不同微生态调节剂对2型糖尿病血糖及胰岛素水平调控的Meta分析

Effects of Microecological modulators on blood glucose and insulin levels in Type 2 Diabete:A Meta-Analysis

目的评价微生态调节剂益生元、益生菌及合生元对2型糖尿病患者血糖及胰岛素的影响。方法应用计算机搜索PubMed,Embase,Cochrane Library和中国知网(CNKI)中微生态调解剂干预2型糖尿病的随机对照试验(randomized controlled trial,RCT),搜索时间为建库至2020年6月。符合纳入标准的研究使用Cochrane系统评价及RevMan5.3进行研究内容的质量评价,使用Stata14进行网状meta分析。结局指标包括空腹血糖(fasting blood glucose,FBG)、糖化血红蛋白(hemoglobin A1c,HbA1 c)及胰岛素水平。结果共纳入15个RCT,共990例2型糖尿病患者,包括益生元、益生菌和合生元3种干预措施。①平均血糖水平:益生菌、益生元和合生元相较于安慰组对血糖的影响差异无统计学意义(P>0.05);等级概率排序结果显示,对血糖的控制效果益生菌优于益生元和合生元。②糖化血红蛋白:与安慰剂组相比,益生菌组能明显降低患者的HbA1c水平(P<0.05),其他两组与安慰剂组差异无统计学意义(P>0.05);等级概率排序结果显示,降低糖化血红蛋白的效果益生菌、益生元、合生元依次减弱。③胰岛素水平:对胰岛素水平的影响,3组制剂与安慰组比较差异无统计学意义(P>0.05);降低胰岛素水平的效果排序中,合生元排第一位,其次是益生菌和益生元。结论在降低空腹血糖和糖化血红蛋白的作用中,益生菌效果最好;调解空腹胰岛素水平方面,合生元优于益生菌和益生元。

Objective To evaluate the effects of probiotics,prebiotics and synbiotics on blood glucose and insulin levels in type 2 diabetes mellitus patients.Methods We searched PubMed,Embase,Cochrane Library and CNKI for randomized controlled trials(RCTs)about the intervention of microecological mediators in type 2 diabetes mellitus,from the start to June 2020.Cochran evaluation was used to evaluate the quality of included studies and figure was drafted by RevMan5.3.Stata14 was applied to process the network Meta-analysis.Outcomes included fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c)and insulin levels.Results 15 RCTs consisted by 990 patients were qualified to our study.Prebiotics,Probiotics and Synbiotics intervention measures were compared for their efficiency for T2DM patients.①The average level of blood glucose:there was no significant difference between probiotics,prebiotics,synbiotics and the placebo group(P>0.05);the rank probability results showed that probiotics had better control effect on blood glucose than synbiotics and prebiotics.②HbA1c:compared with the placebo group,probiotics might significantly reduce the HbA1c level of patients(P<0.05),and there was no significant difference between the other two groups and the placebo group(P>0.05);the rank probability figure concluded that probiotics reducing HbA1c faster than prebiotics and synbiotics.③Insulin level:there was no significant difference between the three microecological modulator groups and the placebo group(P>0.05);in terms of the effection of increasing insulin level,synbiotics stated at first,followed by probiotics and prebiotics.Conclusion The results showed that probiotics had the top effect in reducing fasting blood glucose and HbA1c levels among three methods.Synbiotics were better than probiotics and prebiotics in regulating fasting insulin level.