PDF(Pubmed)
Abstract：
Background: The objective was to evaluate the efficacy of the combination of Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), dipeptidyl peptidase-4 inhibitors (DPP-4i), and sodium-glucose cotransporter 2 inhibitor (SGLT-2i) in the treatment of Type 2 diabetes with poor efficacy of basic insulin and metformin/sulfonylurea by umbrella review. Materials and Methods: Forming the data of publication of each database through 13 September 2022, PubMed, EMBASE, and Cochrane Library were surveyed. Results: A total of seven meta-analyses were included in the umbrella review. The combination of GLP-1 RA (WMD -3.41 [-5.61, -1.21], p = 0.002), SGLT-2i (WMD -5.34 [-9.56, -1.13], p = 0.013), and DPP-4i (WMD -5.56 [-7.39, -3.73], p ≤ 0.001) can significantly reduce HbA1c levels, respectively. The combination of GLP-1 RA (WMD -1.55 [-2.92, -0.18], p = 0.027), SGLT-2i (WMD -2.96 [-6.68, 0.77], p = 0.12), and DPP-4i (WMD -2.05 [-2.82, -1.28], p ≤ 0.001) can significantly reduce fasting plasma glucose (FPG) levels, respectively. The combination of GLP-1 RA (WMD -3.24 [-5.14, -1.34], p < 0.001) can significantly reduce body weight of Type 2 diabetes mellitus (T2DM). The dose of basic insulin in diabetes patients after combined use of GLP-1 RA (WMD -2.74 [-4.26, -1.22], p ≤ 0.001) was significantly reduced. The combination use of GLP-1 RAs (OR 1.28 [1.05, 1.56], p = 0.017) increases the risk of hypoglycemia. Conclusions: The combination of GLP-1 RAs, DPP-4i, and SGLT-2i can effectively lower HbA1c and FPG in T2DM patients who have poor therapeutic effects on basic insulin combined with metformin/sulfonylureas, respectively. Compared to placebo, GLP-1 RAs can significantly reduce body weight and basic insulin dosage, while DPP-4i and SGLT-2i have a lower risk of hypoglycemia. Trial Registration: CRD42023410345.
摘要：
背景：目的是评估胰高血糖素样肽-1受体激动剂（GLP-1RAs）组合的疗效，二肽基肽酶-4抑制剂（DPP-4i），和钠-葡萄糖协同转运蛋白2抑制剂（SGLT-2i）治疗2型糖尿病，基础胰岛素和二甲双胍/磺酰脲疗效不佳。材料和方法：形成每个数据库到2022年9月13日的发布数据，PubMed，EMBASE,和Cochrane图书馆进行了调查。结果：共有7项荟萃分析纳入了综述。GLP-1RA（WMD-3.41[-5.61，-1.21]，p=0.002),SGLT-2i(WMD-5.34[-9.56,-1.13],p=0.013),和DPP-4i(大规模杀伤性武器-5.56[-7.39，-3.73]，p≤0.001)可显著降低HbA1c水平，分别。GLP-1RA（WMD-1.55[-2.92，-0.18]，p=0.027),SGLT-2i(WMD-2.96[-6.68，0.77]，p=0.12),和DPP-4i（大规模杀伤性武器-2.05[-2.82，-1.28]，p≤0.001)可显著降低空腹血糖(FPG)水平,分别。GLP-1RA（WMD-3.24[-5.14，-1.34]，p<0.001)可显著降低2型糖尿病(T2DM)的体重。糖尿病患者联合使用GLP-1RA后的基础胰岛素剂量（WMD-2.74[-4.26，-1.22]，p≤0.001)显著降低。GLP-1RA的联合使用（OR1.28[1.05，1.56]，p=0.017）增加低血糖的风险。结论：GLP-1RAs的组合，DPP-4i,SGLT-2i可有效降低基础胰岛素联合二甲双胍/磺脲类药物治疗效果不佳的T2DM患者的HbA1c和FPG，分别。与安慰剂相比，GLP-1RAs可以显着降低体重和基本胰岛素剂量，而DPP-4i和SGLT-2i的低血糖风险较低。试用注册：CRD42023410345。
