早期2型糖尿病患者的初始药物策略:系统综述和网络荟萃分析。

IF 6.8 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Jong Han Choi, Bo Kyung Koo, Ye Seul Yang, Se Hee Min, Jong Suk Park, Sang Youl Rhee, Hyun Jung Kim, Min Kyong Moon
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引用次数: 0

摘要

背景:2型糖尿病(T2DM)早期需要严格控制血糖以预防并发症。早期T2DM最有效的治疗方案尚不清楚。该研究旨在比较早期T2DM单药治疗和联合治疗的疗效和安全性。方法:根据系统评价和荟萃分析的首选报告项目(PRISMA)指南进行系统评价和网络荟萃分析。纳入了血糖控制、体重和不良事件的随机对照试验。主要结局是糖化血红蛋白(HbA1c)的变化和6个月后达到目标HbA1c的几率。结果:联合治疗均优于单药治疗。二甲双胍+胰高血糖素样肽-1受体激动剂(GLP-1RA)(加权平均差[WMD] -1.50%;95%置信区间[CI] -2.04至-0.96)和二甲双胍+二肽基肽酶-4抑制剂(WMD -1.46%;95% CI(-1.96 ~ -0.95)对改变HbA1c最有效。GLP-1RA和钠-葡萄糖共转运蛋白-2抑制剂导致体重减轻。除了磺脲类药物的低血糖风险增加外,不同治疗方案的不良事件没有显著差异。结论:早期联合治疗可有效改善早期T2DM患者的血糖控制,且不良风险未明显增加。未来的研究应该探索新的组合,包括有效的GLP-1RA。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Initial Pharmacological Strategies in People with Early Type 2 Diabetes Mellitus: A Systematic Review and Network Meta-Analysis.

Background: Type 2 diabetes mellitus (T2DM) requires stringent glycemic control from an early stage to prevent complications. The most effective treatment regimen for early T2DM remains unclear. The study aimed to compare the efficacy and safety of monotherapies and combination therapies for early T2DM.

Methods: A systematic review and network meta-analysis were conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Randomized controlled trials focused on glycemic control, body weight, and adverse events were included. The primary outcomes were changes in glycosylated hemoglobin (HbA1c) and odds of achieving the target HbA1c after 6 months.

Results: All combination therapies were more effective than monotherapy. Metformin+glucagon-like peptide-1 receptor agonists (GLP-1RA) (weighted mean difference [WMD] -1.50%; 95% confidence interval [CI] -2.04 to -0.96) and metformin+dipeptidyl peptidase-4 inhibitors (WMD -1.46%; 95% CI, -1.96 to -0.95) were the most effective for change in HbA1c. GLP-1RA and sodium- glucose cotransporter-2 inhibitors led to weight reduction. Apart from the increased risk of hypoglycemia with sulfonylureas, no significant differences in adverse events were observed across regimens.

Conclusion: Early combination therapy effectively improved glycemic control in patients with early T2DM without significantly increasing adverse risks. Future studies should explore new combinations, including potent GLP-1RA.

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来源期刊
Diabetes & Metabolism Journal
Diabetes & Metabolism Journal Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
10.40
自引率
6.80%
发文量
92
审稿时长
52 weeks
期刊介绍: The aims of the Diabetes & Metabolism Journal are to contribute to the cure of and education about diabetes mellitus, and the advancement of diabetology through the sharing of scientific information on the latest developments in diabetology among members of the Korean Diabetes Association and other international societies. The Journal publishes articles on basic and clinical studies, focusing on areas such as metabolism, epidemiology, pathogenesis, complications, and treatments relevant to diabetes mellitus. It also publishes articles covering obesity and cardiovascular disease. Articles on translational research and timely issues including ubiquitous care or new technology in the management of diabetes and metabolic disorders are welcome. In addition, genome research, meta-analysis, and randomized controlled studies are welcome for publication. The editorial board invites articles from international research or clinical study groups. Publication is determined by the editors and peer reviewers, who are experts in their specific fields of diabetology.
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