Tu Shiqi, Zhang Ruiqi, Zheng Qiyue, Wang Jiaojiao, Chen Yun, Li Xiaosi, He Jieyu, Zhou Zhaokai, Lu Qiong
Department of Pharmacy, The Second Xiangya Hospital of Central South University, 139 Middle Renmin Road, Changsha, Hunan, 410011, PR China.
Institute of Clinical Pharmacy, Central South University, Changsha, 410011, PR China.
Cardiovasc Drugs Ther. 2025 Mar 20. doi: 10.1007/s10557-025-07683-4.
Verapamil, an L-type calcium channel blocker treating hypertension, arrhythmia, and other cardiovascular diseases, has emerged as a potential drug for lowering blood glucose by regulating cellular calcium homeostasis and affecting expression of apoptosis-related proteins in pancreatic β-cells. However, this promising effect must be weighed against potential risks, including cardiovascular adverse effects of this drug.
We conducted a systematic review and meta-analysis and included randomized controlled trials (RCTs) assessing verapamil in individuals with type 1 or type 2 diabetes. The primary outcomes were glycated hemoglobin (HbA1c) and serum glucose concentration. The secondary outcomes were area under the curve (AUC) values for C-peptide level, body weight, changes in HbA1c and blood glucose concentration pre- and post-intervention, and adverse drug reactions.
A total of eight RCTs involving 1100 patients were included in the analysis. Meta-analysis showed that verapamil effectively lowered blood glucose levels (weighted mean difference [WMD] -6.38, 95% CI -12.52, -0.25 mg/dL, P = 0.04; 6 trials), decreased HbA1c (WMD -0.45, 95% CI -0.66, -0.23%, P < 0.001; 7 trials), and increased C-peptide AUC (WMD 0.27, 95% CI 0.21, 0.32 pmol/mL, P < 0.0001; 2 trials) in patients with both type 1 and type 2 diabetes, without significant trial-related adverse events (OR 1.33, 95% CI 0.85, 2.09, P = 0.21).
The adjunctive use of verapamil to standard hypoglycemic therapy is a safe and effective means of improving glycemic control in diabetic patients. However, the limited scale of RCTs and heterogeneity of basic glucose-lowering regimens across studies might constrain generalizability of these findings. Future high-quality research is warranted to further elucidate the role of verapamil in diabetes management.
维拉帕米是一种用于治疗高血压、心律失常及其他心血管疾病的L型钙通道阻滞剂，已成为一种通过调节细胞钙稳态和影响胰腺β细胞中凋亡相关蛋白表达来降低血糖的潜在药物。然而，这种有前景的效果必须与潜在风险相权衡，包括该药物的心血管不良反应。
我们进行了一项系统评价和荟萃分析，纳入了评估维拉帕米对1型或2型糖尿病患者疗效的随机对照试验（RCT）。主要结局指标为糖化血红蛋白（HbA1c）和血清葡萄糖浓度。次要结局指标为C肽水平的曲线下面积（AUC）值、体重、干预前后HbA1c和血糖浓度的变化以及药物不良反应。
分析共纳入8项RCT，涉及1100例患者。荟萃分析表明，维拉帕米可有效降低1型和2型糖尿病患者的血糖水平（加权均数差[WMD] -6.38，95%可信区间[-12.52, -0.25]mg/dL，P = 0.04；6项试验），降低HbA1c（WMD -0.45，95%可信区间[-0.66, -0.23]%，P < 0.001；7项试验）并增加C肽AUC（WMD 0.27，95%可信区间[0.21, 0.32]pmol/mL，P < 0.0001；2项试验），且无显著的试验相关不良事件（比值比[OR] 1.33，95%可信区间[0.85, 2.09]，P = 0.21）。
在标准降糖治疗中加用维拉帕米是改善糖尿病患者血糖控制的一种安全有效的方法。然而，RCT的规模有限以及各研究中基础降糖方案的异质性可能会限制这些结果的普遍性。未来需要高质量的研究来进一步阐明维拉帕米在糖尿病管理中的作用。
