Amer Basma Ehab, Abdelgalil Mahmoud Shaaban, Hamad Abdullah Ashraf, Abdelsayed Kerollos, Elaraby Ahmed, Abozaid Ahmed Mohamed, Abd-ElGawad Mohamed
Faculty of Medicine, Benha University, Benha, Egypt.
Faculty of Medicine, Ain-shams University, Cairo, Egypt.
Diabetol Metab Syndr. 2024 Nov 14;16(1):273. doi: 10.1186/s13098-024-01504-8.
We conducted this meta-analysis of randomized controlled trials (RCTs) to compare the efficacy of adding metformin to lifestyle interventions versus lifestyle interventions alone in individuals with prediabetes.
We searched four databases from inception until March 20, 2024. Our primary outcomes included the incidence of type 2 diabetes, hemoglobin A1c (HbA1c), and fasting plasma glucose (FPG). Secondary outcomes included blood pressure, plasma lipids, and weight measurements. Dichotomous outcomes were pooled as the risk ratio (RR) and its 95% confidence interval (CI), while continuous outcomes were pooled as the standardized mean difference (SMD) and its 95% CI in the random effect model. All statistical analyses were conducted using the "meta" package of RStudio software.
We included 12 RCTs, comprising 2720 patients. Adding metformin to lifestyle interventions significantly reduced HbA1c levels (SMD = -0.10, 95% CI [-0.19, -0.01], P = 0.03) and the incidence of type 2 diabetes (RR = 0.85, 95% CI [0.75, 0.97], P = 0.01). Interestingly, adding metformin to lifestyle interventions was comparable to lifestyle interventions alone in terms of FPG at both 3 and 6 months; however, it significantly reduced FPG at 12 months (SMD = -0.34, 95% CI [-0.59, -0.08], P = 0.01). There were no significant differences between the two groups in terms of all secondary outcomes.
Our findings suggest that adding metformin to lifestyle interventions may improve glycemic control in individuals with prediabetes and reduce their risk of progression to diabetes, compared to lifestyle interventions alone. A longer duration of this combined approach may be required to observe the desired effects.
我们进行了这项随机对照试验（RCT）的荟萃分析，以比较在糖尿病前期个体中，在生活方式干预基础上加用二甲双胍与单纯生活方式干预的疗效。
我们检索了四个数据库，从数据库建立至2024年3月20日。我们的主要结局包括2型糖尿病的发病率、糖化血红蛋白（HbA1c）和空腹血糖（FPG）。次要结局包括血压、血脂和体重测量。二分结局合并为风险比（RR）及其95%置信区间（CI），而连续结局在随机效应模型中合并为标准化均数差（SMD）及其95%CI。所有统计分析均使用RStudio软件的“meta”包进行。
我们纳入了12项RCT，共2720例患者。在生活方式干预基础上加用二甲双胍可显著降低HbA1c水平（SMD = -0.10，95%CI [-0.19, -0.01]，P = 0.03）和2型糖尿病的发病率（RR = 0.85，95%CI [0.75, 0.97]，P = 0.01）。有趣的是，在生活方式干预基础上加用二甲双胍在3个月和6个月时的空腹血糖方面与单纯生活方式干预相当；然而，在12个月时它显著降低了空腹血糖（SMD = -0.34，95%CI [-0.59, -0.08]，P = 0.01）。两组在所有次要结局方面均无显著差异。
我们的研究结果表明，与单纯生活方式干预相比，在生活方式干预基础上加用二甲双胍可能改善糖尿病前期个体的血糖控制，并降低其进展为糖尿病的风险。可能需要更长时间的这种联合方法来观察到预期效果。
