二肽基肽酶-4 抑制剂对 2 型糖尿病患者葡萄糖依赖性胰岛素多肽的影响：系统评价和荟萃分析。
Impact of dipeptidyl peptidase-4 inhibitors on glucose-dependent insulinotropic polypeptide in type 2 diabetes mellitus: a systematic review and meta-analysis.
机构信息
Merck Research Laboratories (MRL) Global Medical Affairs, Merck Sharp & Dohme (MSD) China, Shanghai, China.
Hatter Cardiovascular Institute, University College London, London, United Kingdom.
出版信息
Front Endocrinol (Lausanne). 2023 Aug 10;14:1203187. doi: 10.3389/fendo.2023.1203187. eCollection 2023.
AIMS
Glucose-dependent insulinotropic polypeptide (GIP) confers a variety of metabolic benefits in type 2 diabetes mellitus (T2DM). This meta-analysis was conducted to investigate the impact of dipeptidyl peptidase 4 (DPP4) inhibitors on GIP levels in T2DM patients.
METHODS
Medline (PubMed), CENTER (Cochrane Library), and Embase (Ovid) were searched and randomized controlled trials (RCTs) evaluating the impact of DPP4 inhibitors on fasting and postprandial GIP levels were obtained. For postprandial GIP, only studies with the data of GIP changes reported as the total area under the curve (AUC) using a meal or oral glucose tolerance test were included. A random-effects model was used for data pooling after incorporating heterogeneity.
RESULTS
Overall, 14 RCTs with 541 T2DM patients were included. Compared to placebo/no treatment, the use of DPP4 inhibitors significantly increased the fasting GIP level (standard mean difference [SMD]: 0.77, 95% confidence interval [CI]: 0.48-1.05, <0.001; 52%) and postprandial AUC (SMD: 1.33, 95% CI: 1.02-1.64, <0.001; 65%). Influence analysis by excluding one dataset at a time showed consistent results. Sensitivity analyses only including studies with radioimmunoassay showed also consistent results (fasting GIP: SMD: 0.75, 95% CI: 0.51-1.00, P<0.001; I0%; and postprandial AUC: SMD: 1.48, 95% CI: 1.18-1.78, <0.001; 54%). Further subgroup analyses demonstrated that the influence of DPP4 inhibitors on fasting and postprandial GIP levels in T2DM patients was not significantly changed by study characteristics such as study design, patient mean age, baseline glycated hemoglobin (HbA1c) concentration, body mass index (BMI), background treatment, treatment duration, or method for postprandial GIP measurement (all for subgroup effects <0.05).
CONCLUSION
The use of DPP4 inhibitors effectively increases the fasting and postprandial GIP concentrations in T2DM patients.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/, identifier CRD42022356716.
目的
葡萄糖依赖性胰岛素促分泌多肽（GIP）在 2 型糖尿病（T2DM）中具有多种代谢益处。本荟萃分析旨在研究二肽基肽酶 4（DPP4）抑制剂对 T2DM 患者 GIP 水平的影响。
方法
检索 Medline（PubMed）、CENTRAL（Cochrane 图书馆）和 Embase（Ovid），获取评估 DPP4 抑制剂对空腹和餐后 GIP 水平影响的随机对照试验（RCT）。对于餐后 GIP，仅纳入使用餐或口服葡萄糖耐量试验报告 GIP 变化总曲线下面积（AUC）数据的研究。在纳入异质性后，使用随机效应模型进行数据合并。
结果
共纳入 14 项 RCT，包含 541 例 T2DM 患者。与安慰剂/无治疗相比，DPP4 抑制剂的使用显著增加了空腹 GIP 水平（标准均数差 [SMD]：0.77，95%置信区间 [CI]：0.48-1.05，<0.001；52%）和餐后 AUC（SMD：1.33，95% CI：1.02-1.64，<0.001；65%）。逐一排除一个数据集的影响分析显示出一致的结果。仅纳入放射免疫分析研究的敏感性分析也显示出一致的结果（空腹 GIP：SMD：0.75，95% CI：0.51-1.00，P<0.001；I0%；餐后 AUC：SMD：1.48，95% CI：1.18-1.78，<0.001；54%）。进一步的亚组分析表明，DPP4 抑制剂对 T2DM 患者空腹和餐后 GIP 水平的影响不受研究设计、患者平均年龄、基线糖化血红蛋白（HbA1c）浓度、体重指数（BMI）、背景治疗、治疗持续时间或餐后 GIP 测量方法等研究特征的显著改变（所有亚组效应<0.05）。
结论
DPP4 抑制剂的使用可有效增加 T2DM 患者空腹和餐后 GIP 浓度。
系统评价注册
https://www.crd.york.ac.uk/prospero/，标识符 CRD42022356716。
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