The effects of exenatide bid on metabolic control, medication use and hospitalization in patients with type 2 diabetes mellitus in clinical practice: a systematic review
The effects of exenatide bid on metabolic control, medication use and hospitalization in patients with type 2 diabetes mellitus in clinical practice: a systematic review
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DOI：
10.1111/j.1463-1326.2011.01533.x
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发表时间：
2012-05-01
影响因子：
5.8
通讯作者：
Garrison, L. P.
中科院分区：
文献类型：
--
作者：
Best, J. H.;Lavillotti, K.;Garrison, L. P.
本系统性综述的目的是评估已发表的关于艾塞那肽每日两次（艾塞那肽）在临床实践中的有效性的文献，特别是其对血红蛋白A1 c（A1 C）、空腹血糖（FG）、体重、收缩压（SBP）、药物使用、住院和心血管疾病（CVD）结局的影响。使用MEDLINE数据库对2005年1月至2011年5月期间发表的英文文献进行了系统性文献检索。该综述包括回顾性或前瞻性观察性研究，每个治疗组包括100例或更多患者。共确定了15项符合纳入标准的研究。研究显示A1 C显著降低-0.4至-0.9%，FG显著降低-10 mg/dl，体重显著降低-2至-11 kg，SBP显著降低-2至-11 mmHg。在每项评估药物变化的观察性研究中，发现开始艾塞那肽治疗后口服降糖药物或胰岛素的使用或剂量出现统计学显著性减少，包括磺脲类药物剂量减少75%，二甲双胍减少22%，噻唑烷二酮类（TZD）或TZD联合治疗减少66%，餐时胰岛素减少75%。艾塞那肽治疗患者的全因和CVD相关住院和CVD事件发生率显著低于其他治疗患者。在这篇观察性研究的综述中，艾塞那肽的启动与临床相关结局的显著降低相关。本综述中观察性研究中A1 C、FG、体重和SBP的改善与对照临床试验中观察到的改善一致。
The objective of this systematic review was to assess the published literature on the effectiveness of exenatide twice daily (exenatide) in clinical practice, specifically its effects on haemoglobin A1c (A1C), fasting glucose (FG), weight, systolic blood pressure (SBP), medication use, hospitalization and cardiovascular disease (CVD) outcomes. A systematic literature search using the MEDLINE database of English language literature published between January 2005 and May 2011 was performed. The review included retrospective or prospective observational studies that included 100 or more patients per treatment group. A total of 15 studies meeting the inclusion criteria were identified. The studies revealed significant reductions of -0.4 to -0.9% in A1C, -10 mg/dl in FG, -2 to -11 kg in body weight and -2 to -11 mmHg in SBP. Statistically significant reductions in the use or dosage of either oral glucose-lowering medications or insulin after initiating exenatide treatment were found in every observational study that assessed medication changes, including reductions in dosage of up to 75% in sulphonylureas dosages, 22% in metformin, 66% in thiazolidinediones (TZD) or TZD combination therapy and 75% in prandial insulin. Exenatide-treated patients experienced significantly lower rates of all-cause and CVD-related hospitalization and CVD events than patients treated with other therapies overall. In this review of observational studies, exenatide initiation was associated with significant reductions in clinically relevant outcomes. Improvements in A1C, FG, weight and SBP in the observational studies in this review were consistent with improvements observed in controlled clinical trials.