Glucagon-like peptide-1 receptor agonist and basal insulin combination tre atment for the management of type 2 diabetes: a systematic review and meta-analysis
Glucagon-like peptide-1 receptor agonist and basal insulin combination tre atment for the management of type 2 diabetes: a systematic review and meta-analysis
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DOI：
10.1016/s0140-6736(14)61335-0
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发表时间：
2014-12-20
期刊：
影响因子：
168.9
通讯作者：
Retnakaran, Ravi
中科院分区：
文献类型：
--
作者：
Eng, Conrad;Kramer, Caroline K.;Retnakaran, Ravi
背景：胰升糖素样肽-1(GLP-1)激动剂和基础胰岛素的联合治疗已被认为是一种治疗2型糖尿病的策略，它可以提供强大的降糖能力，同时低血糖或体重增加的风险很低。因此，我们对随机对照试验进行了系统的综述和荟萃分析，以评估这种联合治疗对2型糖尿病患者的血糖控制、低血糖和体重增加的效果。方法系统地搜索PubMed、Embase、Cochrane、Web of Knowledge、FDA.gov和ClinicalTrials.gov，查找随机对照试验(发表于1950年1月1日至2014年7月29日之间；没有语言限制)，将GLP-1激动剂和基础胰岛素联合治疗与其他抗糖尿病治疗进行比较。我们的主要终点是血糖控制、低血糖和体重变化。我们使用随机效应模型对汇集的数据进行评估。在2905项确定的研究中，15项符合条件并纳入我们的分析(N=4348名参与者)。与其他抗糖尿病治疗相比，GLP-1激动剂和基础胰岛素联合治疗改善了糖化血红蛋白(HBA(1c))的平均降幅-0.44%(95%CI-0.60至-0.29)，改善了达到7.0%或更低目标HBA(1c)的可能性(相对风险[RR]1.92；95%CI 1.43至2.56)，低血糖的相对风险没有增加(0.99；体重平均减轻-3.22公斤(-4.90至-1.54)。此外，与基础推注胰岛素方案相比，联合治疗的HBA(1c)平均降低-0.1%(-0.17至-0.02)，低血糖的相对风险较低(0.67，0.56至0.80)，平均体重减少(-5.66千克；-9.8至-1.51)。翻译GLP-1激动剂和基础胰岛素联合治疗可实现糖尿病治疗的理想三连冠：在不增加低血糖或体重增加的情况下强有力地控制血糖。因此，这种结合是一种潜在的治疗策略，可以改善2型糖尿病患者的管理。
Background Combination treatment with a glucagon-like peptide-1 (GLP-1) agonist and basal insulin has been proposed as a treatment strategy for type 2 diabetes that could provide robust glucose-lowering capability with low risk of hypoglycaemia or weight gain. We thus did a systematic review and meta-analysis of randomised controlled trials to assess the effect of this combination treatment on glycaemic control, hypoglycaemia, and weight gain in patients with type 2 diabetes.Methods We systematically searched PubMed, Embase, Cochrane, Web of Knowledge, FDA.gov, and ClinicalTrials.gov for randomised controlled trials (published between Jan 1, 1950, and July 29, 2014; no language restrictions) comparing GLP-1 agonist and basal insulin combination treatment to other anti-diabetic treatments. Our main endpoints were glycaemic control, hypoglycaemia, and change in weight. We assessed pooled data by use of a random-effects model.Findings Of 2905 identified studies, 15 were eligible and were included in our analysis (N=4348 participants). Compared with other anti-diabetic treatments, GLP-1 agonist and basal insulin combination treatment yielded an improved mean reduction in glycated haemoglobin (HbA(1c)) of -0.44% (95% CI -0.60 to -0.29), an improved likelihood of achieving the target HbA(1c) of 7.0% or lower (relative risk [RR] 1.92; 95% CI 1.43 to 2.56), no increased relative risk of hypoglycaemia (0.99; 0.76 to 1.29), and a mean reduction in weight of -3.22 kg (-4.90 to -1.54). Furthermore, compared with basal-bolus insulin regimens, the combination treatment yielded a mean reduction in HbA(1c) of -0.1% (-0.17 to -0.02), with lower relative risk of hypoglycaemia (0.67, 0.56 to 0.80), and reduction in mean weight (-5.66 kg; -9.8 to -1.51).Interpretation GLP-1 agonist and basal insulin combination treatment can enable achievement of the ideal trifecta in diabetic treatment: robust glycaemic control with no increased hypoglycaemia or weight gain. This combination is thus a potential therapeutic strategy that could improve the management of patients with type 2 diabetes.