A novel approach to control hyperglycemia in type 2 diabetes: Sodium glucose co-transport (SGLT) inhibitors. Systematic review and meta-analysis of randomized trials
A novel approach to control hyperglycemia in type 2 diabetes: Sodium glucose co-transport (SGLT) inhibitors. Systematic review and meta-analysis of randomized trials
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DOI：
10.3109/07853890.2011.560181
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发表时间：
2012-06-01
影响因子：
4.4
通讯作者：
Pagano, Gianfranco
中科院分区：
文献类型：
--
作者：
Musso, Giovanni;Gambino, Roberto;Pagano, Gianfranco
背景目前2型糖尿病（T2 DM）高血糖症的治疗通常是无效的，并具有不良影响。因此，新型抗糖尿病药物正在开发中。评估新型抗糖尿病药物钠葡萄糖共转运蛋白2（SGLT 2）抑制剂治疗2型糖尿病的疗效和安全性。截至2010年12月，在MEDLINE、科克伦图书馆、EMBASE、PubMed、国际会议摘要上发表的151篇文章中，纳入了13项随机安慰剂对照试验（RCT）。两名评审员检索文章并通过适当的评分评价研究质量。主要结果采用随机或固定效应模型进行汇总。达格列净显著降低HbA 1c（加权平均差（WMD）-0.52%，95%CI-0.46，-0.57%，P < 0.00001）（WMD -18.28 mg/dL; 95% CI-20.66，-15.89; P < 0.00001），体重指数（WMD-1.17%;-1.41，-0.92%; P < 0.00001），收缩压舒张压（WMD-1.16 mmHg;-1.67，-0.66）和血尿酸（WMD-41.50 μ mol/L;-47.22，-35.79）。其他SGLT 2抑制剂显示了类似的结果。达格列净治疗增加了泌尿道（OR 1.34; 1.05-1.71）和生殖道（OR 3.57; 2.59-4.93）感染的风险;当与胰岛素联合给药时，还轻度增加了低血糖的风险（OR 1.27; 1.05-1.53）。文献的局限性包括RCT的数量、规模和持续时间较少。结论.在等待更大规模RCT的确认的情况下，该分析显示SGLT 2抑制剂可安全有效地治疗T2 DM患者的高血糖。
Background. Current treatment of hyperglycemia in type 2 diabetes (T2DM) is often ineffective and has unwanted effects. Therefore, novel antidiabetic drugs are under development.Objective. To assess efficacy and safety of the new antidiabetic drugs sodium glucose co-transport-2 (SGLT2) inhibitors in T2DM.Design and setting. Among 151 articles published on MEDLINE, Cochrane Library, EMBASE, PubMed, International meeting abstracts through December 2010, 13 randomized placebo-controlled trials (RCT) were included.Measurements. Two reviewers retrieved articles and evaluated study quality by appropriate scores. Main outcomes were pooled using random-or fixed-effects models.Results. Dapagliflozin significantly reduced HbA1c (weighted mean difference (WMD) -0.52%; 95% CI -0.46, -0.57%; P < 0.00001) fasting plasma glucose (WMD -18.28 mg/dL; 95% CI -20.66, -15.89; P < 0.00001), body mass index (WMD -1.17%; -1.41, -0.92%; P < 0.00001), systolic (WMD -4.08 mmHg; -4.91, -3.24), and diastolic (WMD -1.16 mmHg; -1.67, -0.66) blood pressure, and serum uric acid (WMD -41.50 mu mol/L; -47.22, -35.79). Other SGLT2 inhibitors showed similar results. Dapagliflozin treatment increased the risk of urinary (OR 1.34; 1.05-1.71) and genital (OR 3.57; 2.59-4.93) tract infection; it also mildly increased the risk of hypoglycemia (OR 1.27; 1.05-1.53) when co-administered with insulin.Limitations. Limitations of the literature include the small number, size, and duration of RCTs. Conclusions. Pending confirmation from larger RCTs, this analysis shows SGLT2 inhibitors are safe and effective for hyperglycemia treatment in T2DM.