铬用于2型糖尿病辅助治疗的有效性和安全性评价

Systematic review of the efficacy and safety of chromium for adjuvant treatment in type 2 diabetes mellitus

目的系统评价铬用于2型糖尿病辅助治疗的有效性和安全性。方法计算机检索Pubmed、The Cochrane Library、EMbase以及中国期刊全文数据库,收集在标准降糖治疗基础上添加铬治疗2型糖尿病的随机对照试验,同时辅以手工检索,检索时限均从各数据库建库至2020年12月31日。评价纳入研究的质量,并对结果进行meta分析。结果共纳入23项试验,合计患者1098例。试验组患者的胰岛素抵抗指数[SMD=-1.32,95%CI(-2.56,-0.09),P=0.04]、空腹血糖[SMD=-1.93,95%CI(-2.69,-1.17),P<0.00001]、空腹血胰岛素[SMD=-0.83,95%CI(-1.53,-0.14),P=0.02]、糖化血红蛋白[SMD=-0.71,95%CI(-1.27,-0.15),P=0.01]、总胆固醇[SMD=-0.66,95%CI(-1.31,-0.01),P=0.05]和三酰甘油[SMD=-1.80,95%CI(-2.50,-1.11),P<0.00001]水平均显著低于对照组患者,铬对2型糖尿病患者血糖和血脂的改善效果明显。与对照组比较,试验组患者在体质量指数[SMD=-0.59,95%CI(-1.23,0.06),P=0.08]、收缩压[SMD=-0.23,95%CI(-1.02,0.57),P=0.58]、舒张压[SMD=-0.34,95%CI(-1.00,0.33),P=0.32]以及不良反应事件发生数量[RR=0.95,95%CI(0.77,1.17),P=0.61]方面,差异均无统计学意义。结论铬添加在2型糖尿病患者的治疗中,可以显著改善患者胰岛素抵抗、血糖和血脂情况,并且不良反应的发生没有显著增加。

Objective To systematically evaluate the efficacy and safety of chromium for adjuvant treatment in type 2 diabetes mellitus(T2DM).Methods Pubmed,the Cochrane Library,EMbase and CJFD database were retrieved,and randomized controlled trials(RCT)on chromium used in the adjuvant treatment in T2DM on the basis of standard anti-glycemic therapy were collected.The retrieval time was from the establishment of the databases to December 31st,2020.Quality evaluation and metaanalysis of included literatures were conducted.Results Totally 23 RCTs were included,involving 1098 patients.The insulin resistance index in the test group(chromium supplementation)[SMD=-1.32,95%CI(-2.56,-0.09),P=0.04],the fasting blood glucose[SMD=-1.93,95%CI(-2.69,-1.17),P<0.00001],the fasting blood insulin[SMD=-0.83,95%CI(-1.53,-0.14),P=0.02],the glycosylated hemoglobin[SMD=-0.71,95%CI(-1.27,-0.15),P=0.01],total cholesterol[SMD=-0.66,95%CI(-1.31,-0.01),P=0.05],and triglycerides[SMD=-1.80,95%CI(-2.50,-1.11),P<0.00001]all lower than those of the control group,revealing obvious effect of chromium on improving blood glucose and blood lipid in T2DM patients.The body mass index[SMD=-0.59,95%CI(-1.23,0.06),P=0.08],the systolic blood pressure[SMD=-0.23,95%CI(-1.02,0.57),P=0.58],diastolic blood pressure[SMD=-0.34,95%CI(-1.00,0.33),P=0.32]and adverse events number[RR=0.95,95%CI(0.77,1.17),P=0.61]of the test group had no significant difference as compared with those of the control group.Conclusion Chromium supplementation for patients with T2DM significantly improves insulin resistance,blood glucose and blood lipids,without obvious increase of adverse reactions.