Diabetes, Endocrinology, Metabolism Section, Department of Medicine I, Katholisches Klinikum Bochum Sankt Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.
Diabetes, Endocrinology, Metabolism Section, Department of Medicine I, Katholisches Klinikum Bochum Sankt Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
BMJ Open Diabetes Res Care. 2023 Jul;11(4). doi: 10.1136/bmjdrc-2022-003296.
Basal insulin treatment for type 2 diabetes is usually initiated on a background of oral glucose-lowering medications (OGLM). We wanted to examine the influence of various OGLMs on fasting plasma glucose (FPG) and hemoglobin A (HbA) values achieved after titration. A PubMed literature search retrieved 42 publications (clinical trials introducing basal insulin in 17 433 insulin-naïve patients with type 2 diabetes on a defined background of OGLM) and reporting FPG, HbA, target achievement, hypoglycemic events, and insulin doses. 60 individual study arms were grouped by OGLM (combinations) allowed during the titration process: (a) metformin only; (b) sulfonylureas only; (c) metformin and sulfonylureas; or (d) metformin and dipeptidyl peptidase-4 (DPP-4) inhibitors. For all OGLM categories, weighted means and SD were calculated for baseline and end-of-treatment FPG, HbA, target achievement, incidence of hypoglycemic events, and insulin doses. Primary end point was a difference in FPG after titration between OGLM categories. Statistics: analysis of variance and post hoc comparisons. Sulfonylureas, alone or in combination with metformin, impair the titration of basal insulin (insulin doses 30%-40% lower, more hypoglycemic episodes), thus leading to poorer final glycemic control (p<0.05 for FPG and HbA after titration). Conversely, adding a DPP-4 inhibitor to metformin is superior to metformin alone (p<0.05 for FPG and HbA achieved) in patients with type 2 diabetes initiating basal insulin therapy. In conclusion, OGLM are a major determinant of the success of basal insulin therapy. Sulfonylureas impair, while DPP-4 inhibitors (added to metformin) may facilitate the achievement of ambitious fasting glucose targets. PROSPERO registration number CRD42019134821.
在口服降糖药物（OGLM）的背景下，通常开始对 2 型糖尿病进行基础胰岛素治疗。我们想研究各种 OGLM 对滴定后空腹血糖（FPG）和血红蛋白 A（HbA）值的影响。通过 PubMed 文献检索，共检索到 42 篇文献（在 OGLM 确定的背景下，在 17433 名 2 型糖尿病胰岛素初治患者中引入基础胰岛素的临床试验），并报告了 FPG、HbA、达标情况、低血糖事件和胰岛素剂量。60 个单独的研究臂根据 OGLM（联合）分组（允许在滴定过程中使用）：（a）仅使用二甲双胍；（b）仅使用磺酰脲类药物；（c）二甲双胍和磺酰脲类药物；或（d）二甲双胍和二肽基肽酶-4（DPP-4）抑制剂。对于所有 OGLM 类别，均计算了基线和治疗结束时 FPG、HbA、达标情况、低血糖事件发生率和胰岛素剂量的加权平均值和标准差。主要终点是滴定后 OGLM 类别之间的 FPG 差异。统计学：方差分析和事后比较。磺酰脲类药物，单独或与二甲双胍联合使用，会损害基础胰岛素的滴定（胰岛素剂量降低 30%-40%，更多低血糖发作），从而导致最终血糖控制较差（滴定后 FPG 和 HbA 差异有统计学意义，p<0.05）。相反，在开始基础胰岛素治疗的 2 型糖尿病患者中，将 DPP-4 抑制剂添加到二甲双胍中优于单独使用二甲双胍（FPG 和 HbA 达标差异有统计学意义，p<0.05）。总之，OGLM 是基础胰岛素治疗成功的主要决定因素。磺酰脲类药物会产生干扰，而 DPP-4 抑制剂（添加到二甲双胍中）可能有助于实现有野心的空腹血糖目标。PROSPERO 注册号 CRD42019134821。
