不同降糖药物和胰岛素对糖尿病患者新发心房颤动风险的影响：一项网状Meta分析
Effect of different hypoglycemic drugs and insulin on the risk of new-onset atrial fibrillation in people with diabetes: a network meta-analysis.
作者信息
Lv Qianyu, Yang Yingtian, Lv Yanfei, Wu Qian, Hou Xinzheng, Li Lanlan, Ye Xuejiao, Yang Chenyan, Wang Shihan
机构信息
Guang'anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, 100053, China.
Fudan University, Shanghai, 200433, China.
出版信息
Eur J Med Res. 2024 Jul 31;29(1):399. doi: 10.1186/s40001-024-01954-w.
OBJECTIVE
Diabetes is considered a significant risk factor for the development of atrial fibrillation/flutter (AF/AFL). However, there is still insufficient evidence to determine the varying effects of different hypoglycemic drugs (HDs) on the incidence of new-onset AF/AFL in diabetic patients. To address this gap, we conducted a network meta-analysis to investigate whether various HDs have different effects on the risk of new-onset AF/AFL compared with insulin.
METHOD
We conducted a comprehensive search in PubMed, EMBASE, Cochrane Library, and Web of Science to identify all clinical trials investigating the association between various HDs or insulin and incident AF/AFL up until April 1, 2024. Bayesian random-effects model was used for network meta-analysis, and the results were expressed as relative risk (RR) and 95% confidence interval (CI).
RESULT
After searching 2070 articles, a total of 12 studies (2,349,683 patients) were included in the network meta-analysis. The treatment regimen comprised insulin and 8 HDs hypoglycemic drugs, which are sodium-dependent glucose transporters 2 inhibitor (SGLT2i), glucagon-like peptide 1 receptor agonist (GLP-1RA), dipeptidyl peptidase 4 inhibitors (DPP4i), metformin (Met), sulfonylureas (SU), non-sulfonylureas (nSU), thiazolidinedione (TZD) and α-glycosidase inhibitors (AGI). The use of SGLT2i [RR 0.23, 95%CI (0.11, 0.49)], GLP-1RA [RR 0.28, 95%CI (0.13, 0.57)], and DPP4i [RR 0.34, 95%CI (0.17, 0.67)] demonstrated significant efficacy in reducing the incidence of new-onset AF/AFL when compared to insulin. When HDs were compared in pairs, SGLT2i is more effective than Met [RR 0.35, 95% CI (0.19, 0.62)], SU (RR 0.27, 95% CI (0.14, 0.51)], nSU [RR 0.28, 95% CI (0.08, 0.95)], TZD [RR 0.34, 95% CI (0.17, 0.7)], GLP-1RA is more effective Met [RR 0.42, 95% CI (0.25, 0.71)], SU (RR 0.33, 95% CI (0.18, 0.6)], TZD [RR 0.41, 95% CI (0.21, 0.82)], while Met[RR 1.98, 95% CI (1.23, 3.23)], SU [RR 2.54, 95% CI (1.46, 4.43)], TZD [RR 2.01, 95% CI (1.05, 3.79)] was not as effective as DPP4i.
CONCLUSION
SGLT-2i, GLP-1RA, and DPP4i showed a superior efficacy in reducing the risk of new-onset AF/AFL compared to insulin therapy.
目的
糖尿病被认为是心房颤动/扑动（AF/AFL）发生的重要危险因素。然而，仍缺乏足够证据来确定不同降糖药物（HDs）对糖尿病患者新发AF/AFL发生率的不同影响。为填补这一空白，我们进行了一项网状Meta分析，以研究与胰岛素相比，各种HDs对新发AF/AFL风险是否有不同影响。
方法
我们在PubMed、EMBASE、Cochrane图书馆和Web of Science中进行了全面检索，以识别截至2024年4月1日所有调查各种HDs或胰岛素与AF/AFL发生之间关联的临床试验。采用贝叶斯随机效应模型进行网状Meta分析，结果以相对风险（RR）和95%置信区间（CI）表示。
结果
在检索2070篇文章后，共有12项研究（2349683例患者）纳入网状Meta分析。治疗方案包括胰岛素和8种HDs降糖药物，即钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）、胰高血糖素样肽1受体激动剂（GLP-1RA）、二肽基肽酶4抑制剂（DPP4i）、二甲双胍（Met）、磺脲类（SU）、非磺脲类（nSU）、噻唑烷二酮类（TZD）和α-糖苷酶抑制剂（AGI）。与胰岛素相比，使用SGLT2i[RR 0.23，95%CI（0.11，0.49）]、GLP-1RA[RR 0.28，95%CI（0.13，0.57）]和DPP4i[RR 0.34，95%CI（0.17，0.67）]在降低新发AF/AFL发生率方面显示出显著疗效。当对HDs进行两两比较时，SGLT2i比Met[RR 0.35，95%CI（0.19，0.62）]、SU（RR 0.27，95%CI（0.14，0.51）]、nSU[RR 0.28，95%CI（0.08，0.95）]、TZD[RR 0.34，95%CI（0.17，0.7）]更有效，GLP-1RA比Met[RR 来更有效，GLP-1RA比Met[RR 0.42，95%CI（0.25，0.71）]、SU（RR 0.33，95%CI（0.18，0.6）]、TZD[RR 0.41，95%CI（0.21，0.82）]更有效，而Met[RR 1.98，95%CI（1.23，3.23）]、SU[RR 2.54，95%CI（1.46，4.43）]、TZD[RR 2.01，95%CI（1.05，3.79）]不如DPP4i有效。
结论
与胰岛素治疗相比，SGLT-2i、GLP-RA和DPP4i在降低新发AF/AFL风险方面显示出更高的疗效。
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