2型糖尿病患者中使用钠-葡萄糖协同转运蛋白2抑制剂和胰高血糖素样肽-1受体激动剂作为一线治疗对心血管疾病低风险人群的影响：一项荟萃分析
First-line treatment with sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists in type 2 diabetic population at low risk of cardiovascular disease: a meta-analysis.
作者信息
Deng Rui, Mei Kaibo, Song Tiangang, Huang Jinyi, Wu Yifan, Yu Peng, Yan Zhiwei, Liu Xiao
机构信息
Department of Operating Room, The Third Hospital of Nanchang, Nanchang, Jiangxi, China.
Department of Anesthesiology, The People's Hospital of Shangrao, Shangrao, Jiangxi, China.
出版信息
Front Endocrinol (Lausanne). 2024 Jan 29;15:1289643. doi: 10.3389/fendo.2024.1289643. eCollection 2024.
BACKGROUND
The benefit of first-line use of sodium-dependent glucose transport 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) in type 2 diabetes mellitus (T2DM) with low risk of cardiovascular diseases are not clear.
METHODS
PubMed, EMBASE and Cochrane Library databases were searched to identify eligible randomized controlled trials. We used the odds ratio (OR) and mean difference (MD) and the corresponding 95% confidence interval (CI) to assess the dichotomous and continuous variable, respectively.
RESULTS
Thirteen studies involving 2,885 T2DM at low risk of cardiovascular diseases were included. Compared to placebo, first line use of SGLT2i significantly reduced glycosylated hemoglobin type A1C (HbA1c) (MD: -0.72), weight (MD: -1.32) and fasting plasma glucose (FPG) (MD: -27.05) levels. Compared with metformin, SGLT2i reduced body weight (MD: -1.50) and FPG (MD: -10.13) more effectively, with similar reduction for HbA1c (MD: -0.05). No significant increased safety adverse was found for SGLT2i, including nasopharyngitis (OR: 1.07), urinary tract infection (OR: 2.31), diarrhea (OR: 1.18) and hypoglycemia (OR: 1.06). GLP-1RAs significantly reduced HbA1c (MD: -1.13), weight (MD: -2.12) and FPG (MD: -31.44) levels as first-line therapy compared to placebo. GLP-1RAs significantly increased occurrence of diarrhea (OR: 2.18), hypoglycemia (OR: 3.10), vomiting (OR: 8.22), and nausea (OR: 4.41).
CONCLUSION
First line use of SGLT2i and GLP-1RAs is effective in reducing HbA1c, weight, and FPG levels in T2DM patients at low risk for cardiovascular disease. SGLT2i may be superior to metformin in controlling body weight and FPG. GLP-1RAs may increase the occurrence of diarrhea, hypoglycemia, vomiting, and nausea.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO (International Prospective Register of Systematic Reviews. https://www.york.ac.uk/inst/crd, CRD42022347233).
背景
在心血管疾病风险较低的2型糖尿病（T2DM）患者中，一线使用钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）和胰高血糖素样肽-1受体激动剂（GLP-1RAs）的获益尚不清楚。
方法
检索PubMed、EMBASE和Cochrane图书馆数据库，以识别符合条件的随机对照试验。我们分别使用比值比（OR）和均值差（MD）以及相应的95%置信区间（CI）来评估二分变量和连续变量。
结果
纳入了13项涉及2885例心血管疾病风险较低的T2DM患者的研究。与安慰剂相比，一线使用SGLT2i可显著降低糖化血红蛋白A1C（HbA1c）（MD：-0.72）、体重（MD：-1.32）和空腹血糖（FPG）（MD：-27.05）水平。与二甲双胍相比，SGLT2i在降低体重（MD：-1.50）和FPG（MD：-10.13）方面更有效，HbA1c降低程度相似（MD：-0.05）。未发现SGLT2i有显著增加的安全性不良事件，包括鼻咽炎（OR：1.07）、尿路感染（OR：2.31）、腹泻（OR：1.18）和低血糖（OR：1.06）。与安慰剂相比，GLP-1RAs作为一线治疗可显著降低HbA1c（MD：-1.13）、体重（MD：-2.12）和FPG（MD：-31.44）水平。GLP-1RAs显著增加腹泻（OR：2.18）、低血糖（OR：3.10）、呕吐（OR：8.22）和恶心（OR：4.41）的发生率。
结论
一线使用SGLT2i和GLP-1RAs可有效降低心血管疾病风险较低的T2DM患者的HbA1c、体重和FPG水平。SGLT2i在控制体重和FPG方面可能优于二甲双胍。GLP-1RAs可能增加腹泻、低血糖、呕吐和恶心的发生率。
系统评价注册
PROSPERO（国际系统评价前瞻性注册库。https://www.york.ac.uk/inst/crd，CRD42022347233）
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