Kan Bo, Hou Jiaoyu, Leslie William D, Jiang Depeng, Zhang Juan, Yang Shuman
Department of Clinical Laboratory, The Second Hospital of Jilin University, Changchun, Jilin, China.
Department of Geriatrics, The First Hospital of Jilin University, Changchun, Jilin, China.
Bone. 2023 Jun;171:116738. doi: 10.1016/j.bone.2023.116738. Epub 2023 Mar 16.
Anti-resorptive therapy (AT) increases insulin resistance and decrease insulin secretion through reduced undercarboxylated osteocalcin in mice. However, there are inconsistent findings regarding the impact of AT use on the risk of diabetes mellitus in humans. We examined the association between AT and incident diabetes mellitus using classical and Bayesian meta-analysis. We searched Pubmed, Medline, Embase, Web of Science, Cochrane, and Google Scholar for studies listed from database inception to 25 February 2022. Randomized controlled trials (RCTs) and cohort studies reporting associations of estrogen therapy (ET) and non-estrogen anti-resorptive therapy (NEAT) with incident diabetes mellitus were included. Two reviewers independently extracted research data such as ET and NEAT, diabetes mellitus, risk ratios (RRs), and 95 % confidence intervals (CIs) for incident diabetes mellitus associated with ET and NEAT from individual studies. This meta-analysis included data from nineteen original studies, consisting of fourteen ET and five NEAT studies. ET was associated with reduced risk of diabetes mellitus in the classical meta-analysis (RR: 0.90; 95 % CI: 0.81-0.99). Slightly stronger results were found in the meta-analysis of RCTs (RR: 0.83; 95 % CI: 0.77-0.89). The probability that RR < 1.0 was 95 % in the overall analysis and 99 % in RCTs under weakly informative prior. Although NEAT was associated with reduced risk of diabetes mellitus overall (RR: 0.80; 95 % CI: 0.67-0.97), this was not found in the RCT meta-analysis (RR: 0.90; 95 % CI: 0.75-1.10). Under weakly informative prior, the probabilities that NEAT reduces diabetes mellitus by >0 % were 99 %, and 73 % in the overall and RCT meta-analysis, respectively. In conclusion, meta-analysis provided consistent evidence against the hypothesis that AT increases diabetes risk. ET may reduce the risk of diabetes mellitus. Whether NEAT reduces the risk of diabetes mellitus is uncertain and requires additional evidence from RCTs.
抗吸收治疗（AT）通过降低小鼠中羧化不足的骨钙素增加胰岛素抵抗并减少胰岛素分泌。然而，关于使用AT对人类糖尿病风险的影响存在不一致的研究结果。我们使用经典和贝叶斯荟萃分析研究了AT与新发糖尿病之间的关联。我们在PubMed、Medline、Embase、Web of Science、Cochrane和谷歌学术上搜索了从数据库建立到2022年2月25日列出的研究。纳入了报告雌激素治疗（ET）和非雌激素抗吸收治疗（NEAT）与新发糖尿病之间关联的随机对照试验（RCT）和队列研究。两名审阅者独立提取研究数据，如ET和NEAT、糖尿病、风险比（RRs）以及来自个体研究的与ET和NEAT相关的新发糖尿病的95%置信区间（CIs）。这项荟萃分析纳入了19项原始研究的数据，包括14项ET研究和5项NEAT研究。在经典荟萃分析中，ET与糖尿病风险降低相关（RR：0.90；95%CI：0.81 - 0.99）。在RCT的荟萃分析中发现了稍强的结果（RR：0.83；95%CI：0.77 - 0.89）。在总体分析中RR < 1.0的概率为95%，在弱信息先验下RCT中为99%。虽然NEAT总体上与糖尿病风险降低相关（RR：0.80；95%CI：0.67 - 0.97），但在RCT荟萃分析中未发现这一点（RR：0.90；95%CI：0.75 - 1.10）。在弱信息先验下，NEAT降低糖尿病>0%的概率在总体和RCT荟萃分析中分别为99%和73%。总之，荟萃分析提供了一致的证据反对AT增加糖尿病风险这一假设。ET可能降低糖尿病风险。NEAT是否降低糖尿病风险尚不确定，需要来自RCT的更多证据。
