Comparison of different drugs as add-on treatments to metformin in type 2 diabetes: A meta-analysis
Comparison of different drugs as add-on treatments to metformin in type 2 diabetes: A meta-analysis
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DOI：
10.1016/j.diabres.2007.08.024
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发表时间：
2008-02-01
影响因子：
5.1
通讯作者：
Mannucci, Edoardo
中科院分区：
文献类型：
--
作者：
Monami, Matteo;Lamanna, Caterina;Mannucci, Edoardo
背景：二甲双胍被推荐作为 2 型糖尿病患者的一线治疗。有几种药物可以用作二甲双胍单一疗法失败的附加治疗。大多数关于不同药物降血糖功效的临床试验都是以单一疗法或与二甲双胍以外的药物联合进行。本荟萃分析的目的是收集有关不同降糖药物与二甲双胍联合治疗对二甲双胍或其他口服单一疗法失败的患者的疗效的可用信息。方法：进行了广泛的 Medline 搜索，并手动搜索检索到的文章中的参考文献，以识别随机临床试验，比较不同药物与安慰剂或其他活性药物联合二甲双胍治疗未能口服降糖药的患者的 HbA1c 疗效治疗。考虑对16-36个月时的HbA1c降低进行荟萃分析。结果：共检索到27项临床试验。结合不同安慰剂对照试验的结果，磺脲类、α-葡萄糖苷酶抑制剂和噻唑烷二酮类药物可使 HbA1c 降低 [95%CI] 0.85 [0.78；0.78]。 0.94], 0.61[0.55; 0.67], 0.42[0.40; 0.44]%，分别。在直接比较中，磺脲类药物比噻唑烷二酮类药物能更大程度地降低 HbA1c（0.17 [0.16；0.18]%），并且具有与胰岛素相似的效果。结论：当与二甲双胍联合使用时，磺脲类药物和 U-葡萄糖苷酶抑制剂对 HbA1c 表现出相似的功效。作为二甲双胍单一疗法的附加药物的效果可能与单一疗法中观察到的效果不同。 (c) 2007 Elsevier Ireland Ltd. 保留所有权利。
Background: Metformin is recommended as first-line treatment in type 2 diabetic patients. Several agents can be used as add-on treatments in metformin monotherapy failure. Most available clinical trials on the hypoglycemic efficacy of different drugs were performed either in monotherapy or in combination with agents other than metformin. Aim of the present meta-analysis is to collect available information on the efficacy of different hypoglycemic drugs, in combination with metformin, in patients failing to metformin, or to other oral monotherapies.Methods: An extensive Medline search, together with manual search of references from retrieved articles, was performed to identify randomized clinical trials comparing the efficacy on HbA1c of different agents, compared with placebo or with other active drugs, in combination with metformin, in patients failing to oral hypoglycemic therapy. HbA1c reduction at 16-36 months was considered for meta-analysis.Results: A total of 27 clinical trials were retrieved. Combining the results of different placebo-controlled trials, sulphonylureas, alpha-glucosidase inhibitors and thiazolidinediones induced a reduction [95%CI] of HbA1c of 0.85 [0.78; 0.94], 0.61 [0.55; 0.67], 0.42 [0.40; 0.44]%, respectively. in direct comparisons, sulphonylureas induced a greater reduction of HbA1c (of 0.17 [0.16; 0.18]%) than thiazolidinediones, and had a similar effect as insulin.Conclusions: When combined with metformin, sulphonylureas and U-glucosidase inhibitors show a similar efficacy on HbA1c. The effects of drugs used as add-on to metformin monotherapy could be different from those observed in monotherapy. (c) 2007 Elsevier Ireland Ltd. All rights reserved.