Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Department of Pharmacy, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Diabetes Obes Metab. 2021 Sep;23(9):2125-2136. doi: 10.1111/dom.14452. Epub 2021 Jun 22.
To determine the overall efficacy of high- versus low-dose sodium-glucose co-transporter-2 (SGLT2) inhibitors in patients with type 2 diabetes (T2D).
A literature search using MEDLINE, EMBASE and the Cochrane Library was performed from 1 January 2006 to 23 September 2020. Random effects models were used to calculate mean differences (MDs) and pooled relative risk (RR). Prespecified subgroup analyses for each SGLT2 inhibitor, follow-up and controls were performed. Leave-one-out sensitivity and meta-regression analyses were conducted.
A total of 51 randomized controlled trials involving 23 989 participants (weighted mean age, 58.9 years; men, 58.8%) were eligible for our meta-analysis. For glycaemic regulation ability, a significant reduction in HbA1c (MD -0.080%, 95% confidence interval [CI] -0.100 to -0.060), fasting plasma glucose (MD -0.227 mmol/L, 95% CI -0.282 to -0.173) and postprandial plasma glucose (MD -0.834 mmol/L, 95% CI -1.268 to -0.400) levels was observed in the high-dose SGLT2 inhibitor group. Treatment with high-dose SGLT2 inhibitors enabled easier achievement of the target (HbA1c <7%) than low-dose SGLT2 inhibitors (RR 1.148, 95% CI 1.104 to 1.193). High-dose SGLT2 inhibitor-based treatment resulted in more efficient regulation of body weight and blood pressure (body weight: MD -0.346 kg, 95% CI -0.437 to -0.254; systolic blood pressure: MD -0.583 mmHg, 95% CI -0.903 to -0.263; diastolic blood pressure: MD -0.352 mmHg, 95% CI -0.563 to -0.142). The results were similar in sensitivity analyses.
The overall efficacy of SGLT2 inhibitors, mainly canagliflozin, dapagliflozin and empagliflozin, was found to be dose dependent.
评估高剂量与低剂量钠-葡萄糖协同转运蛋白 2（SGLT2）抑制剂在 2 型糖尿病（T2D）患者中的总体疗效。
检索 2006 年 1 月 1 日至 2020 年 9 月 23 日的 MEDLINE、EMBASE 和 Cochrane 图书馆中的文献。使用随机效应模型计算均值差（MD）和合并相对风险（RR）。对每个 SGLT2 抑制剂、随访和对照组进行了预设的亚组分析。进行了敏感性分析和荟萃回归分析。
共有 51 项随机对照试验（RCT）纳入 23989 名参与者（加权平均年龄 58.9 岁，男性 58.8%），符合本荟萃分析的条件。在血糖调节能力方面，高剂量 SGLT2 抑制剂组可显著降低糖化血红蛋白（HbA1c；MD-0.080%，95%置信区间[CI]：-0.100 至 -0.060）、空腹血糖（MD-0.227mmol/L，95%CI：-0.282 至 -0.173）和餐后血糖（MD-0.834mmol/L，95%CI：-1.268 至 -0.400）水平。与低剂量 SGLT2 抑制剂相比，高剂量 SGLT2 抑制剂更有利于实现目标（HbA1c＜7%）（RR 1.148，95%CI：1.104 至 1.193）。高剂量 SGLT2 抑制剂治疗可更有效地调节体重和血压（体重：MD-0.346kg，95%CI：-0.437 至 -0.254；收缩压：MD-0.583mmHg，95%CI：-0.903 至 -0.263；舒张压：MD-0.352mmHg，95%CI：-0.563 至 -0.142）。敏感性分析的结果相似。
SGLT2 抑制剂（主要是卡格列净、达格列净和恩格列净）的总体疗效呈剂量依赖性。
