Li Hui, Yang Aimin, Zhao Shi, Chow Elaine Yk, Javanbakht Mohammad, Li Yinhui, Lin Dandan, Xu Lijuan, Zang Deng, Wang Kai, Ma Li
Department of endocrine, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Urumqi 830000, China.
Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong 999077, China.
Pharmaceuticals (Basel). 2022 Jul 30;15(8):953. doi: 10.3390/ph15080953.
The clinical efficacy of continuous subcutaneous insulin infusion (CSII) therapy combined with six classes of oral glucose-lowering drugs (GLDs) (TZDs/metformin/acarbose/GLP-1 receptor agonist/SGLT-2 inhibitor/DPP-4 inhibitor) was evaluated by a network meta-analysis to provide an evidence-based reference in making a clinical decision on CSII combined with drugs in the treatment of type 2 diabetes. Data were retrieved from eight databases: the Chinese Journal Full-Text Database (CNKI), VIP Chinese Science and Technology Periodicals Full-Text Database (VP-CSFD), Wanfang Data Journal Paper Resource (WANFANG), China Biomedical Database (CBM), PubMed, Embase, Cochrane Library, and Web of Science. The retrieval period dated from the library's construction to 27 June 2021. The search was for randomized, controlled trial studies (RCT) on insulin infusion (CSII) combined with oral hypoglycemic drugs (TZDs/metformin/acarbose/GLP-1 receptor agonist/SGLT-2 inhibitor/DPP-4 inhibitor) in the treatment of type 2 diabetes. Quality evaluation and data extraction were performed on the studies included, and network meta-analysis was performed with R4.0.1 software. A total of 56 publications was included in the final network meta-analysis, with a total sample size of 4395. Results based on the network meta-analysis were that CSII combined with a metformin works best on fasting blood glucose (FBG) and 2 h postprandial blood glucose (2hPG) and improves insulin resistance (lower HOMA-IR levels). CSII combined with a DPP-4 inhibitor had the best clinical effect in reducing glycosylated hemoglobin levels. Treatment with CSII combined with a DPP-4 inhibitor was the fastest way to achieve the blood glucose standard. In terms of insulin dosage, an insulin pump (CSII) combined with the GLP-1 receptor agonist can significantly reduce insulin dosage. Network meta-analysis evidence suggests that an insulin infusion (CSII) combined with oral hypoglycemic drugs can improve clinical efficacy in controlling blood sugar and improving insulin resistance, insulin dosage, and standard time. However, the most outstanding performance was that of insulin infusion (CSII) combined with metformin, which had the best clinical effect in controlling blood sugar and improving insulin resistance.
通过网状Meta分析评估持续皮下胰岛素输注（CSII）疗法联合六类口服降糖药（GLDs）（噻唑烷二酮类/二甲双胍/阿卡波糖/胰高血糖素样肽-1受体激动剂/钠-葡萄糖协同转运蛋白2抑制剂/二肽基肽酶-4抑制剂）的临床疗效，为临床决策中CSII联合药物治疗2型糖尿病提供循证参考。数据从八个数据库检索：中国期刊全文数据库（CNKI）、维普中文科技期刊全文数据库（VP-CSFD）、万方数据期刊论文资源（WANFANG）、中国生物医学数据库（CBM）、PubMed、Embase、Cochrane图书馆和Web of Science。检索期从各数据库建库至2０21年6月27日。检索胰岛素输注（CSII）联合口服降糖药（噻唑烷二酮类/二甲双胍/阿卡波糖/胰高血糖素样肽-1受体激动剂/钠-葡萄糖协同转运蛋白2抑制剂/二肽基肽酶-4抑制剂）治疗2型糖尿病的随机对照试验研究（RCT）。对纳入研究进行质量评估和数据提取，并使用R4.0.1软件进行网状Meta分析。最终的网状Meta分析共纳入56篇文献，总样本量为4395。基于网状Meta分析的结果是，CSII联合二甲双胍对空腹血糖（FBG）和餐后2小时血糖（2hPG）效果最佳，并改善胰岛素抵抗（降低HOMA-IR水平）。CSII联合二肽基肽酶-4抑制剂在降低糖化血红蛋白水平方面临床效果最佳。CSII联合二肽基肽酶-4抑制剂治疗是达到血糖标准的最快途径。在胰岛素剂量方面，胰岛素泵（CSII）联合胰高血糖素样肽-1受体激动剂可显著降低胰岛素剂量。网状Meta分析证据表明，胰岛素输注（CSII）联合口服降糖药可提高控制血糖、改善胰岛素抵抗、胰岛素剂量和达标时间的临床疗效。然而，最突出的表现是胰岛素输注（CSII）联合二甲双胍，在控制血糖和改善胰岛素抵抗方面临床效果最佳。
