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首页> 外文期刊>Current therapeutic research, clinical and experimental. >Glue agon-Like Peptide-1 Receptor Agonists Versus Insulin Glargine for Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
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Glue agon-Like Peptide-1 Receptor Agonists Versus Insulin Glargine for Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

机译：胶激动剂样肽1受体激动剂与胰岛素甘精胰岛素治疗2型糖尿病：随机对照试验的系统评价和荟萃分析

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Background; Glucagon-like peptide-1 (GLP-1) receptor agonists are a new class of hypoglycemic drugs, including exenatide, liraglutide, albiglutide, lixisenatide, and taspoglutide. Insulin glargine is a standard agent used to supplement basal insulin in type 2 diabetes mellitus (T2DM).OBJECTIVE! The aim of this study was to review the efficacy and safety profiles of GLP-1 receptor agonists versus insulin glargine in type 2 diabetic patients who have not achieved treatment goals with oral hypoglycemic agents.Methods: The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, and the database of ongoing trials were searched from inception through April 2010. Additional data were sought from relevant Web sites, the American Diabetes Association, reference lists of included trials and related (systematic) reviews, and industry. Randomized controlled trials (RCTs) were selected if they were >3 months in duration, compared GLP-1 receptor agonists with insulin glargine in patients with T2DM, and included >1 of the following outcomes: mortality, complications of T2DM, glycemic control, weight, lipids, blood pressure, adverse effects, and health-related quality of life. Quasirandomized controlled trials were excluded. The quality of the eligible studies was assessed on the basis of the following aspects: randomization procedure, allocation concealment, blinding, incomplete outcome data (intent-to-treat [ITT] analysis), selective outcome reporting, and publication bias.RESULTS! A total of 410 citations were retrieved; 5 multicenter RCTs that met the inclusion criteria were identified. They were all open-label designs with an insulin glargine arm, predefined outcomes reported, and ITT analysis. One trial had an unclear randomization procedure and allocation concealment. Publication bias was not able to be determined. No data were found with regard to mortality or diabetes-associated complications, and few data were found on quality of life. The results of the meta-analysis suggest that insulin glargine was significantly better in reducing the fasting blood glucose (mean difference [MD] [95% CI}, 1.31 [1-04 to 1.58}; P < 0.001), but exhibits greater incidence of nocturnal hypoglycemia (risk ratio [RR} [95% CI}, 0.40 [0.23 to 0.71}; P = 0.002) and influenza (RR [95% CI}, 0.56 [0.32 to 0.98}; P = 0.04). GLP-1 receptor agonists are more conducive to reducing weight (MD [95% CI}, -3.96 [-5.14 to -2.77}; P < 0.001), postprandial blood glucose (after breakfast, P < 0.001; after dinner, P < 0.001), and LDL-C (MD [95% CI}, -0.18 [-0.28 to -0.08}; P < 0.001), but have significantly more gastrointestinal adverse effects (eg, nausea/ vomiting, P < 0.001). There were no significant differences between GLP-1 receptor agonists and insulin glargine in reducing glycosylated hemoglobin (HbA_(1c)) levels (MD [95% CI}, -0.03 [-0.13 to 0.08}) and the overall incidence of hypoglycemia (RR [95% CI}, 0.69 [0.42 to 1.14}).CONCLUSIONS: Compared with insulin glargine, GLP-1 receptor agonists did not have a significant difference in regard to reducing HbA_(1c) levels and they were significantly associated with decreased weight but increased gastrointestinal adverse events. It remains unclear whether GLP-1 receptor agonists influence mortality or diabetes-associated complications in patients with T2DM. More trials with longer follow-up are needed to determine the exact long-term efficacy and safety profiles of this new class of hypoglycemic drugs.
机译：背景;胰高血糖素样肽-1（GLP-1）受体激动剂是一类新型的降血糖药物，包括艾塞那肽，利拉鲁肽，阿比鲁肽，利西拉肽和他葡糖苷。甘精胰岛素是用于补充2型糖尿病（T2DM）中基础胰岛素的标准药物。这项研究的目的是回顾GLP-1受体激动剂与甘精胰岛素对尚未通过口服降糖药达到治疗目标的2型糖尿病患者的疗效和安全性。方法：Cochrane文库，MEDLINE，EMBASE，Science Citation索引已扩展，从开始到2010年4月一直在搜索正在进行的数据库。从相关的网站，美国糖尿病协会，纳入的试验和相关（系统的）评价参考清单以及行业中寻求其他数据。如果持续时间> 3个月，则选择随机对照试验（RCT），将T2DM患者的GLP-1受体激动剂与甘精胰岛素进行比较，并包括以下1种结果：死亡率，T2DM并发症，血糖控制，体重，脂质，血压，不良反应以及与健康相关的生活质量。排除准随机对照试验。合格研究的质量是基于以下几个方面进行评估的：随机程序，分配隐藏，盲法，不完整的结果数据（意向性治疗[ITT]分析），选择性的结果报告和发表偏倚。总共检索到410条引文;确定了5个符合纳入标准的多中心RCT。它们都是带有甘精胰岛素胰岛素臂的开放标签设计，报告了预定义的结果，并进行了ITT分析。一项试验的随机程序和分配隐匿性不清楚。无法确定出版偏向。没有发现有关死亡率或糖尿病相关并发症的数据，也没有发现有关生活质量的数据。荟萃分析的结果表明，甘精胰岛素在降低空腹血糖方面效果显着更好（平均差[MD] [95％CI}，1.31 [1-04至1.58}; P <0.001），但发生率更高夜间低血糖（风险比[RR] [95％CI}，0.40 [0.23至0.71}; P = 0.002]和流感（RR [95％CI}，0.56 [0.32至0.98}; P = 0.04）。 GLP-1受体激动剂更有助于减轻体重（MD [95％CI}，-3.96 [-5.14至-2.77}; P <0.001），餐后血糖（早餐后，P <0.001;晚餐后，P < 0.001）和LDL-C（MD [95％CI}，-0.18 [-0.28至-0.08}; P <0.001），但对胃肠道的不良反应明显更多（例如，恶心/呕吐，P <0.001）。 GLP-1受体激动剂和甘精胰岛素在降低糖基化血红蛋白（HbA_（1c））水平（MD [95％CI}，-0.03 [-0.13至0.08}]和低血糖的总体发生率（RR）方面无显着差异[95％CI}，0.69 [0.42至1.14}）。结论：与甘精胰岛素相比，GLP-1受体激动剂在降低HbA_（1c）水平方面无显着差异，并且与体重减轻显着相关，但胃肠道不良事件增加。尚不清楚GLP-1受体激动剂是否会影响T2DM患者的死亡率或与糖尿病相关的并发症。需要更多随访时间更长的试验来确定这种新型降血糖药物的确切长期疗效和安全性。

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