Department of Endocrinology and Metabolism Peking University International Hospital, Beijing 102206, China.
Department of Epidemiology and Biostatistics Peking University School of Public Health, Beijing 100083, China.
J Diabetes Res. 2024 Jul 20;2024:8145388. doi: 10.1155/2024/8145388. eCollection 2024.
The objective was to evaluate the efficacy of the combination of Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), dipeptidyl peptidase-4 inhibitors (DPP-4i), and sodium-glucose cotransporter 2 inhibitor (SGLT-2i) in the treatment of Type 2 diabetes with poor efficacy of basic insulin and metformin/sulfonylurea by umbrella review. Forming the data of publication of each database through 13 September 2022, PubMed, EMBASE, and Cochrane Library were surveyed. A total of seven meta-analyses were included in the umbrella review. The combination of GLP-1 RA (WMD -3.41 [-5.61, -1.21], = 0.002), SGLT-2i (WMD -5.34 [-9.56, -1.13], = 0.013), and DPP-4i (WMD -5.56 [-7.39, -3.73], ≤ 0.001) can significantly reduce HbA1c levels, respectively. The combination of GLP-1 RA (WMD -1.55 [-2.92, -0.18], = 0.027), SGLT-2i (WMD -2.96 [-6.68, 0.77], = 0.12), and DPP-4i (WMD -2.05 [-2.82, -1.28], ≤ 0.001) can significantly reduce fasting plasma glucose (FPG) levels, respectively. The combination of GLP-1 RA (WMD -3.24 [-5.14, -1.34], < 0.001) can significantly reduce body weight of Type 2 diabetes mellitus (T2DM). The dose of basic insulin in diabetes patients after combined use of GLP-1 RA (WMD -2.74 [-4.26, -1.22], ≤ 0.001) was significantly reduced. The combination use of GLP-1 RAs (OR 1.28 [1.05, 1.56], = 0.017) increases the risk of hypoglycemia. The combination of GLP-1 RAs, DPP-4i, and SGLT-2i can effectively lower HbA1c and FPG in T2DM patients who have poor therapeutic effects on basic insulin combined with metformin/sulfonylureas, respectively. Compared to placebo, GLP-1 RAs can significantly reduce body weight and basic insulin dosage, while DPP-4i and SGLT-2i have a lower risk of hypoglycemia. CRD42023410345.
通过伞式综述评价 GLP-1 受体激动剂（GLP-1RA）、二肽基肽酶-4 抑制剂（DPP-4i）和钠-葡萄糖共转运蛋白 2 抑制剂（SGLT-2i）联合基础胰岛素和二甲双胍/磺酰脲类药物治疗疗效不佳的 2 型糖尿病的疗效。通过 2022 年 9 月 13 日，对 PubMed、EMBASE 和 Cochrane Library 中的每个数据库的出版物数据进行了调查。伞式综述共纳入 7 项荟萃分析。GLP-1RA（WMD-3.41[-5.61，-1.21]， = 0.002）、SGLT-2i（WMD-5.34[-9.56，-1.13]， = 0.013）和 DPP-4i（WMD-5.56[-7.39，-3.73]，≤0.001）联合治疗可显著降低 HbA1c 水平。GLP-1RA（WMD-1.55[-2.92，-0.18]， = 0.027）、SGLT-2i（WMD-2.96[-6.68，0.77]， = 0.12）和 DPP-4i（WMD-2.05[-2.82，-1.28]，≤0.001）联合治疗可显著降低空腹血糖（FPG）水平。GLP-1RA（WMD-3.24[-5.14，-1.34]，<0.001）可显著降低 2 型糖尿病（T2DM）患者的体重。GLP-1RA 联合使用后，糖尿病患者基础胰岛素剂量（WMD-2.74[-4.26，-1.22]，≤0.001）显著降低。GLP-1RA 联合使用（OR 1.28[1.05，1.56]， = 0.017）会增加低血糖的风险。GLP-1RA、DPP-4i 和 SGLT-2i 联合使用可有效降低基础胰岛素联合二甲双胍/磺酰脲类药物治疗疗效不佳的 T2DM 患者的 HbA1c 和 FPG，与安慰剂相比，GLP-1RA 可显著降低体重和基础胰岛素剂量，而 DPP-4i 和 SGLT-2i 低血糖风险较低。CRD42023410345。
