Salamah Hazem Mohamed, Marey Ahmed, Abugdida Mohamed, Abualkhair Khaled Alsayed, Elshenawy Salem, Elhassan Wael Atif Fadl, Naguib Mostafa Mahmoud, Malnev Dmitrii, Durrani Jamrose, Bailey Ronelle, Tsyunchyk Anastasiia, Ibrahim Lena, Zavgorodneva Zhanna, Sherazi Andleeb
Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt.
Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Diabetol Metab Syndr. 2024 Jun 14;16(1):129. doi: 10.1186/s13098-024-01371-3.
Prediabetes is a condition preceding the development of diabetes and is associated with an increased risk of a number of complications. The primary mode of management is thought to be lifestyle modification. Pharmacological therapy, such as glucagon-like peptide-1 receptor agonists (GLP-1RAs), were not well addressed in the literature and were only evaluated in trials as secondary and exploratory outcomes with a limited sample size. Here, GLP-1RAs are evaluated as a comprehensive therapy approach for patients with prediabetes.
A comprehensive search of Web of Science, SCOPUS, PubMed, and Cochrane was performed on May 5, 2023, to retrieve randomized controlled trials (RCTs) comparing the effect of GLP-1RAs to placebo and/or lifestyle modification on prediabetes reversion to normoglycemia, prevention of overt diabetes, glycemic control, anthropometric parameters, and lipid profiles. Review Manager (RevMan) version 5.4 was used. The quality of RCTs was assessed using the revised version of the Cochrane Risk of Bias Tool. GRADE was performed to evaluate the certainty of evidence.
Twelve trials involving 2903 patients in the GLP-1RAs group and 1413 in the control group were included in the meta-analysis. Low quality of evidence revealed that GLP-1RAs significantly increased the incidence of prediabetes reversion to the normoglycemic state [RR = 1.76, 95% CI (1.45, 2.13), P < 0.00001] and moderate quality of evidence showed that GLP-1RAs significantly prevented new-onset diabetes [RR = 0.28, 95% CI (0.19, 0.43), P < 0.00001]. Significant reductions in HbA1c, fasting plasma glucose, body weight, waist circumference, triglycerides, and LDL were observed in the GLP-1RAs arm (P < 0.05). However, higher incidences of gastrointestinal disorders were reported in the GLP-1RAs group (P < 0.05).
GLP-1RAs combined with lifestyle modification proved to be a more effective therapy for managing prediabetic patients than lifestyle modification alone, with a tolerable safety profile. Future guidelines should consider GLP-1RAs as an adjunct to lifestyle modification in the management of prediabetic patients to provide better management and improve treatment adherence.
糖尿病前期是糖尿病发生之前的一种状态，与多种并发症风险增加相关。主要的管理模式被认为是生活方式改变。诸如胰高血糖素样肽-1受体激动剂（GLP-1RAs）等药物治疗在文献中未得到充分探讨，仅在试验中作为次要和探索性结局进行评估，样本量有限。在此，对GLP-1RAs作为糖尿病前期患者的综合治疗方法进行评估。
于2023年5月5日对Web of Science、SCOPUS、PubMed和Cochrane进行全面检索，以检索比较GLP-1RAs与安慰剂和/或生活方式改变对糖尿病前期逆转至正常血糖、预防显性糖尿病、血糖控制、人体测量参数和血脂谱影响的随机对照试验（RCTs）。使用Review Manager（RevMan）5.4版本。采用Cochrane偏倚风险工具修订版评估RCTs的质量。进行GRADE评估以评价证据的确定性。
荟萃分析纳入了12项试验（GLP-1RAs组2903例患者，对照组1413例患者）。低质量证据显示，GLP-1RAs显著增加糖尿病前期逆转至正常血糖状态的发生率[RR = 1.76，95%CI（1.45，2.13），P < 0.00001]，中等质量证据表明，GLP-1RAs显著预防新发糖尿病[RR = 0.28，95%CI（0.19，0.43），P < 0.00001]。在GLP-1RAs组观察到糖化血红蛋白、空腹血糖、体重、腰围、甘油三酯和低密度脂蛋白显著降低（P < 0.05）。然而，GLP-1RAs组报告的胃肠道疾病发生率较高（P < 0.05）。
与单纯生活方式改变相比，GLP-1RAs联合生活方式改变被证明是治疗糖尿病前期患者更有效的方法，且安全性可耐受。未来指南应考虑将GLP-1RAs作为糖尿病前期患者管理中生活方式改变的辅助手段，以提供更好的管理并提高治疗依从性。
