Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Diabetes Centre, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Diabetes Obes Metab. 2021 Sep;23(9):2116-2124. doi: 10.1111/dom.14451. Epub 2021 Jun 15.
To compare the effects of glucose-lowering drugs on body weight and blood pressure in adults with type 2 diabetes.
We searched Medline, Embase, the Cochrane Library, and grey literature sources until 29 September 2020 for randomized controlled trials of at least 24 weeks' duration assessing the effects of glucose-lowering drugs on body weight and blood pressure in adults with type 2 diabetes. We performed frequentist network meta-analyses and calculated weighted mean differences and 95% confidence intervals combining trial arms of different approved doses of a given intervention into a single group. We evaluated the confidence in pooled estimates using the CINeMA (Confidence In Network Meta-Analysis) framework.
In total, 424 trials (276 336 patients) assessing 21 antidiabetic medications from nine drug classes were included. Subcutaneous semaglutide was the most efficacious in reducing body weight followed by oral semaglutide, exenatide twice-daily, liraglutide, and the sodium-glucose co-transporter-2 (SGLT-2) inhibitors empagliflozin, canagliflozin, dapagliflozin and ertugliflozin. The same agents also conferred the greatest reductions in systolic blood pressure. Metformin had a modest effect in reducing body weight and systolic blood pressure. Diastolic blood pressure was reduced with the SGLT-2 inhibitors pioglitazone, exenatide twice-daily and semaglutide. In subgroup analyses of trials with over 52 weeks' duration, semaglutide and SGLT-2 inhibitors reduced both body weight and systolic blood pressure.
Semaglutide and SGLT-2 inhibitors conferred reductions both in body weight and blood pressure that were sustainable for over 1 year of treatment. These agents may be preferable treatment options for patients with type 2 diabetes who are overweight/obese and/or hypertensive.
比较降糖药物对 2 型糖尿病成人患者体重和血压的影响。
我们检索了 Medline、Embase、Cochrane 图书馆和灰色文献资源，以获取至少 24 周评估降糖药物对 2 型糖尿病成人患者体重和血压影响的随机对照试验，检索截至 2020 年 9 月 29 日。我们进行了频率网络荟萃分析，并将不同批准剂量试验臂的加权均数差值和 95%置信区间组合成一个单一的组。我们使用 CINeMA（网络荟萃分析置信度）框架评估汇总估计的置信度。
共纳入了 424 项试验（276336 例患者），评估了来自九个药物类别的 21 种降糖药物。皮下注射司美格鲁肽在降低体重方面最有效，其次是口服司美格鲁肽、艾塞那肽双周制剂、利拉鲁肽和钠-葡萄糖共转运蛋白-2（SGLT-2）抑制剂恩格列净、卡格列净、达格列净和埃格列净。同样的药物也能最大程度地降低收缩压。二甲双胍对降低体重和收缩压有适度作用。SGLT-2 抑制剂吡格列酮、艾塞那肽双周制剂和司美格鲁肽可降低舒张压。在持续超过 52 周的试验的亚组分析中，司美格鲁肽和 SGLT-2 抑制剂均能降低体重和收缩压。
司美格鲁肽和 SGLT-2 抑制剂可降低体重和血压，且在 1 年以上的治疗中具有可持续性。对于超重/肥胖和/或高血压的 2 型糖尿病患者，这些药物可能是更好的治疗选择。
