PDF(Pubmed)
Abstract：
BACKGROUND: Prediabetes is a condition preceding the development of diabetes and is associated with an increased risk of a number of complications. The primary mode of management is thought to be lifestyle modification. Pharmacological therapy, such as glucagon-like peptide-1 receptor agonists (GLP-1RAs), were not well addressed in the literature and were only evaluated in trials as secondary and exploratory outcomes with a limited sample size. Here, GLP-1RAs are evaluated as a comprehensive therapy approach for patients with prediabetes.
METHODS: A comprehensive search of Web of Science, SCOPUS, PubMed, and Cochrane was performed on May 5, 2023, to retrieve randomized controlled trials (RCTs) comparing the effect of GLP-1RAs to placebo and/or lifestyle modification on prediabetes reversion to normoglycemia, prevention of overt diabetes, glycemic control, anthropometric parameters, and lipid profiles. Review Manager (RevMan) version 5.4 was used. The quality of RCTs was assessed using the revised version of the Cochrane Risk of Bias Tool. GRADE was performed to evaluate the certainty of evidence.
RESULTS: Twelve trials involving 2903 patients in the GLP-1RAs group and 1413 in the control group were included in the meta-analysis. Low quality of evidence revealed that GLP-1RAs significantly increased the incidence of prediabetes reversion to the normoglycemic state [RR = 1.76, 95% CI (1.45, 2.13), P < 0.00001] and moderate quality of evidence showed that GLP-1RAs significantly prevented new-onset diabetes [RR = 0.28, 95% CI (0.19, 0.43), P < 0.00001]. Significant reductions in HbA1c, fasting plasma glucose, body weight, waist circumference, triglycerides, and LDL were observed in the GLP-1RAs arm (P < 0.05). However, higher incidences of gastrointestinal disorders were reported in the GLP-1RAs group (P < 0.05).
CONCLUSIONS: GLP-1RAs combined with lifestyle modification proved to be a more effective therapy for managing prediabetic patients than lifestyle modification alone, with a tolerable safety profile. Future guidelines should consider GLP-1RAs as an adjunct to lifestyle modification in the management of prediabetic patients to provide better management and improve treatment adherence.
METHODS: A comprehensive search of Web of Science, SCOPUS, PubMed, and Cochrane was performed on May 5, 2023, to retrieve randomized controlled trials (RCTs) comparing the effect of GLP-1RAs to placebo and/or lifestyle modification on prediabetes reversion to normoglycemia, prevention of overt diabetes, glycemic control, anthropometric parameters, and lipid profiles. Review Manager (RevMan) version 5.4 was used. The quality of RCTs was assessed using the revised version of the Cochrane Risk of Bias Tool. GRADE was performed to evaluate the certainty of evidence.
RESULTS: Twelve trials involving 2903 patients in the GLP-1RAs group and 1413 in the control group were included in the meta-analysis. Low quality of evidence revealed that GLP-1RAs significantly increased the incidence of prediabetes reversion to the normoglycemic state [RR = 1.76, 95% CI (1.45, 2.13), P < 0.00001] and moderate quality of evidence showed that GLP-1RAs significantly prevented new-onset diabetes [RR = 0.28, 95% CI (0.19, 0.43), P < 0.00001]. Significant reductions in HbA1c, fasting plasma glucose, body weight, waist circumference, triglycerides, and LDL were observed in the GLP-1RAs arm (P < 0.05). However, higher incidences of gastrointestinal disorders were reported in the GLP-1RAs group (P < 0.05).
CONCLUSIONS: GLP-1RAs combined with lifestyle modification proved to be a more effective therapy for managing prediabetic patients than lifestyle modification alone, with a tolerable safety profile. Future guidelines should consider GLP-1RAs as an adjunct to lifestyle modification in the management of prediabetic patients to provide better management and improve treatment adherence.
摘要：
背景：糖尿病前期是糖尿病发展之前的一种疾病，并且与许多并发症的风险增加有关。主要的管理模式被认为是生活方式的改变。药物治疗,如胰高血糖素样肽-1受体激动剂（GLP-1RAs），在文献中没有得到很好的解决,并且仅在有限样本量的试验中作为次要和探索性结局进行评估.这里,GLP-1RA被评估为糖尿病前期患者的综合治疗方法。
方法：对WebofScience的全面搜索，Scopus,PubMed,和Cochrane于2023年5月5日进行，以检索随机对照试验（RCT），比较GLP-1RA与安慰剂和/或生活方式改变对糖尿病前期恢复到血糖正常的影响，预防明显的糖尿病，血糖控制,人体测量参数,和脂质分布。使用了ReviewManager(RevMan)5.4版。使用修订版本的Cochrane偏差风险工具评估随机对照试验的质量。进行评分以评估证据的确定性。
结果：12项研究纳入了GLP-1RAs组2903例患者和对照组1413例患者的荟萃分析。低质量的证据表明，GLP-1RA显著增加了糖尿病前期恢复到正常血糖状态的发生率[RR=1.76,95%CI(1.45,2.13),P<0.00001]和中等质量的证据表明，GLP-1RA可以显著预防新发糖尿病[RR=0.28，95%CI(0.19，0.43)，P<0.00001]。HbA1c显著降低,空腹血糖，体重,腰围,甘油三酯，在GLP-1RAs组中观察到LDL(P<0.05)。然而,GLP-1RAs组胃肠道疾病发生率较高(P<0.05).
结论：GLP-1RAs联合生活方式改变被证明是治疗糖尿病前期患者的一种比单独的生活方式改变更有效的治疗方法。具有可容忍的安全性。未来的指南应考虑将GLP-1RA作为糖尿病前期患者管理中生活方式改变的辅助手段，以提供更好的管理并提高治疗依从性。
方法：对WebofScience的全面搜索，Scopus,PubMed,和Cochrane于2023年5月5日进行，以检索随机对照试验（RCT），比较GLP-1RA与安慰剂和/或生活方式改变对糖尿病前期恢复到血糖正常的影响，预防明显的糖尿病，血糖控制,人体测量参数,和脂质分布。使用了ReviewManager(RevMan)5.4版。使用修订版本的Cochrane偏差风险工具评估随机对照试验的质量。进行评分以评估证据的确定性。
结果：12项研究纳入了GLP-1RAs组2903例患者和对照组1413例患者的荟萃分析。低质量的证据表明，GLP-1RA显著增加了糖尿病前期恢复到正常血糖状态的发生率[RR=1.76,95%CI(1.45,2.13),P<0.00001]和中等质量的证据表明，GLP-1RA可以显著预防新发糖尿病[RR=0.28，95%CI(0.19，0.43)，P<0.00001]。HbA1c显著降低,空腹血糖，体重,腰围,甘油三酯，在GLP-1RAs组中观察到LDL(P<0.05)。然而,GLP-1RAs组胃肠道疾病发生率较高(P<0.05).
结论：GLP-1RAs联合生活方式改变被证明是治疗糖尿病前期患者的一种比单独的生活方式改变更有效的治疗方法。具有可容忍的安全性。未来的指南应考虑将GLP-1RA作为糖尿病前期患者管理中生活方式改变的辅助手段，以提供更好的管理并提高治疗依从性。
