■糖尿病视网膜病变(DR)是2型糖尿病最常见的并发症,仍然是可预防失明的主要原因。由于先前的荟萃分析没有确凿的证据,因此当前有关使用抗糖尿病药物的临床决定并未充分纳入DR的风险。本综述旨在系统评价抗糖尿病药物对2型糖尿病患者DR的影响。
■在Medline进行了系统的文献检索,Embase,和Cochrane图书馆(从开始到2022年5月17日)没有语言限制,以确定随机对照试验或纵向研究的系统评价和荟萃分析,这些研究检查了2型糖尿病患者抗糖尿病药物与DR之间的关联.两位作者使用AMSTAR-2(评估系统评价的计量工具)清单独立提取数据并评估纳入研究的质量,并使用等级进行证据评估(建议分级,评估,开发和评估)。应用随机效应模型以95%置信区间(CI)计算相对风险(RR)或比值比(OR)。本研究在PROSPERO(CRD42022332052)注册。
■根据来自11项系统评价和荟萃分析的试验证据,我们发现使用胰高血糖素样肽-1受体激动剂(GLP-1RA),钠-葡萄糖协同转运蛋白-2抑制剂(SGLT-2i),或二肽基肽酶-4抑制剂(DPP-4i)与DR的风险无统计学关联,与任一安慰剂相比(RR:GLP-1RA,0.98,0.89-1.08;SGLT-2i,1.00,95%CI0.79-1.27;DPP-4i,1.17、0.99-1.39)或其他抗糖尿病药物。与其他抗糖尿病药物相比,美格列丁(0.34,0.01-8.25),SGLT-2i(0.73,0.10-5.16),噻唑烷二酮(0.92,0.67-1.26),二甲双胍(1.15,0.81-1.63),磺酰脲类(1.24,0.93-1.65),阿卡波糖(4.21,0.44-40.43)与DR的风险无统计学关联。只有纵向研究的证据,与其他抗糖尿病药物相比,胰岛素的DR风险更高(OR:2.47,95%CI:2.04-2.99).
■我们的研究结果表明,在2型糖尿病患者中,抗糖尿病药物通常是安全的。进一步的强大和大规模的试验调查胰岛素的影响,meglinides,和阿卡波糖在DR上是有保证的。
■https://www.crd.约克。AC.uk/prospro/display_record.php?RecordID=332052,标识符CRD42022332052。
Diabetic retinopathy (DR) is the most frequent complication of type 2 diabetes and remains the leading cause of preventable blindness. Current clinical decisions regarding the administration of antidiabetic drugs do not sufficiently incorporate the risk of DR due to the inconclusive evidence from preceding meta-analyses. This umbrella review aimed to systematically evaluate the effects of antidiabetic drugs on DR in people with type 2 diabetes.
A systematic literature search was undertaken in Medline, Embase, and the Cochrane Library (from inception till 17th May 2022) without language restrictions to identify systematic reviews and meta-analyses of randomized controlled trials or longitudinal studies that examined the association between antidiabetic drugs and DR in people with type 2 diabetes. Two authors independently extracted data and assessed the quality of included studies using the AMSTAR-2 (A MeaSurement Tool to Assess Systematic Reviews) checklist, and evidence assessment was performed using the GRADE (Grading of recommendations, Assessment, Development and Evaluation). Random-effects models were applied to calculate relative risk (RR) or odds ratios (OR) with 95% confidence intervals (CI). This study was registered with PROSPERO (CRD42022332052).
With trial evidence from 11 systematic reviews and meta-analyses, we found that the use of glucagon-like peptide-1 receptor agonists (GLP-1 RA), sodium-glucose cotransporter-2 inhibitors (SGLT-2i), or dipeptidyl peptidase-4 inhibitors (DPP-4i) was not statistically associated with the risk of DR, compared to either placebo (RR: GLP-1 RA, 0.98, 0.89-1.08; SGLT-2i, 1.00, 95% CI 0.79-1.27; DPP-4i, 1.17, 0.99-1.39) or other antidiabetic drugs. Compared to other antidiabetic drugs, meglitinides (0.34, 0.01-8.25), SGLT-2i (0.73, 0.10-5.16), thiazolidinediones (0.92, 0.67-1.26), metformin (1.15, 0.81-1.63), sulphonylureas (1.24, 0.93-1.65), and acarbose (4.21, 0.44-40.43) were not statistically associated with the risk of DR. With evidence from longitudinal studies only, insulin was found to have a higher risk of DR than other antidiabetic drugs (OR: 2.47, 95% CI: 2.04-2.99).
Our results indicate that antidiabetic drugs are generally safe to prescribe regarding the risk of DR among people with type 2 diabetes. Further robust and large-scale trials investigating the effects of insulin, meglitinides, and acarbose on DR are warranted.
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=332052, identifier CRD42022332052.