摘要
目的系统评价胰岛素联用α-葡萄糖苷酶抑制剂(AGIs)治疗成人1型糖尿病(T1DM)的疗效和安全性。方法检索中英文数据库,纳入关于胰岛素联用AGIs治疗成人T1DM患者的随机或非随机对照试验。使用Review Manager 5.3软件进行Meta分析。结果共纳入10项研究,616例患者。与安慰剂或空白对照相比,在有效性方面,胰岛素联合AGIs可改善成人T1DM患者的糖化血红蛋白;降低平均血糖、空腹血糖和餐后2小时血糖;改善血糖波动情况,包括平均血糖波动幅度和最大血糖波动幅度(均P<0.05)。在安全性方面,AGIs增加总不良反应发生的风险(P<0.05),其中主要是胃肠道不适,但未增加低血糖的发生率和发生次数(均P>0.05)。胰岛素联合AGIs减少了每日胰岛素总剂量(P<0.05),但对体重、甘油三酯和高密度脂蛋白胆固醇无显著影响(均P>0.05)。结论胰岛素联合AGIs可降低成人T1DM患者的糖化血红蛋白,改善血糖水平和血糖波动情况。AGIs不会增加低血糖的风险,但需重视其不良反应,特别是胃肠道不良反应。
Objective To systematically evaluate the efficacy and safety of adding alpha-glucosidase inhibitors(AGIs) to insulin therapy in adult patients with type 1 diabetes(T1 DM). Methods Articles about randomized or non-randomized controlled trials of insulin combined with AGIs in adult patients with T1 DM were retrieved from Chinese and English database. Meta-analyses were performed by using Review Manager 5.3. Results A total of 616 patients were included from 10 clinical trials. Compared with adding placebo or nothing, in terms of efficacy, the addition of AGIs resulted in decreased HbA1 c, mean blood glucose, fasting plasma blood glucose and 2-hour postprandial blood glucose levels(all P<0.05). And this scheme improved the glucose variability including mean amplitude of glycemic excursions and the largest amplitude of glycemic excursions(P<0.05, respectively). As to safety, AGIs increased the risk of total adverse reactions(P<0.05), most of them were gastrointestinal complaints, while the occurrence and the frequency of hypoglycemia were similar(P>0.05, respectively). This scheme could also lead to the reduced total daily insulin dose(P<0.05) but had no significant effect on body weight, triglyceride or cholesterol concentration(P>0.05, respectively). Conclusions The addition of AGIs to insulin therapy in adult patients with T1 DM may reduce HbA1 c and improve the glucose levels and glucose variability. But total adverse effects especially the gastrointestinal complaints should also be considered in the use of AGIs although it does not increase the risk of hypoglycemia.
作者
刘芷谷
杨黛稚
陈丹蕊
林惠敏
吕婧
邓洪容
姚斌
许雯
LIU Zhigu;YANG Daizhi;CHEN Danrui;LIN Huimin;LV Jing;DENG Hongrong;YAO Bin;XU Wen(Department of Endocrinology and Metabolism,the Third Affiliated Hospital of Sun Yat-sen University,Guangdong Provincial Key Laboratory of Diabetology,Guangzhou 510630,China)
出处
《广州医药》
2022年第3期118-126,130,共10页
Guangzhou Medical Journal
基金
国家重点研发项目(2017YFC1309600)。
