胰升血糖素样肽-1类似物与甘精胰岛素治疗2型糖尿病患者疗效及安全性的Meta分析

The efficacy and safety of GLP-1 analogue and glargine on type 2 diabetic patients:A meta-analysis

目的评价胰升血糖素样肽-1(GLP-1)类似物与甘精胰岛素对采用口服降糖药(OADs)治疗但血糖控制不佳的T2DM患者疗效及安全性。方法采用Medline、PubMed、Embase、The National Register、Cochrane、Current Controlled Trials、中国生物医学文献数据库、中国期刊全文数据库、VIP、CNKI和万方数据库检索,查找符合标准的随机对照试验(RCTs)进行质量评价。结果最终纳入7篇RCTs,共2653例患者,其中,GLP-1类似物(包括艾塞那肽、利拉鲁肽)组1347例,甘精胰岛素组1306例。两组均可降低FPG、HbA1c水平,GLP-1类似物组降低HbA1c水平较甘精胰岛素组高,甘精胰岛素组降低FPG水平较GLP-1类似物组高(P<0.01)。GLP-1类似物组可降低体重,甘精胰岛素组可增加体重,两组比较差异有统计学意义(P<0.01)。GLP-1类似物组低血糖事件发生率较甘精胰岛素组降低43%。GLP-1类似物组胃肠道不良反应较甘精胰岛素组常见,多为恶心、呕吐,症状短暂、轻微。结论采用OADs治疗但血糖控制不佳的T2DM患者,GLP-1类似物和甘精胰岛素均可降低其FPG、HbA1c水平,但GLP-1类似物可降低体重,低血糖发生风险低,胃肠道不良反应较常见,症状短暂、轻微,是T2DM患者新的治疗选择。

Objective To evaluate the efficacy and safety of GLP‐1 analogue and glargine in T2DM patients with unsatisfactory glycemic control using oral antidiabetic drug （OAD）. Methods Quality assessments of the randomized controlled trials （RCTs） in accordance with the inclusive criteria which were retrieved from Medline ,PubMed ,Embase ,The National Register ,Cochrane ,Current Controlled Trials ,CBMdisc ,CJFD ,VIP ,CNKI and Wanfang database. The analysis were performed using Revman version5.2.Results 7RCTswith2653patientswereincorporatedintoourstudy：1347patientsin GLP‐1 analogue group and 1306 patients in glargine group. The results showed that ,FPG and HbA1c were all reduced in both GLP‐1 analogue and glargine group. Compared with glargine group ,the reduction of HbA1c level was relatively lower in GLP‐1 analogue group. The reduction of FPG was greater in Glargine group than GLP‐1 analogue group （ P〈 0.01 ）. Weight was decreased in GLP‐1 analogue group ,but increased in glargine group. There were statistically significant differences in weight change between two groups （P〈0.01）. The rate of hypoglycaemia events in GLP‐1 analogue group had a 43% reduction than glargine group （P〈0.01）. The gastrointestinal side effect in GLP‐1 analogue group were more frequently than glargine group ,such as nausea and vomiting ,slight and transient. Conclusion Both GLP‐1 analogue and glargine could reduce FPG and HbA1 c level in T2DM patients with unsatisfactory glycemic control using OAD. GLP‐1 analogue could significantly reduce weight ,has lower hypoglycaemia risk and slight and transient gastrointestinal side effect. It has become a new choice of T2DM.