胰岛素复方制剂治疗2型糖尿病的网状Meta分析

Network Meta-analysis on insulin compound preparation in treatment of type 2 diabetes

目的采用网状Meta分析比较德谷门冬胰岛素、德谷胰岛素利拉鲁肽和甘精胰岛素利司那肽治疗2型糖尿病的疗效和安全性。方法检索国内外数据库(数据库创建时间到2024年9月18日),纳入德谷门冬胰岛素、德谷胰岛素利拉鲁肽、甘精胰岛素利司那肽与基础胰岛素相互比较的随机对照试验。以糖化血红蛋白<7%人数、糖化血红蛋白、体质量、空腹血糖和低血糖人数为结局指标。采用R语言贝叶斯方法进行网状Meta分析,绘制两两比较的联赛图,并通过计算累积排序概率图下面积(SUCRA)进行排序。结果最终纳入25项随机对照试验。德谷胰岛素利拉鲁肽增加糖化血红蛋白<7%患者比例、降低糖化血红蛋白、减轻体质量、降低低血糖时间的发生风险的效果最好。甘精胰岛素利司那肽与基础胰岛素相比,可以增加糖化血红蛋白<7%的人数、降低糖化血红蛋白和减轻体质量。从排序结果来看,德谷胰岛素利拉鲁肽在改善糖化血红蛋白<7%的人数、糖化血红蛋白、体质量、空腹血糖和低血糖风险上更优。结论德谷胰岛素利拉鲁肽具有改善糖化血红蛋白、降低体质量的疗效优势,同时具有降低低血糖风险的安全性优势。

Objective To compare the efficacy and safety among insulin degludec and insulin aspart(IDegAsp),insulin degludec and liraglutide(IDegLira),and insulin glargine and lixisenatide(iGlarlixi)in treatment of type 2 diabetes by network Meta-analysis.Methods Domestic and foreign database were comprehensively searched to identify randomized controlled trials(RCTs)of effects of IDegAsp,IDegLira,and iGlarlixi from inception to July 18,2024.The outcomes were the achieving an HbA1c<7%,HbA1c,body weight,fasting plasma glucose,and incidence of hypoglycaemia.R software was used to conduct Bayesian network Meta-analysis and drawing the league map of pairwise comparison.The ranking probabilities of all treatments on efficacy and safety outcomes were displayed on their surface under the cumulative ranking(SUCRA)probabilities.Results A total of 25 RCTs were included in the analysis.IDegLira had the best effect on increasing the proportion of patients with HbA1c<7%,reducing glycated hemoglobin,reducing body weight,and lowering the incidence of hypoglycemia.IGlarlixi was superior to basal insulin in achieving an HbA1c<7%,decreasing HbA1c,and losing body weight.According to the ranking results,IDegLira might better in achieving an HbA1c<7%,decreasing HbA1c and fasting plasma glucose,losing body weight and reducing incidence of hypoglycaemia.Conclusion IDegLira has therapeutic advantages in improving HbA1c and reducing body weight,while also having safety advantages in reducing the risk of hypoglycemia.