减重手术、新型降糖药物与胰岛素治疗 2 型糖尿病合并肥胖：基于随机对照试验的贝叶斯网状 Meta 分析。
Bariatric surgery, novel glucose-lowering agents, and insulin for type 2 diabetes and obesity: Bayesian network meta-analysis of randomized controlled trials.
机构信息
Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
出版信息
BJS Open. 2023 Jul 10;7(4). doi: 10.1093/bjsopen/zrad077.
BACKGROUND
This network meta-analysis aimed to compare the effects of bariatric surgery, novel glucose-lowering agents (SGLT2i, GLP1RA, DPP4i), and insulin for patients with type 2 diabetes mellitus (T2DM) and obesity.
METHODS
Four databases were searched from inception to April 2023 to identify randomized controlled trials (RCTs) comparing bariatric surgery, SGLT2i, GLP1RA, DPP4i, insulin, and/or placebo/usual care among patients with T2DM and obesity in the achievement of HbA1c < 7.0 per cent within one year, and 12-month changes in HbA1c and body weight.
RESULTS
A total of 376 eligible RCTs (149 824 patients) were analysed. Bariatric surgery had significantly higher rates of achieving HbA1c < 7.0 per cent than SGLT2i (RR = 2.46, 95 per cent c.i. = 1.28, 4.92), DPP4i (RR = 2.59, 95 per cent c.i. = 1.36, 5.13), insulin (RR = 2.27, 95 per cent c.i. = 1.18, 4.58) and placebo/usual care (RR = 4.02, 95 per cent c.i. = 2.13, 7.93), but had no statistically significant difference from GLP1RA (RR = 1.73, 95 per cent c.i. = 0.91, 3.44), regardless of oral (RR = 1.33, 95 per cent c.i. = 0.66, 2.79) or injectable (RR = 1.75, 95 per cent c.i. = 0.92, 3.45) administration. Significantly more GLP1RA patients achieved HbA1c < 7.0 per cent than other non-surgical treatments. Bariatric surgery had the greatest reductions in HbA1c (∼1 per cent more) and body weight (∼15 kg more) at 12 months. Among novel glucose-lowering medications, GLP1RA was associated with greater reductions in HbA1c than SGLT2i (-0.39 per cent, 95 per cent c.i. = -0.55, -0.22) and DPP4i (-0.51 per cent, 95 per cent c.i. = -0.64, -0.39) at 12 months, while GLP1RA (-1.74 kg, 95 per cent c.i. = -2.48, -1.01) and SGLT2i (-2.23 kg, 95 per cent c.i. = -3.07, -1.39) showed greater reductions in body weight than DPP4i at 12 months.
CONCLUSION
Bariatric surgery showed superiority in glycaemic control and weight management compared to non-surgical approaches. GLP1RA administered by oral or injectable form demonstrated reduced HbA1c and body weight at 12 months, and was preferable over other non-surgical treatments among patients with T2DM and obesity.
PROSPERO REGISTRATION NO
CRD42020201507.
背景
本网络荟萃分析旨在比较减重手术、新型降糖药物（SGLT2i、GLP1RA、DPP4i）和胰岛素在 2 型糖尿病（T2DM）合并肥胖患者中的疗效。
方法
从数据库建立到 2023 年 4 月，检索了比较 T2DM 合并肥胖患者在一年内糖化血红蛋白（HbA1c）<7.0%和 12 个月时 HbA1c 和体重变化的减重手术、SGLT2i、GLP1RA、DPP4i、胰岛素和/或安慰剂/常规治疗的随机对照试验（RCT）。
结果
共纳入 376 项符合条件的 RCT（149824 例患者）进行分析。与 SGLT2i（RR=2.46，95%置信区间=1.28，4.92）、DPP4i（RR=2.59，95%置信区间=1.36，5.13）、胰岛素（RR=2.27，95%置信区间=1.18，4.58）和安慰剂/常规治疗（RR=4.02，95%置信区间=2.13，7.93）相比，减重手术达到 HbA1c<7.0%的比例显著更高，但与 GLP1RA（RR=1.73，95%置信区间=0.91，3.44）相比无统计学差异，无论口服（RR=1.33，95%置信区间=0.66，2.79）或注射（RR=1.75，95%置信区间=0.92，3.45）给药途径均如此。GLP1RA 组有更多患者达到 HbA1c<7.0%。减重手术在 12 个月时 HbA1c（降低约 1%）和体重（降低约 15kg）的降幅最大。在新型降糖药物中，与 SGLT2i（-0.39%，95%置信区间=-0.55，-0.22）和 DPP4i（-0.51%，95%置信区间=-0.64，-0.39）相比，GLP1RA 可使 HbA1c 在 12 个月时降低更多，而 GLP1RA（-1.74kg，95%置信区间=-2.48，-1.01）和 SGLT2i（-2.23kg，95%置信区间=-3.07，-1.39）可使体重在 12 个月时降低更多。
结论
与非手术方法相比，减重手术在血糖控制和体重管理方面表现出优越性。GLP1RA 无论口服还是注射给药，在 12 个月时均可降低 HbA1c 和体重，且在 T2DM 合并肥胖患者中优于其他非手术治疗。
PROSPERO 注册号：CRD42020201507。
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