目的为医保目录遴选和临床使用司美格鲁肽注射液提供参考依据。方法计算机检索PubMed,Embase,The Cochrane Library,Web of Science,以及中国知网、维普数据库和万方数据库,收集司美格鲁肽注射液治疗2型糖尿病(T2DM)的药物经济学研究文...目的为医保目录遴选和临床使用司美格鲁肽注射液提供参考依据。方法计算机检索PubMed,Embase,The Cochrane Library,Web of Science,以及中国知网、维普数据库和万方数据库,收集司美格鲁肽注射液治疗2型糖尿病(T2DM)的药物经济学研究文献,检索时限自建库起至2021年8月25日。使用卫生经济学评价报告标准共识(CHEERS)清单评估纳入研究的质量,对研究结果进行分析、归纳、总结。结果共纳入11篇文献(2019年7篇,2020年4篇),均为成本-效果分析。根据CHEERS量表进行评分,均为高质量文献。9篇文献结果显示,司美格鲁肽注射液比其他胰高血糖素样肽-1受体激动剂更具经济性;1篇文献结果显示,司美格鲁肽比甘精胰岛素效果更好,成本更低;2篇文献结果显示,司美格鲁肽比恩格列净更具有成本-效果优势;1篇文献结果显示,司美格鲁肽比西格列汀更具有经济性。结论司美格鲁肽注射液治疗T2DM疗效优且经济性佳,临床可根据患者情况选择。我国需尽早展开有关司美格鲁肽注射液的药物经济学研究。展开更多
Glucagon-like peptide-1(GLP-1)receptor agonists result in greater improvements in glycemic control than placebo and promote weight loss with minimal hypoglycemia in patients with type 2 diabetes mellitus.A number of c...Glucagon-like peptide-1(GLP-1)receptor agonists result in greater improvements in glycemic control than placebo and promote weight loss with minimal hypoglycemia in patients with type 2 diabetes mellitus.A number of case reports show an association of GLP-1receptor agonists,mainly exenatide,with the development of acute kidney injury.The present review aims to present the available data regarding the effects of GLP-1 receptor agonists on renal function,their use in subjects with chronic renal failure and their possible association with acute kidney injury.Based on the current evidence,exenatide is eliminated by renal mechanisms and should not be given in patients with severe renal impairment or end stage renal disease.Liraglutide is not eliminated by renal or hepatic mechanisms,but it should be used with caution since there are only limited data in patients with renal or hepatic impairment.There is evidence from animal studies that GLP-1 receptor agonists exert protective role in diabetic nephropathy with mechanisms that seem to be independent of their glucose-lowering effect.Additionally,there is evidence that GLP-1 receptor agonists influence water and electrolyte balance.These effects may represent new ways to improve or even prevent diabetic nephropathy.展开更多
Objective To evaluate the effects of incretin-based therapies on body weight as the primary outcome,as well as on body mass index(BMI)and waist circumference(WC)as secondary outcomes.Methods Databases including Medlin...Objective To evaluate the effects of incretin-based therapies on body weight as the primary outcome,as well as on body mass index(BMI)and waist circumference(WC)as secondary outcomes.Methods Databases including Medline,Embase,the Cochrane Library,and clinicaltrials.gov(www.clinicaltrials.gov)were searched for randomized controlled trials(RCTs).Standard pairwise meta-analysis and network meta-analysis(NMA)were both carried out.The risk of bias(ROB)tool recommended by the Cochrane handbook was used to assess the quality of studies.Subgroup analysis,sensitivity analysis,meta-regression,and quality evaluation based on the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)were also performed.Results A total of 292 trials were included in this study.Compared with placebo,dipeptidyl-peptidase IV inhibitors(DPP-4 Is)increased weight slightly by 0.31 kg[95%confidence interval(CI):0.05,0.58]and had negligible effects on BMI and WC.Compared with placebo,glucagon-like peptide-1 receptor agonists(GLP-1 RAs)lowered weight,BMI,and WC by-1.34 kg(95%CI:-1.60,-1.09),-1.10 kg/m2(95%CI:-1.42,-0.78),and-1.28 cm(95%CI:-1.69,-0.86),respectively.Conclusion GLP-1 RAs were more effective than DPP-4 Is in lowering the three indicators.Overall,the effects of GLP-1 RAs on weight,BMI,and WC were favorable.展开更多
目的:观察达格列净联合利拉鲁肽治疗2型糖尿病肾病的效果及安全性。方法:选取2020年4月-2021年11月孝感市第一人民医院内分泌门诊及住院部就诊的96例糖尿病肾病(DKD)患者,采用随机数字表法将其按1∶1比例分为对照组(n=48)和治疗组(n=48...目的:观察达格列净联合利拉鲁肽治疗2型糖尿病肾病的效果及安全性。方法:选取2020年4月-2021年11月孝感市第一人民医院内分泌门诊及住院部就诊的96例糖尿病肾病(DKD)患者,采用随机数字表法将其按1∶1比例分为对照组(n=48)和治疗组(n=48)。对照组在原降糖方案基础上加用达格列净治疗,治疗组在原有降糖方案上予以达格列净联合利拉鲁肽注射液治疗。比较两组体重指数(BMI)、血压[收缩压(SBP)、舒张压(DBP)]、空腹血糖(FBG)、餐后2小时血糖(2 h PG)、糖化血红蛋白(HbA1c)、目标范围内葡萄糖达标时间百分比(TIR)、血脂[总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]、肾功能[尿素氮(BUN)、肌酐(Scr)、尿酸(SUA)、估算的肾小球滤过率(eGFR)]、尿微量白蛋白/肌酐比值(UACR)、肝功能[谷丙转氨酶(ALT)、谷草转氨酶(AST)],记录治疗期间出现的不良事件。结果:治疗后,两组BMI、SBP、FBG、2 h PG、HbA1c、TC、TG、UACR、SUA均较治疗前降低,治疗组DBP、LDL-C、ALT、AST均较治疗前降低,且治疗组BMI、SBP、2 h PG、HbA1c、UACR、SUA、LDL-C均较对照组治疗后下降更明显(P<0.05)。治疗8、16周,治疗组TIR均高于对照组(P<0.05)。两组治疗后BUN、Scr、eGFR、HDL-C与治疗前比较,差异均无统计学意义(P>0.05)。对照组治疗后DBP、LDL-C、ALT、AST均较治疗前无明显变化(P>0.05)。治疗组低血糖、胃肠道反应发生率均较对照组高(P<0.05)。两组酮症酸中毒、泌尿生殖道感染、注射部位皮疹发生率比较,差异均无统计学意义(P>0.05)。结论:达格列净联合利拉鲁肽可平稳显著降糖,还具有减重、降压、降脂、降低蛋白尿、改善肝功能等多重获益,优于单用达格列净,不良反应较少。展开更多
Background: The objective of this study was to compare and analyze the variations in clinical indices before and after treatment of type 2 mellitus (T2DM) combined with nonalcoholic fatty liver disease (NAFLD) that we...Background: The objective of this study was to compare and analyze the variations in clinical indices before and after treatment of type 2 mellitus (T2DM) combined with nonalcoholic fatty liver disease (NAFLD) that were treated with glucagon-like peptide 1 receptor agonists (GLP-1RAs). Methods: The electronic medical record system was utilized to search for a total of 16 patients with type 2 diabetes complicated by NAFLD who were hospitalized at the First Affiliated Hospital of Yangtze University from October 2022 to April 2023 and treated with GLP-1RA for the first time. The clinical indices were compared before and after 12 weeks of treatment with GLP-1RA. Results: The liver-spleen CT ratio (L/S), alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT), total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) in all patients treated with GLP-1RA after 12 weeks were significantly different (P 0.05). The patients were categorized into two groups based on the types of GLP-1RAs. The changes in L/S, TC, TG, and LDL-C in the long-acting group after treatment were statistically significant (P Conclusions: GLP-1RAs can improve liver function, regulate lipid metabolism, and reduce the severity of fatty liver in patients with T2DM complicated by NAFLD, which demonstrates the importance of clinical applications.展开更多
There are many advantages of combining incretin therapy[glucagon-like peptide-1(GLP-1)receptor agonists and dipeptidyl peptidase-4(DPP-4)inhibitors]with insulin therapy as a glucose-lowering strategy in type2 diabetes...There are many advantages of combining incretin therapy[glucagon-like peptide-1(GLP-1)receptor agonists and dipeptidyl peptidase-4(DPP-4)inhibitors]with insulin therapy as a glucose-lowering strategy in type2 diabetes.One important advantage is the complementary mode of the mechanistic action of incretin and insulin therapy.Another advantage is the reduction in risk of hypoglycemia and weight gain when adding incretin therapy to insulin.Several clinical trials have studied the addition of GLP-1 receptor agonists[exenatide BID(twice daily),lixisenatide,albiglutide]or DPP-4inhibitors(vildagliptin,sitagliptin,saxagliptin,alogliptin,linagliptin)to ongoing insulin therapy or adding insulin to ongoing therapy with a GLP-1 receptor agonist(liraglutide).These studies show improved glycemia in the presence of limited risk for hypoglycemia and weight gain with the combination of incretin therapy with insulin.This article reviews the background and clinical studies on this combination.展开更多
文摘目的为医保目录遴选和临床使用司美格鲁肽注射液提供参考依据。方法计算机检索PubMed,Embase,The Cochrane Library,Web of Science,以及中国知网、维普数据库和万方数据库,收集司美格鲁肽注射液治疗2型糖尿病(T2DM)的药物经济学研究文献,检索时限自建库起至2021年8月25日。使用卫生经济学评价报告标准共识(CHEERS)清单评估纳入研究的质量,对研究结果进行分析、归纳、总结。结果共纳入11篇文献(2019年7篇,2020年4篇),均为成本-效果分析。根据CHEERS量表进行评分,均为高质量文献。9篇文献结果显示,司美格鲁肽注射液比其他胰高血糖素样肽-1受体激动剂更具经济性;1篇文献结果显示,司美格鲁肽比甘精胰岛素效果更好,成本更低;2篇文献结果显示,司美格鲁肽比恩格列净更具有成本-效果优势;1篇文献结果显示,司美格鲁肽比西格列汀更具有经济性。结论司美格鲁肽注射液治疗T2DM疗效优且经济性佳,临床可根据患者情况选择。我国需尽早展开有关司美格鲁肽注射液的药物经济学研究。
文摘Glucagon-like peptide-1(GLP-1)receptor agonists result in greater improvements in glycemic control than placebo and promote weight loss with minimal hypoglycemia in patients with type 2 diabetes mellitus.A number of case reports show an association of GLP-1receptor agonists,mainly exenatide,with the development of acute kidney injury.The present review aims to present the available data regarding the effects of GLP-1 receptor agonists on renal function,their use in subjects with chronic renal failure and their possible association with acute kidney injury.Based on the current evidence,exenatide is eliminated by renal mechanisms and should not be given in patients with severe renal impairment or end stage renal disease.Liraglutide is not eliminated by renal or hepatic mechanisms,but it should be used with caution since there are only limited data in patients with renal or hepatic impairment.There is evidence from animal studies that GLP-1 receptor agonists exert protective role in diabetic nephropathy with mechanisms that seem to be independent of their glucose-lowering effect.Additionally,there is evidence that GLP-1 receptor agonists influence water and electrolyte balance.These effects may represent new ways to improve or even prevent diabetic nephropathy.
基金supported by the National Natural Science Foundation of China[No.81302508,71673003,81473067,and 91646107].
文摘Objective To evaluate the effects of incretin-based therapies on body weight as the primary outcome,as well as on body mass index(BMI)and waist circumference(WC)as secondary outcomes.Methods Databases including Medline,Embase,the Cochrane Library,and clinicaltrials.gov(www.clinicaltrials.gov)were searched for randomized controlled trials(RCTs).Standard pairwise meta-analysis and network meta-analysis(NMA)were both carried out.The risk of bias(ROB)tool recommended by the Cochrane handbook was used to assess the quality of studies.Subgroup analysis,sensitivity analysis,meta-regression,and quality evaluation based on the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)were also performed.Results A total of 292 trials were included in this study.Compared with placebo,dipeptidyl-peptidase IV inhibitors(DPP-4 Is)increased weight slightly by 0.31 kg[95%confidence interval(CI):0.05,0.58]and had negligible effects on BMI and WC.Compared with placebo,glucagon-like peptide-1 receptor agonists(GLP-1 RAs)lowered weight,BMI,and WC by-1.34 kg(95%CI:-1.60,-1.09),-1.10 kg/m2(95%CI:-1.42,-0.78),and-1.28 cm(95%CI:-1.69,-0.86),respectively.Conclusion GLP-1 RAs were more effective than DPP-4 Is in lowering the three indicators.Overall,the effects of GLP-1 RAs on weight,BMI,and WC were favorable.
文摘目的:观察达格列净联合利拉鲁肽治疗2型糖尿病肾病的效果及安全性。方法:选取2020年4月-2021年11月孝感市第一人民医院内分泌门诊及住院部就诊的96例糖尿病肾病(DKD)患者,采用随机数字表法将其按1∶1比例分为对照组(n=48)和治疗组(n=48)。对照组在原降糖方案基础上加用达格列净治疗,治疗组在原有降糖方案上予以达格列净联合利拉鲁肽注射液治疗。比较两组体重指数(BMI)、血压[收缩压(SBP)、舒张压(DBP)]、空腹血糖(FBG)、餐后2小时血糖(2 h PG)、糖化血红蛋白(HbA1c)、目标范围内葡萄糖达标时间百分比(TIR)、血脂[总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]、肾功能[尿素氮(BUN)、肌酐(Scr)、尿酸(SUA)、估算的肾小球滤过率(eGFR)]、尿微量白蛋白/肌酐比值(UACR)、肝功能[谷丙转氨酶(ALT)、谷草转氨酶(AST)],记录治疗期间出现的不良事件。结果:治疗后,两组BMI、SBP、FBG、2 h PG、HbA1c、TC、TG、UACR、SUA均较治疗前降低,治疗组DBP、LDL-C、ALT、AST均较治疗前降低,且治疗组BMI、SBP、2 h PG、HbA1c、UACR、SUA、LDL-C均较对照组治疗后下降更明显(P<0.05)。治疗8、16周,治疗组TIR均高于对照组(P<0.05)。两组治疗后BUN、Scr、eGFR、HDL-C与治疗前比较,差异均无统计学意义(P>0.05)。对照组治疗后DBP、LDL-C、ALT、AST均较治疗前无明显变化(P>0.05)。治疗组低血糖、胃肠道反应发生率均较对照组高(P<0.05)。两组酮症酸中毒、泌尿生殖道感染、注射部位皮疹发生率比较,差异均无统计学意义(P>0.05)。结论:达格列净联合利拉鲁肽可平稳显著降糖,还具有减重、降压、降脂、降低蛋白尿、改善肝功能等多重获益,优于单用达格列净,不良反应较少。
文摘Background: The objective of this study was to compare and analyze the variations in clinical indices before and after treatment of type 2 mellitus (T2DM) combined with nonalcoholic fatty liver disease (NAFLD) that were treated with glucagon-like peptide 1 receptor agonists (GLP-1RAs). Methods: The electronic medical record system was utilized to search for a total of 16 patients with type 2 diabetes complicated by NAFLD who were hospitalized at the First Affiliated Hospital of Yangtze University from October 2022 to April 2023 and treated with GLP-1RA for the first time. The clinical indices were compared before and after 12 weeks of treatment with GLP-1RA. Results: The liver-spleen CT ratio (L/S), alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT), total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) in all patients treated with GLP-1RA after 12 weeks were significantly different (P 0.05). The patients were categorized into two groups based on the types of GLP-1RAs. The changes in L/S, TC, TG, and LDL-C in the long-acting group after treatment were statistically significant (P Conclusions: GLP-1RAs can improve liver function, regulate lipid metabolism, and reduce the severity of fatty liver in patients with T2DM complicated by NAFLD, which demonstrates the importance of clinical applications.
文摘There are many advantages of combining incretin therapy[glucagon-like peptide-1(GLP-1)receptor agonists and dipeptidyl peptidase-4(DPP-4)inhibitors]with insulin therapy as a glucose-lowering strategy in type2 diabetes.One important advantage is the complementary mode of the mechanistic action of incretin and insulin therapy.Another advantage is the reduction in risk of hypoglycemia and weight gain when adding incretin therapy to insulin.Several clinical trials have studied the addition of GLP-1 receptor agonists[exenatide BID(twice daily),lixisenatide,albiglutide]or DPP-4inhibitors(vildagliptin,sitagliptin,saxagliptin,alogliptin,linagliptin)to ongoing insulin therapy or adding insulin to ongoing therapy with a GLP-1 receptor agonist(liraglutide).These studies show improved glycemia in the presence of limited risk for hypoglycemia and weight gain with the combination of incretin therapy with insulin.This article reviews the background and clinical studies on this combination.
