Efficacy and safety of GLP-1 receptor agonists as add-on to SGLT2 inhibitors in type 2 diabetes mellitus: A meta-analysis
Efficacy and safety of GLP-1 receptor agonists as add-on to SGLT2 inhibitors in type 2 diabetes mellitus: A meta-analysis
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DOI：
10.1038/s41598-019-55524-w
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发表时间：
2019-12-18
影响因子：
4.6
通讯作者：
Giorgino, Francesco
中科院分区：
文献类型：
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作者：
Castellana, Marco;Cignarelli, Angelo;Giorgino, Francesco
GLP-1受体激动剂（GLP-1 RA）和SGLT 2抑制剂（SGLT 2 i）与血糖控制改善、体重减轻以及心血管风险因素和结局的有利变化相关。我们进行了一项系统综述和荟萃分析，以评价在SGLT 2 i基础上添加GLP-1 RA对血糖控制不佳的2型糖尿病患者的影响。检索了6个数据库，直至2019年3月。选择随访至少24周的随机对照试验（RCT），报告HbA 1c、体重、收缩压、血脂、HbA 1c <7%的实现情况、因高血糖和低血糖事件需要补救治疗。纳入了4项RCT。与SGLT 2 i相比，GLP-1 RA/SGLT 2 i联合给药与HbA 1c（-0.74%）、体重（-1.61 kg）和收缩压（-3.32 mmHg）的降幅更大相关。达到HbA 1c < 7%（RR = 2.15）的患者数量较多，需要的补救治疗较低（RR = 0.37），低血糖发生率相似。发现总胆固醇和LDL胆固醇降低。本综述支持GLP-1 RA强化治疗接受SGLT 2 i治疗但未控制的2型糖尿病患者。这种药物方案可以提供改善的HbA 1c控制，以及增强的体重减轻和血压和血脂控制。
GLP-1 receptor agonists (GLP-1RA) and SGLT2 inhibitors (SGLT2i) have been associated with improved glycemic control, body weight loss and favorable changes in cardiovascular risk factors and outcomes. We conducted a systematic review and meta-analysis to evaluate the effects of the addition of GLP-1RA to SGLT2i in patients with type 2 diabetes mellitus and inadequate glycemic control. Six databases were searched until March 2019. Randomized controlled trials (RCT) with a follow-up of at least 24 weeks reporting on HbA1c, body weight, systolic blood pressure, lipids, achievement of HbA1c < 7%, requirement of rescue therapy due to hyperglycemia and hypoglycemic events were selected. Four RCTs were included. Compared to SGLT2i, the GLP-1RA/SGLT2i combination was associated with greater reduction in HbA1c (-0.74%), body weight (-1.61 kg), and systolic blood pressure (-3.32 mmHg). A higher number of patients achieved HbA1c < 7% (RR = 2.15), with a lower requirement of rescue therapy (RR = 0.37) and similar incidence of hypoglycemia. Reductions in total and LDL cholesterol were found. The present review supports treatment intensification with GLP-1RA in uncontrolled type 2 diabetes on SGLT2i. This drug regimen could provide improved HbA1c control, together with enhanced weight loss and blood pressure and lipids control.