Wang Wanqing, Huang Fei, Han Chunchao
Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, Jiangsu Province, China.
College of Pharmacy, Shandong University of Traditional Chinese Medicine, No. 4655, University Road, University Science and Technology Park, Changqing District, Jinan, 250355, Shandong Province, China.
Diabetes Ther. 2023 Oct;14(10):1723-1752. doi: 10.1007/s13300-023-01459-5. Epub 2023 Aug 16.
Latent autoimmune diabetes in adults (LADA) is a highly heterogeneous autoimmune condition with clinical and genetic characteristics that fall between those of type 1 diabetes mellitus and type 2 diabetes mellitus; therefore, there are no uniform criteria for the selection of therapeutic agents. We conducted a network meta-analysis to evaluate the efficacy of various therapeutic agents for LADA by comparing their effects on various indicators used to reflect LADA.
We searched the PubMed, Cochrane Library, Embase and Web of Science databases from their inception to March 2023 and collected data from 14 randomized controlled trials on glucose-lowering drugs for LADA, including 23 studies and 15 treatment regimens. The effectiveness of drugs was ranked and evaluated by combining surface under the cumulative ranking (SUCRA) plots and forest plots. Factors that may influence study heterogeneity were also searched and analyzed by combining subgroup analysis, publication bias, funnel plots and sensitivity analysis.
The results of the network meta-analysis showed that insulin had the most significant effect on the control of change from baseline in glycosylated hemoglobin, type A1 (ΔHbA1c). Insulin combined with dipeptidyl peptidase-4 (DPP-4) inhibitors performed the best in reducing fasting blood glucose and body mass index. Treatment regimens involving thiazolidinediones were the most advantageous in HbA1c, fasting C-peptide and postprandial C-peptide control. Longer dosing may be more beneficial in maintaining islet β-cell function in the LADA population.
LADA is an immune condition with high heterogeneity, and treatment should be administered according to the C-peptide level of the LADA population. For this population with LADA with a certain level of β-cell function, combinations of insulin with DPP-4 inhibitors or thiazolidinediones probably can be more effective treatment options to maintain islet function and normal blood glucose.
PROSPERO CRD42023410795.
成人隐匿性自身免疫性糖尿病（LADA）是一种高度异质性的自身免疫性疾病，其临床和遗传特征介于1型糖尿病和2型糖尿病之间；因此，在治疗药物的选择上没有统一的标准。我们进行了一项网状Meta分析，通过比较各种治疗药物对反映LADA的各项指标的影响，来评估其对LADA的疗效。
我们检索了PubMed、Cochrane图书馆、Embase和Web of Science数据库自建库至2023年3月的数据，并收集了14项关于LADA降糖药物的随机对照试验数据，包括23项研究和15种治疗方案。通过累积排序曲线下面积（SUCRA）图和森林图相结合的方式对药物疗效进行排序和评估。还通过亚组分析、发表偏倚、漏斗图和敏感性分析相结合的方式，搜索和分析可能影响研究异质性的因素。
网状Meta分析结果显示，胰岛素对糖化血红蛋白A1型（ΔHbA1c）从基线变化的控制效果最为显著。胰岛素联合二肽基肽酶-4（DPP-4）抑制剂在降低空腹血糖和体重指数方面表现最佳。涉及噻唑烷二酮类的治疗方案在糖化血红蛋白、空腹C肽和餐后C肽控制方面最为有利。更长时间的给药可能对维持LADA人群的胰岛β细胞功能更有益。
LADA是一种具有高度异质性的免疫性疾病，治疗应根据LADA人群的C肽水平进行。对于具有一定β细胞功能水平的LADA人群，胰岛素与DPP-4抑制剂或噻唑烷二酮类的联合使用可能是维持胰岛功能和正常血糖的更有效治疗选择。
PROSPERO CRD42023410795。
Zotero 插件
