The effects of incretin-based therapies on beta-cell function and insulin resistance in type 2 diabetes: A systematic review and network meta-analysis combining 360 trials
The effects of incretin-based therapies on beta-cell function and insulin resistance in type 2 diabetes: A systematic review and network meta-analysis combining 360 trials
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基于肠促胰素的疗法对 2 型糖尿病 β 细胞功能和胰岛素抵抗的影响：结合 360 项试验的系统评价和网络荟萃分析
DOI：
10.1111/dom.13613
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Zhan Siyan
中科院分区：
文献类型：
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作者：
Wu Shanshan;Gao Le;Cipriani Andrea;Huang Yi;Yang Zhirong;Yang Jun;Yu Shuqing;Zhang Yuan;Chai Sanbao;Zhang Zilu;Sun Feng;Zhan Siyan
目的比较胰岛素治疗对2型糖尿病(T2 DM)患者β细胞功能和胰岛素抵抗的影响。材料与方法检索Medline、Embase、Cochrane图书馆和www.Clinicaltrials.gov的随机对照试验。进行网络Meta分析，然后进行分组分析和Meta回归分析。使用建议评估、发展和评价分级(等级)系统对证据质量进行评估。值得关注的结果包括β细胞功能(HOMA-β)和胰岛素抵抗(HOMA-IR)的稳态模型评估、空腹C肽和空腹血糖。结果共纳入360例随机对照试验(74%，至少双盲)，共纳入157696例 患者的随机对照试验。以胰岛素为基础的治疗与其他六类降糖药物或安慰剂进行了比较。与安慰剂相比，GLP-1RAs(WMDDAP20.31[95%CI，16.34~24.39])和 = (WMDDP4IS)的HOMA-β和空腹C肽水平显著升高(WMDDAP20.31[95%CI，16.34~24.39]；WMDDPP-4IS[WMD = 9.90[95%CI，8.27~11.61])；WMDGLP-1RAS的HOMA-IR和 = 显著降低(WMDGLP-1RAS为0.67[95%CI， 1.08至 = −0.27])，−为0.67[95%CI，−1.08至GLP-1RAS为0.27]； = −-4IS[WMD DPP-4为0.23[95%CI，−0.38~−0.08]，质量较差； = −分别为0.77 /L[95%CI，−0.98至−0.57]，质量中等。结论与安慰剂相比，胰岛素治疗不仅能提高HOMA-β和空腹C肽水平，而且能降低HOMA-IR和空腹血糖。尽管在大多数比较中，分级评分显示为低到中等，但基于胰岛素的治疗似乎是长期治疗以保护β细胞功能的可取选择。
AimTo evaluate the comparative effects of incretin‐based therapies, including glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) and dipeptidyl peptidase‐4 inhibitors (DPP‐4Is), on β‐cell function and insulin resistance in patients with type 2 diabetes mellitus (T2DM).Materials and MethodsMedline, Embase, the Cochrane Library and www.clinicaltrials.gov were searched for randomized controlled trials (RCTs) with a duration of at least 4 weeks. Network meta‐analysis was performed, followed by subgroup analysis and meta‐regression. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the quality of evidence. Outcomes of interest include homeostasis model assessment for β cell function (HOMA‐β) and insulin resistance (HOMA‐IR), fasting C‐peptide and fasting plasma glucose (FPG). Weighted mean difference (WMD) with 95% confidence interval (CI) was calculated as the measure of effect size.ResultsA total of 360 RCTs (74% at least double‐blinded) with 157 696 patients were included. Incretin‐based therapies were compared with six other classes of glucose‐lowering drugs or with placebo. Compared with placebo, a significant increase in HOMA‐β and fasting C‐peptide was detected for GLP‐1RAs (WMD = 20.31 [95% CI, 16.34‐24.39] with low quality; WMD = 0.16 ng/mL [95% CI, 0.03‐0.29] with low quality) and for DPP‐4Is (WMD = 9.90 [95% CI, 8.27‐11.61] with moderate quality; WMD = 0.09 ng/mL [95% CI, 0.04‐0.14] with moderate quality) separately, while a significant reduction in HOMA‐IR and FPG were found in favour of GLP‐1RAs (WMD = −0.67 [95% CI, −1.08 to −0.27] with low quality; WMD = −1.04 mmol/L [95% CI, −1.26 to −0.83] with moderate quality) and DPP‐4Is (WMD = −0.23 [95% CI, −0.38 to −0.08] with low quality; WMD = −0.77 mmol/L [95% CI, −0.98 to −0.57] with moderate quality), respectively.ConclusionsIncretin‐based therapies not only show an increase in HOMA‐β and fasting C‐peptide level, but also achieve a reduction in HOMA‐IR and FPG in comparison with placebo. Although GRADE scores indicate low to moderate for most comparisons, incretin‐based therapies seem to be an advisable option for long‐term treatment to preserve β‐cell function.