Huang Gerile, Li Yujie, Shang YuQi, Wang Huiduo, Zhang Wenjing, Guo Hao
Department of Pharmacy, Inner Mongolia People's Hospital, Hohhot, 010017, Inner Mongolia, China.
School of Pharmacy, Inner Mongolia Medical University, Hohhot, 010059, Inner Mongolia, China.
Eur J Clin Pharmacol. 2025 Oct;81(10):1493-1506. doi: 10.1007/s00228-025-03882-y. Epub 2025 Jul 31.
Thiazolidinediones (TZDs), including pioglitazone and rosiglitazone, and non-TZD insulin sensitisers (chiglitazar sodium) demonstrate potential; however, their comparative efficacy and safety remain unclear. We aimed to analyse the efficacy and safety of commonly used insulin sensitisers, including chiglitazar sodium, sitagliptin, pioglitazone, and rosiglitazone for treating type 2 diabetes mellitus (T2DM).
A computer-based search was conducted in the China National Knowledge Infrastructure, Wanfang Data, the VIP database, PubMed, Embase, and Cochrane Library databases from the establishment date of each database to January 2025. Included study quality was evaluated using the Cochrane risk of bias tool. Surface under the cumulative ranking curve was calculated for each outcome indicator to compare the efficacy and safety of different interventions.
In reducing haemoglobin A1c, 8 mg of rosiglitazone was superior over 100 mg sitagliptin, 30 mg pioglitazone, and 15 mg pioglitazone (P < 0.05), with no significant differences among the remaining medications. To reduce fasting plasma glucose, 45 mg of pioglitazone was more effective than any dosage of chiglitazar sodium, sitagliptin, or rosiglitazone (P < 0.05). Regarding safety, the incidence rate of adverse reactions was higher with 45 mg of pioglitazone than with 8 mg of rosiglitazone (P < 0.05), with no significant differences in adverse events among other medications.
Compared with placebo, all four drugs were safe and effective in the treatment of T2DM. High-dose TZDs may be more effective than mitiglinide and sitagliptin. However, 45 mg of pioglitazone was associated with a higher incidence of adverse events, warranting close monitoring of its safety profile.
噻唑烷二酮类药物（TZDs），包括吡格列酮和罗格列酮，以及非TZDs胰岛素增敏剂（西格列他钠）已显示出一定潜力；然而，它们的相对疗效和安全性仍不明确。我们旨在分析常用胰岛素增敏剂，包括西格列他钠、西他列汀、吡格列酮和罗格列酮治疗2型糖尿病（T2DM）的疗效和安全性。
在中国知网、万方数据、维普数据库、PubMed、Embase和Cochrane图书馆数据库中进行基于计算机的检索，检索时间从各数据库建库日期至2025年1月。使用Cochrane偏倚风险工具评估纳入研究的质量。计算每个结局指标的累积排名曲线下面积，以比较不同干预措施的疗效和安全性。
在降低糖化血红蛋白方面，8毫克罗格列酮优于100毫克西他列汀、30毫克吡格列酮和15毫克吡格列酮（P＜0.05），其余药物之间无显著差异。为降低空腹血糖，45毫克吡格列酮比任何剂量的西格列他钠、西他列汀或罗格列酮更有效（P＜0.05）。在安全性方面，45毫克吡格列酮的不良反应发生率高于8毫克罗格列酮（P＜0.05），其他药物之间的不良事件无显著差异。
与安慰剂相比，所有四种药物治疗T2DM均安全有效。高剂量TZDs可能比米格列奈和西他列汀更有效。然而，45毫克吡格列酮的不良事件发生率较高，需要密切监测其安全性。
