Age and Sex Differences in Efficacy of Treatments for Type 2 Diabetes

医学 内科学 2型糖尿病 临床试验 胰高血糖素样肽1受体 糖尿病 二肽基肽酶-4 安慰剂 不利影响 梅德林 内分泌学 受体 兴奋剂 替代医学 病理 政治学 法学
作者
Peter Hanlon,Elaine Butterly,Lili Wei,Heather Wightman,Saleh Ali M. Almazam,Khalid Alsallumi,Jamie Crowther,Ryan McChrystal,Heidi Rennison,Katherine Hughes,Jim Lewsey,Robert S. Lindsay,Stuart J. McGurnaghan,John L. Petrie,Laurie A. Tomlinson,Sarah H. Wild,Amanda Adler,Naveed Sattar,David Phillippo,Sofia Dias
出处
期刊:JAMA [American Medical Association]
被引量:1
标识
DOI:10.1001/jama.2024.27402
摘要

Importance Sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, and dipeptidyl peptidase 4 (DPP4) inhibitors improve hyperglycemia, and SGLT2 inhibitors and GLP-1 receptor agonists reduce the risk of major adverse cardiovascular events (MACEs) among individuals with type 2 diabetes. It is not clear whether efficacy varies by age or sex. Objective To assess whether age or sex are associated with differences in the efficacy of SGLT2 inhibitors, GLP-1 receptor agonists, and DPP4 inhibitors. Data Sources and Study Selection The MEDLINE and Embase databases and US and Chinese clinical trial registries were searched for articles published from inception to November 2022; in August 2024, the search was updated to capture the trial results. Two reviewers screened for randomized clinical trials of SGLT2 inhibitors, GLP-1 receptor agonists, or DPP4 inhibitors vs a placebo or active comparator in adults with type 2 diabetes. Data Extraction and Synthesis Individual participant data and aggregate data were used to estimate age × treatment interactions and sex × treatment interactions in multilevel network meta-regression models. Main Outcome and Measures Hemoglobin A 1c (HbA 1c ) and MACEs. Results Of the 601 eligible trials identified (592 trials with 309 503 participants reported HbA 1c ; mean age, 58.9 [SD, 10.8] years; 42.3% were female and 23 trials with 168 489 participants reported MACEs; mean age, 64.0 [SD, 8.6] years; 35.3% were female), individual participant data were obtained for 103 trials (103 reported HbA 1c and 6 reported MACEs). The use of SGLT2 inhibitors (vs placebo) was associated with less HbA 1c lowering with increasing age for monotherapy (absolute reduction [AR], 0.24% [95% credible interval {CrI}, 0.10% to 0.38%] per 30-year increment in age), for dual therapy (AR, 0.17% [95% CrI, 0.10% to 0.24%]), and for triple therapy (AR, 0.25% [95% CrI, 0.20% to 0.30%]). The use of GLP-1 receptor agonists was associated with greater HbA 1c lowering with increasing age for monotherapy (AR, −0.18% [95% CrI, −0.31% to −0.05%] per 30-year increment in age) and for dual therapy (AR, −0.24% [95% CrI, −0.40% to −0.07%]), but not for triple therapy (AR, 0.04% [95% CrI, −0.02% to 0.11%]). The use of DPP4 inhibitors was associated with slightly better HbA 1c lowering in older people for dual therapy (AR, −0.09% [95% CrI, −0.15% to −0.03%] per 30-year increment in age), but not for monotherapy (AR, −0.08% [95% CrI, −0.18% to 0.01%]) or triple therapy (AR, −0.01% [95% CrI, −0.06% to 0.05%]). The relative reduction in MACEs with use of SGLT2 inhibitors was greater in older vs younger participants per 30-year increment in age (hazard ratio, 0.76 [95% CrI, 0.62 to 0.93]), and the relative reduction in MACEs with use of GLP-1 receptor agonists was less in older vs younger participants (hazard ratio, 1.47 [95% CrI, 1.07 to 2.02]). There was no consistent evidence for sex × treatment interactions with use of SGLT2 inhibitors and GLP-1 receptor agonists. Conclusions and Relevance The SGLT2 inhibitors and GLP-1 receptor agonists were associated with lower risk of MACEs. Analysis of age × treatment interactions suggested that SGLT2 inhibitors were more cardioprotective in older than in younger people despite smaller reductions in HbA 1c ; GLP-1 receptor agonists were more cardioprotective in younger people.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
3秒前
风趣问雁完成签到 ,获得积分10
4秒前
4秒前
5秒前
111111zx111发布了新的文献求助10
8秒前
9秒前
温柔季节发布了新的文献求助10
10秒前
song完成签到 ,获得积分10
10秒前
qqq发布了新的文献求助10
10秒前
11秒前
11秒前
JamesPei应助王武聪采纳,获得10
12秒前
Rondab应助失眠的狗采纳,获得10
14秒前
15秒前
15秒前
wkjfh完成签到,获得积分0
16秒前
唐卟哩钵完成签到,获得积分10
16秒前
Rondab应助hg08采纳,获得10
17秒前
拓跋凝海完成签到,获得积分10
17秒前
17秒前
19秒前
20秒前
沉默的宛筠应助liu采纳,获得10
20秒前
Transition发布了新的文献求助10
21秒前
家家完成签到 ,获得积分10
21秒前
默默的如凡完成签到,获得积分10
21秒前
22秒前
ioio发布了新的文献求助10
22秒前
qqq完成签到,获得积分10
24秒前
25秒前
天天快乐应助Amon采纳,获得10
26秒前
28秒前
30秒前
包李发布了新的文献求助10
32秒前
111111zx111完成签到,获得积分10
33秒前
精美礼物给精美礼物的求助进行了留言
34秒前
NexusExplorer应助raolixiang采纳,获得10
36秒前
36秒前
哲别发布了新的文献求助10
39秒前
充电宝应助tt采纳,获得10
41秒前
高分求助中
A new approach to the extrapolation of accelerated life test data 1000
ACSM’s Guidelines for Exercise Testing and Prescription, 12th edition 500
‘Unruly’ Children: Historical Fieldnotes and Learning Morality in a Taiwan Village (New Departures in Anthropology) 400
Indomethacinのヒトにおける経皮吸収 400
Phylogenetic study of the order Polydesmida (Myriapoda: Diplopoda) 370
基于可调谐半导体激光吸收光谱技术泄漏气体检测系统的研究 350
Robot-supported joining of reinforcement textiles with one-sided sewing heads 320
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 3989797
求助须知:如何正确求助?哪些是违规求助? 3531914
关于积分的说明 11255516
捐赠科研通 3270597
什么是DOI,文献DOI怎么找? 1805008
邀请新用户注册赠送积分活动 882181
科研通“疑难数据库(出版商)”最低求助积分说明 809190