目的:比较运动的疗效,二甲双胍及其组合对血糖控制异常个体葡萄糖代谢的影响。
方法:系统评价和网络荟萃分析。
方法:Embase,WebofScience,PubMed/MEDLINE和SPORTDiscus。
方法:涉及运动的随机对照试验,纳入了糖尿病前期或2型糖尿病(T2DM)患者的二甲双胍或其联合治疗.结果包括血红蛋白A1c(HbA1c),口服葡萄糖耐量试验期间的2小时葡萄糖,空腹血糖,空腹胰岛素和胰岛素抵抗的稳态模型评估(HOMA-IR)。
结果:纳入了407篇文章和410项随机对照试验(n=33802)。在糖尿病前期,运动对HbA1c水平的疗效优于二甲双胍(平均差异-0.16%,95%CI(-0.23至-0.09)与-0.10%,95%CI(-0.21至0.02),2小时葡萄糖(-0.68mmol/L,95%CI(-0.97至-0.39)与0.01mmol/L,95%CI(-0.38至0.41))和HOMA-IR(-0.54,95%CI(-0.71至-0.36)vs-0.23,95%CI(-0.55至0.10)),而对空腹血糖的疗效相当(-0.26mmol/L,95%CI(-0.32至-0.19)对-0.33mmol/L,95%CI(-0.45至-0.21))。在T2DM中,二甲双胍对HbA1c的影响比运动更有效(-0.88%,95%CI(-1.07至-0.69)vs-0.48%,95%CI(-0.58至-0.38)),2小时葡萄糖(-2.55mmol/L,95%CI(-3.24至-1.86)对-0.97mmol/L,95%CI(-1.52至-0.42))和空腹血糖(-1.52mmol/L,95%CI(-1.73至-1.31)对-0.85mmol/L,95%CI(-0.96至-0.74));运动+二甲双胍在改善HbA1c方面也显示出更大的疗效(-1.23%,95%CI(-2.41至-0.05))和空腹血糖(-2.02mmol/L,95%CI(-3.31至-0.74))比每次单独治疗。然而,通过运动方式和二甲双胍剂量改变疗效。
结论:运动,二甲双胍及其联合用药可有效改善糖尿病前期和T2DM患者的糖代谢。在糖尿病前期,运动的疗效似乎优于二甲双胍,但二甲双胍在T2DM患者中似乎优于运动。
■CRD42023400622。
OBJECTIVE: To compare the efficacy of exercise, metformin and their combination on glucose metabolism in individuals with abnormal glycaemic control.
METHODS: Systematic review and network meta-analysis.
METHODS: Embase, Web of Science, PubMed/MEDLINE and SPORTDiscus.
METHODS: Randomised controlled trials involving exercise, metformin or their combined treatments in individuals with prediabetes or type 2 diabetes mellitus (T2DM) were included. Outcomes included haemoglobin A1c (HbA1c), 2-hour glucose during oral glucose tolerance test, fasting glucose, fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR).
RESULTS: 407 articles with 410 randomised controlled trials (n=33 802) were included. In prediabetes, the exercise showed greater efficacy than metformin on HbA1c levels (mean difference -0.16%, 95% CI (-0.23 to -0.09) vs -0.10%, 95% CI (-0.21 to 0.02)), 2-hour glucose (-0.68 mmol/L, 95% CI (-0.97 to -0.39) vs 0.01 mmol/L, 95% CI (-0.38 to 0.41)) and HOMA-IR (-0.54, 95% CI (-0.71 to -0.36) vs -0.23, 95% CI (-0.55 to 0.10)), while the efficacy on fasting glucose was comparable (-0.26 mmol/L, 95% CI (-0.32 to -0.19) vs -0.33 mmol/L, 95% CI (-0.45 to -0.21)). In T2DM, metformin was more efficacious than exercise on HbA1c (-0.88%, 95% CI (-1.07 to -0.69) vs -0.48%, 95% CI (-0.58 to -0.38)), 2-hour glucose (-2.55 mmol/L, 95% CI (-3.24 to -1.86) vs -0.97 mmol/L, 95% CI (-1.52 to -0.42)) and fasting glucose (-1.52 mmol/L, 95% CI (-1.73 to -1.31) vs -0.85 mmol/L, 95% CI (-0.96 to -0.74)); exercise+metformin also showed greater efficacy in improving HbA1c (-1.23%, 95% CI (-2.41 to -0.05)) and fasting glucose (-2.02 mmol/L, 95% CI (-3.31 to -0.74)) than each treatment alone. However, the efficacies were modified by exercise modality and metformin dosage.
CONCLUSIONS: Exercise, metformin and their combination are efficacious in improving glucose metabolism in both prediabetes and T2DM. The efficacy of exercise appears to be superior to metformin in prediabetes, but metformin appears to be superior to exercise in patients with T2DM.
UNASSIGNED: CRD42023400622.