钠-葡萄糖共转运蛋白-2抑制剂治疗2型糖尿病1年有效性的网状Meta分析

One-Year Efficacy of Sodium-Glucose-Transporter-2 Inhibitors in the Treatment of Type 2 Diabetes Mellitus:A Network Meta-Analysis

目的系统评价钠-葡萄糖共转运蛋白-2抑制剂(SGLT-2i)治疗2型糖尿病(T2DM)1年的有效性。方法计算机检索PubMed,Embase,The Cochrane Library,以及中国生物医学文献数据库、中国期刊全文数据库、维普期刊全文数据库、万方数据库及国际临床试验注册中心数据库,检索时限为各数据库自建库至2019年12月31日;收集SGLT-2i治疗T2DM的随机对照试验(RCT);提取资料,并按Cochrane偏倚风险量表评估文献质量;采用Stata 15.1软件对数据进行网状Meta分析。结果共纳入37个RCT,包括28973例患者。网状Meta分析结果显示,SGLT-2i降低糖化血红蛋白(Hb A1C)水平的能力弱于胰高血糖素样肽-1受体激动剂(GPL-1RAs)和二甲双胍(P<0.05),与磺脲类、噻唑烷二酮类(TZDs)、二肽基肽酶-4抑制剂(DPP-4i)相当(P>0.05);各SGLT-2i间降低Hb A1C水平的能力相当(P>0.05)。SGLT-2i降低空腹血糖(FBG)水平的能力与GLT-1RAs、二甲双胍和TZDs相当(P>0.05),强于磺脲类、DPP-4i(P<0.05);除卡格列净300 mg强于达格列净5 mg外(P<0.05),其余SGLT-2i间降低FBG水平的能力相当(P>0.05)。SGLT-2i降低体质量及血压的能力强于其他口服降糖药(P<0.05);各SGLT-2i间降血压的能力相当(P>0.05)。结论SGLT-2i能显著降低患者的HbA1C和FBG水平及血压和体质量,卡格列净300 mg的疗效可能最好。上述结论尚需开展更大样本、更高质量的多中心RCT证实。

Objective To systematically review the one-year efficacy of sodium-glucose-transporter-2 inhibitors(SGLT-2 i)in the treatment of type 2 diabetes mellitus(T2 DM).Methods The randomized controlled trails(RCTs)of SGLT-2 i in the treatment of T2 DM were searched from PubMed,Embase,The Cochrane Library,CBM,CNKI,VIP,Wanfang database and International Clinical Trial Registry from inception to December 31 st,2019.The related data was extracted from RCTs and the quality of RCTs was evaluated according to the Cochrane bias risk scale.The network Meta-analysis was conducted on the data by the Stata 15.1 software.Results A total of 37 RCTs were included,including 28973 patients.The results of network Meta-analysis showed that the ability of SGLT-2 i to reduce the level of glycosylated hemoglobin(HbA1 C)was weaker than that of glucagon-like peptide-1 receptor agonists(GLP-1 RAs)and metformin(P<0.05),which was equivalent to that of sulfonylureas,thiazolidinediones(TZDs)and dipeptidyl peptidase-4 inhibitors(P>0.05).The ability of each SGLT-2 i to reduce the level of Hb A1 C was similar(P>0.05).The ability of SGLT-2 i to reduce the level of fasting blood glucose(FBG)was equivalent to that of GLP-1 RAs,metformin and TZDs(P>0.05),which was stronger than that of sulfonylurea and dipeptidyl peptidase-4 inhibitors(P<0.05).The ability of other SGLT-2 i to reduce the level of FBG was similar(P>0.05),except that of 300 mg of canagliflozin was stronger than that of 5 mg of dapagliflozin(P<0.05).The ability of SGLT-2 inhibitors to reduce body weight and blood pressure was stronger than that of other oral hypoglycemic drugs(P<0.05).The ability of each SGLT-2 i to reduce blood pressure was similar(P>0.05).Conclusion SGLT-2 i can significantly reduce the levels of Hb A1 C and FBG,blood pressure and body weight of patients.The curative effect of 300 mg of canagliflozin may be the best.However,the above conclusions need to be confirmed by a larger sample of higher-quality multi-center RCTs.