Zaki Hany A, Iftikhar Haris, Shallik Nabil A, Shaban Eman, Al-Marri Nood Dhafi R, Bashir Israr, Elhadad Awny, Zoghlami Fatma, Abdalrubb Abeer
Emergency Medicine, Hamad Medical Corporation, Doha, QAT.
Anaesthesiology, Weill Cornell Medical College in Qatar, Doha, QAT.
Cureus. 2023 May 24;15(5):e39445. doi: 10.7759/cureus.39445. eCollection 2023 May.
Type II diabetes mellitus (T2DM) is a global epidemic affecting people of all ages in developed and developing countries. The disease is usually characterized by insulin resistance and glucose intolerance; therefore, oral antidiabetic drugs such as thiazolidinediones (TZDs) and biguanide metformin are used to counter these defects. Due to the varied action mechanisms of TZDs and Metformin, their effects on insulin sensitivity and glucose tolerance may differ. Therefore, the current study was carried out to compare the effects of Metformin and TZDs on insulin sensitivity and glucose tolerance among patients with T2DM. Two methods, including using a well-outlined search strategy in 5 electronic databases including ScienceDirect, Google Scholar, PubMed, Scopus, and Embase, and a manual search which involved going through the reference lists of studies from the electronic databases were used to retrieve studies published between 2000 and 2022. Additionally, data analysis of outcomes retrieved from the studies eligible for inclusion and the methodological quality was carried out using the Review Manager software (RevMan 5.4.1) and STATA. The meta-analysis has shown that TZDs have a significantly better overall effect on fasting plasma glucose (FPG) (SMD:0.61; 95% CI:0.06, 1.16: p = 0.03) and insulin sensitivity than Metformin (Mean QUICKI: 0.306 ± 0.019 vs. 0.316 ± 0.019, respectively; p=0.0003). However, the TZDs and Metformin offer the same effect on glycemic control as assessed using HBA1c levels (MD: 0.10; 95% CI: -0.20, 0.40; p = 0.52). TZDs offer better insulin sensitivity and glucose tolerance improvements compared to Metformin. This evidence contradicts the current guidelines by the American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD) and the American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE), which recommend the use of Metformin as the first-line drug monotherapy for patients with T2DM.
2型糖尿病（T2DM）是一种全球性流行病，影响着发达国家和发展中国家的所有年龄段人群。该疾病通常以胰岛素抵抗和葡萄糖不耐受为特征；因此，噻唑烷二酮类药物（TZDs）和双胍类二甲双胍等口服抗糖尿病药物被用于对抗这些缺陷。由于TZDs和二甲双胍的作用机制不同，它们对胰岛素敏感性和葡萄糖耐量的影响可能有所不同。因此，本研究旨在比较二甲双胍和TZDs对T2DM患者胰岛素敏感性和葡萄糖耐量的影响。采用两种方法检索2000年至2022年发表的研究，一种方法是在包括ScienceDirect、谷歌学术、PubMed、Scopus和Embase在内的5个电子数据库中使用精心设计的检索策略，另一种方法是手动检索，即查阅电子数据库中研究的参考文献列表。此外，使用Review Manager软件（RevMan 5.4.1）和STATA对符合纳入标准的研究中检索到的结果进行数据分析和方法学质量评估。荟萃分析表明，与二甲双胍相比，TZDs对空腹血糖（FPG）（标准化均值差：0.61；95%置信区间：0.06，1.16；p = 0.03）和胰岛素敏感性的总体效果显著更好（平均QUICKI分别为：0.306±0.019和0.316±0.019；p = 0.0003）。然而，就使用糖化血红蛋白（HBA1c）水平评估的血糖控制而言，TZDs和二甲双胍的效果相同（平均差：0.10；95%置信区间：-0.20，0.40；p = 0.52）。与二甲双胍相比，TZDs能更好地改善胰岛素敏感性和葡萄糖耐量。这一证据与美国糖尿病协会/欧洲糖尿病研究协会（ADA/EASD）以及美国临床内分泌医师协会/美国内分泌学会（AACE/ACE）目前的指南相矛盾，这些指南推荐将二甲双胍作为T2DM患者的一线单药治疗药物。
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