Effects and patient compliance of sustained-release versus immediate-release glipizides in patients with type 2 diabetes mellitus: a systematic review and meta-analysis.
Effects and patient compliance of sustained-release versus immediate-release glipizides in patients with type 2 diabetes mellitus: a systematic review and meta-analysis.
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DOI：
10.1111/j.1756-5391.2011.01158.x
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发表时间：
2011-11-01
影响因子：
--
通讯作者：
Li, Youping
中科院分区：
文献类型：
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作者：
Wang, Li;Sun, Xin;Li, Youping
本文综述了缓释格列吡嗪与速释格列吡嗪对血糖控制、胰岛素分泌和依从性的影响。计算机检索Medline、EMBASE、科克伦图书馆和中国生物医学数据库，检索时间从开始到2011年5月31日，并筛选相关文献，同时联系制药公司。纳入了随机试验和队列研究。我们使用随机效应模型汇总数据。纳入了19项试验（共1440例患者）和2项回顾性队列研究（共13452例患者）。审判质量低下。没有试验报告患者重要结局。缓释格列吡嗪组空腹血糖较基线的降幅大于速释格列吡嗪组（平均差异为-0.26 mmol/L，95% CI为-0.52至-0.01）。两种药物对HbA 1c（-0.03%，-0.20%至0.14%）或餐后2小时血糖（-0.21 mmol/L，-0.96至0.55）的降低无显著差异。缓释格列吡嗪似乎减少了胰岛素分泌，而速释制剂增加了胰岛素分泌（空腹胰岛素：-1.04 vs. 0.88 muIU/ml;餐后2小时胰岛素：-2.94 vs. 0.24 muIU/ml）。使用缓释格列吡嗪的患者低血糖发生率较低（Peto比值比0.21，95% CI 0.08 - 0.52），漏服药物的发生率较低（Peto比值比11. 42，95% CI 6.47至20.18）。队列研究显示患者依从性结果与试验结果一致。与速释格列吡嗪相比，缓释格列吡嗪似乎可以实现相似的血糖控制，降低胰岛素分泌，减少低血糖发作，提高患者依从性。然而，由于研究质量不高、随访时间短以及无法获得患者重要结局，这些结果是不确定的。
This review aimed to address effects of sustained-release versus immediate-release glipizide on glucose control, insulin secretion, and compliance. We searched Medline, EMBASE, the Cochrane Library, and Chinese Biomedical database from inceptions to May 31, 2011, screened reference lists of relevant studies, and contacted pharmaceutical companies. Randomized trials and cohort studies were included. We pooled data using a random-effect model. Nineteen trials involving a total of 1440 patients and 2 retrospective cohort studies with a total of 13452 patients were included. Trials were of low quality. No trials reported patient important outcomes. The reduction of fasting plasma glucose from the baseline appeared larger for sustained-release than for immediate-release glipizide (mean difference -0.26 mmol/L, 95% CI -0.52 to -0.01). The reduction was not significantly different between the two drugs for HbA1c (-0.03%, -0.20% to 0.14%) or 2-hour postprandial plasma glucose (-0.21 mmol/L, -0.96 to 0.55). Sustained-release glipizide appeared to reduce insulin secretion from the baseline, whereas the immediate-release formulation increased the secretion (fasting insulin: -1.04 vs. 0.88 muIU/ml; 2-hour postprandial insulin: -2.94 vs. 0.24 muIU/ml). Patients administering sustained-release glipizide had less hypoglycemia (Peto odds ratio 0.21, 95% CI 0.08 to 0.52) and lower missed dosing (Peto odds ratio 11. 42, 95% CI 6.47 to 20.18). The cohort studies showed patient compliance results consistent with those of the trials. Sustained-release glipizide appears to achieve similar glucose control with decreased insulin secretion, fewer hypoglycemic episodes, and higher patient compliance than immediate-release glipizide. However, these findings are inconclusive due to inadequate study quality, short follow up, and unavailability of patient important outcomes.