Department of Nephrology, The First Affiliated Hospital of Jinan University, Guangzhou, China.
Department of Traditional Chinese Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China.
J Diabetes Investig. 2022 Mar;13(3):468-477. doi: 10.1111/jdi.13675. Epub 2021 Oct 20.
AIMS/INTRODUCTION: The union of dipeptidyl peptidase-4 inhibitors and insulin in patients with type 2 diabetes and chronic kidney disease provides satisfactory glucose management without increasing adverse events (AEs). This research appraised the therapeutic effect and safety of combination therapy in patients with type 2 diabetes and chronic kidney disease.
We carried out a meta-analysis of randomized controlled trials to analyze AEs, hypoglycemia, serious AEs, severe hypoglycemia, estimated glomerular filtration rate, fasting plasma glucose, glycated hemoglobin, insulin dose, low-density lipoprotein cholesterol, uric acid and weight between combination treatment groups and control groups by searching the Cochrane Library, Excerpta Medica Database (Embase), PubMed and Web of Science databanks until October 2020.
Five studies (6 trials, 1,278 participants) met the inclusion criteria. The evidence quality ranged from moderate to high. Glycated hemoglobin (standardized mean difference -0.29, 95% confidence interval -0.44 to -0.14) and insulin dose (standardized mean difference -0.16, 95% confidence interval -0.29 to -0.02) were obviously smaller in the combination cure patients than in the control patients. Compared with the control groups, combination treatment did not increase AEs, hypoglycemia, serious AEs or severe hypoglycemia.
This study showed the effectiveness and safety of dipeptidyl peptidase-4 inhibitors bonded with insulin in patients with type 2 diabetes and chronic kidney disease, but the protective actions of this cure on kidney and cardiovascular outcomes, as well as the functions of other dipeptidyl peptidase-4 inhibitors, need to be affirmed by more good-quality randomized controlled trials.
目的/引言：二肽基肽酶-4 抑制剂与胰岛素联合用于 2 型糖尿病合并慢性肾脏病患者，可在不增加不良事件（AE）的情况下提供满意的血糖控制。本研究评估了二肽基肽酶-4 抑制剂与胰岛素联合治疗 2 型糖尿病合并慢性肾脏病患者的疗效和安全性。
我们通过检索 Cochrane 图书馆、Embase、PubMed 和 Web of Science 数据库，对 2020 年 10 月前发表的随机对照试验进行了荟萃分析，以评估联合治疗组和对照组之间的 AE、低血糖、严重 AE、严重低血糖、估计肾小球滤过率、空腹血糖、糖化血红蛋白、胰岛素剂量、低密度脂蛋白胆固醇、尿酸和体重的差异。
五项研究（6 项试验，1278 名参与者）符合纳入标准。证据质量从中等到高。联合治疗组的糖化血红蛋白（标准化均数差-0.29，95%置信区间-0.44 至-0.14）和胰岛素剂量（标准化均数差-0.16，95%置信区间-0.29 至-0.02）明显低于对照组。与对照组相比，联合治疗并未增加 AE、低血糖、严重 AE 或严重低血糖。
本研究表明二肽基肽酶-4 抑制剂与胰岛素联合治疗 2 型糖尿病合并慢性肾脏病患者的有效性和安全性，但这种治疗对肾脏和心血管结局的保护作用以及其他二肽基肽酶-4 抑制剂的作用仍需更多高质量随机对照试验来证实。
