Comparative efficacy and safety of Glucagon-like pepetide-1 receptor agonists with metformin in Asian versus non-Asian patients with type 2 diabetes: A systematic review and meta-analysis

IF 5.7 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes, Obesity & Metabolism Pub Date : 2025-09-11 DOI:10.1111/dom.70084

Wenxuan Li MSc, Linyan Huang MD, Ruixue Wang MSc, Peiyan Peng MSc, Aowen Song MSc, Yi Zeng MD, Zhen Zhang MD

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引用次数: 0

Abstract

Aims

In type 2 diabetes, glucagon-like peptide-1 receptor agonists (GLP-1RAs) in combination with metformin show better efficacy than metformin alone. Nevertheless, the reactions of different ethnic groups, especially Asian and non-Asian populations, are still controversial. To give clinical medication usage an evidence-based foundation, this meta-analysis examined GLP-1RAs' safety and efficacy when combined with metformin in the treatment of type 2 diabetes mellitus.

Materials and Methods

Up to January 2025, systematic searches for randomised controlled trials were carried out in PubMed, Embase, the Cochrane Library, SinoMed and Wanfang comparing GLP-1RA/metformin combination versus metformin alone in type 2 diabetes, with subgroup analyses for Asian versus non-Asian cohorts. RevMan version 5.3 was used for analyses, and the Cochrane tools for risk of bias were used for quality assessment.

Results

This meta-analysis comprised 11 papers in total (6 Asian trials: 750 people; 5 non-Asian trials: 1096 people). After treatment of GLP-1RAs combined with metformin, the Asian group showed greater improvement in glycosylated haemoglobin (HbA1c) (weighted mean differences [WMD], −1.09; 95% confidence intervals [CI], −1.48 to −0.71; subgroup heterogeneity: I² = 77.7%, p < 0.05) and weight (WMD, −4.16; 95% CI −6.11 to −2.22; subgroup heterogeneity: I² = 89.5%, p < 0.05) with a lower gastrointestinal (GI) events risk (relative risks, 0.76; 95% CI, 0.47 to 1.22; subgroup heterogeneity: I² = 93.7%, p < 0.00001). There were no racial variations in fasting glucose levels (p = 0.78) or hypoglycaemia (p = 0.16).

Conclusions

This meta-analysis suggested potential ethnic variations in the treatment combining GLP-1RAs with metformin, with Asian populations achieving superior HbA1c reduction and weight loss alongside better GI tolerance.

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胰高血糖素样肽-1受体激动剂联合二甲双胍治疗亚洲与非亚洲2型糖尿病患者的疗效和安全性比较：一项系统综述和荟萃分析

目的：在2型糖尿病中，胰高血糖素样肽-1受体激动剂（GLP-1RAs）联合二甲双胍的疗效优于单用二甲双胍。然而，不同种族群体的反应，特别是亚洲和非亚洲人口，仍然存在争议。为了给临床用药提供循证基础，本荟萃分析检验了GLP-1RAs与二甲双胍联合治疗2型糖尿病的安全性和有效性。材料和方法：截至2025年1月，在PubMed、Embase、Cochrane图书馆、中国医学信息中心和万方进行了随机对照试验的系统检索，比较GLP-1RA/二甲双胍联合与单用二甲双胍治疗2型糖尿病，并对亚洲和非亚洲队列进行了亚组分析。采用RevMan 5.3版本进行分析，采用Cochrane偏倚风险评估工具进行质量评估。结果：本荟萃分析共纳入11篇论文（6项亚洲试验：750人；5项非亚洲试验：1096人）。在GLP-1RAs联合二甲双胍治疗后，亚洲组糖化血红蛋白（HbA1c）的改善更大(加权平均差异[WMD]， -1.09； 95%可信区间[CI]， -1.48至-0.71；亚组异质性：I2 = 77.7%, p 2 = 89.5%, p 2 = 93.7%， p结论：该荟萃分析提示GLP-1RAs联合二甲双胍治疗的潜在种族差异，亚洲人群实现了更好的HbA1c降低和体重减轻，以及更好的GI耐受性。

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来源期刊

Diabetes, Obesity & Metabolism 医学-内分泌学与代谢

CiteScore

10.90

自引率

6.90%

发文量

319

审稿时长

3-8 weeks

期刊介绍： Diabetes, Obesity and Metabolism is primarily a journal of clinical and experimental pharmacology and therapeutics covering the interrelated areas of diabetes, obesity and metabolism. The journal prioritises high-quality original research that reports on the effects of new or existing therapies, including dietary, exercise and lifestyle (non-pharmacological) interventions, in any aspect of metabolic and endocrine disease, either in humans or animal and cellular systems. ‘Metabolism’ may relate to lipids, bone and drug metabolism, or broader aspects of endocrine dysfunction. Preclinical pharmacology, pharmacokinetic studies, meta-analyses and those addressing drug safety and tolerability are also highly suitable for publication in this journal. Original research may be published as a main paper or as a research letter.