Treatments for gestational diabetes: a systematic review and meta-analysis.
Treatments for gestational diabetes: a systematic review and meta-analysis.
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DOI：
10.1136/bmjopen-2016-015557
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发表时间：
2017-06-24
期刊：
影响因子：
2.9
通讯作者：
Lawlor DA
中科院分区：
文献类型：
--
作者：
Farrar D;Simmonds M;Bryant M;Sheldon TA;Tuffnell D;Golder S;Lawlor DA
探讨不同治疗方法对妊娠期糖尿病（GDM）的疗效。系统评价、元分析和网络元分析。检索数据来源至2016年7月，包括MEDLINE和Embase。两名作者选择了比较GDM治疗方法的随机试验（护理包（饮食和生活方式干预，根据需要进行药物治疗）、胰岛素、二甲双胍、格列本脲），并对准确性进行了双重检查。结果包括胎龄大、肩难产、新生儿低血糖、剖腹产和先兆子痫。我们使用随机效应荟萃分析合并数据，并使用贝叶斯网络荟萃分析来比较药物治疗（即，包括在试验中未直接比较的治疗）。纳入了42项试验，其报告通常较差，偏倚风险不明确或较高。与常规护理相比，护理包的组成各不相同，降低了大多数不良围产期结局的风险(例如，胎龄大：相对风险0.58 （95% CI 0.49至0.68;I2=0%；试验8项；参与者3462名）。网络荟萃分析表明，与胰岛素或格列本脲相比，二甲双胍在降低大多数结局风险方面最有可能成为最有效的治疗方法。有证据表明，一揽子护理可有效降低大多数不良围产期结局的风险。然而，试验通常包括很少的妇女，报告不明确或高偏倚风险，报告的结果很少。每种治疗在一揽子护理中的作用仍不清楚。目前迫切需要设计良好、实施良好的大型试验。普洛斯彼罗CRD42013004608。
To investigate the effectiveness of different treatments for gestational diabetes mellitus (GDM). Systematic review, meta-analysis and network meta-analysis. Data sources were searched up to July 2016 and included MEDLINE and Embase. Randomised trials comparing treatments for GDM (packages of care (dietary and lifestyle interventions with pharmacological treatments as required), insulin, metformin, glibenclamide (glyburide)) were selected by two authors and double checked for accuracy. Outcomes included large for gestational age, shoulder dystocia, neonatal hypoglycaemia, caesarean section and pre-eclampsia. We pooled data using random-effects meta-analyses and used Bayesian network meta-analysis to compare pharmacological treatments (ie, including treatments not directly compared within a trial). Forty-two trials were included, the reporting of which was generally poor with unclear or high risk of bias. Packages of care varied in their composition and reduced the risk of most adverse perinatal outcomes compared with routine care (eg, large for gestational age: relative risk0.58 (95% CI 0.49 to 0.68; I2=0%; trials 8; participants 3462). Network meta-analyses suggest that metformin had the highest probability of being the most effective treatment in reducing the risk of most outcomes compared with insulin or glibenclamide. Evidence shows that packages of care are effective in reducing the risk of most adverse perinatal outcomes. However, trials often include few women, are poorly reported with unclear or high risk of bias and report few outcomes. The contribution of each treatment within the packages of care remains unclear. Large well-designed and well-conducted trials are urgently needed. PROSPERO CRD42013004608.
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DOI：
10.1136/bmj.h102
发表时间：
2015-01-21
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Balsells M;García-Patterson A;Solà I;Roqué M;Gich I;Corcoy R
通讯作者：
Corcoy R
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N
影响因子：
3.6
作者：
Farrar, Diane;Simmonds, Mark;Sheldon, Trevor A.
通讯作者：
Sheldon, Trevor A.
影响因子：
3.5
作者：
Bonomo, M;Corica, D;Morabito, A
通讯作者：
Morabito, A
影响因子：
3.7
作者：
Gui J;Liu Q;Feng L
通讯作者：
Feng L