抗高血糖药物。对于肥胖和老年人群，GLP-1 RA 与 3 点 MACE 获益相关；对于 ASCVD 患者，SGLT2i 和 GLP-1 RA 均与 3 点 MACE 获益相关，而对于 CHD 患者，只有 SGLT2i 有益。
结论
SGLT2i 和 GLP-1 RA 减少了选定人群的 CV 事件：SGLT2i 导致既往 CHD、ASCVD 和 HF 患者的事件减少。GLP-1 RA 导致 ASCVD、老年患者和肥胖患者的 CV 事件减少。试验序贯分析表明这些发现是结论性的。这篇综述为基于证据的 T2DM 个体化治疗开辟了道路。
登记
PROSPERO CRD42019132807。
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