基础胰岛素联合阿卡波糖对比预混胰岛素治疗2型糖尿病疗效和安全性的Meta分析

Meta-analysis of basal insulin plus Acarbose versus premixed insulin in the treatment of type 2 diabetes

目的系统评价基础胰岛素联合阿卡波糖对比预混胰岛素治疗T2DM的有效性和安全性,为临床治疗提供循证参考。方法计算机检索Medline、PubMed、Science Direct、Springer Link、中国期刊全文数据库、万方和维普数据库从2000~2016年的文献,收集基础胰岛素联合阿卡波糖(试验组)对比预混胰岛素(对照组)治疗T2DM的随机对照试验(RCT),提取资料并进行质量评价后,采用RevMan 5.3和Stata 12.0统计软件进行Meta分析。结果共纳入21项RCTs,试验组818例,对照组809例。Meta分析结果显示,试验组FPG[SMD(95%CI)=-0.26(-0.42^-0.10),总体效应检验:Z=3.14,P=0.002]、2hPG[SMD(95%CI)=-0.27(-0.47^-0.07),总体效应检验:Z=2.66,P=0.008]、BMI[SMD(95%CI)=-0.83(-1.45^-0.20),总体效应检验:Z=2.6,P=0.009]及低血糖发生率[OR(95%CI)=0.33(0.22~0.48),总体效应模型:Z=5.66,P<0.00001]低于对照组,而两组HbA_1c水平比较,差异无统计学意义[SMD(95%CI)=-0.20(-0.44~0.04),总体效应检验:Z=1.61,P=0.11]。结论基础胰岛素联合阿卡波糖治疗T2DM在降低患者FPG、餐后血糖、BMI及低血糖发生率方面均优于预混胰岛素。

Objective To systematically review the efficacy and safety of basal insulin plus Acarbose versus premixed insulin in type 2diabetes（T2DM）. Methods All data were retrieved from Medline,PubMed,Science Direct,Springer Link,CNKI,WANGFANG and VIP database from 2000 to 2016.Randomized controlled trails（RCT）of basal insulin plus Acarbose（experimental group）versus premixed insulin（control group）in T2 DM treatment were selected.Meta-analysis was performed by RevMan 5.3and Stata 12.0after data collection and quality evaluation. Results A total of 21 RCTs were included in this study,including 818 subjects in experimental group and 809 subjects in control group.Meta-analysis revealed that fasting plasma glucose（FPG）[SMD（95%CI）=-0.26（-0.42^-0.10）,Z=3.14,P=0.002],2hpostprandial glucose（2hPG）[SMD（95%CI）=-0.27（-0.47^-0.07）,Z=2.66,P=0.008],body mass index（BMI）[SMD（95%CI）=-0.83（-1.45^-0.20）,Z=2.6,P=0.009]and incidence of hypoglycemia[OR（95%CI）=0.33（0.22~0.48）,Z=5.66,P〈0.00001]were significantly lower in basal insulin plus Acarbose group than in premixed insulin group.There was no difference in HbA1 c level in both groups [SMD（95% CI）=-0.20（-0.44 ~ 0.04）,Z = 1.61,P = 0.11].Conclusion Basal insulin plus Acarbose therapy show obvious advantage in decreasing FPG,2hPG,BMI and the incidence of hypoglycemia compared with premixed insulin therapy in T2 DM patients.