Sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials

医学 2型糖尿病 胰高血糖素样肽1受体 内科学 糖尿病 肾脏疾病 安慰剂 内分泌学 受体 兴奋剂 病理 替代医学
作者
Suetonia C. Palmer,Britta Tendal,Reem A. Mustafa,Per Olav Vandvik,Sheyu Li,Qiukui Hao,David J. Tunnicliffe,Marinella Ruospo,Patrizia Natale,Valeria Saglimbene,Antonio Nicolucci,David W. Johnson,Marcello Tonelli,Maria Chiara Rossi,Sunil V. Badve,Yeoungjee Cho,Annie‐Claire Nadeau‐Fredette,Michael Burke,Labib Imran Faruque,Anita Lloyd
标识
DOI:10.1136/bmj.m4573
摘要

Abstract Objective To evaluate sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists in patients with type 2 diabetes at varying cardiovascular and renal risk. Design Network meta-analysis. Data sources Medline, Embase, and Cochrane CENTRAL up to 11 August 2020. Eligibility criteria for selecting studies Randomised controlled trials comparing SGLT-2 inhibitors or GLP-1 receptor agonists with placebo, standard care, or other glucose lowering treatment in adults with type 2 diabetes with follow up of 24 weeks or longer. Studies were screened independently by two reviewers for eligibility, extracted data, and assessed risk of bias. Main outcome measures Frequentist random effects network meta-analysis was carried out and GRADE (grading of recommendations assessment, development, and evaluation) used to assess evidence certainty. Results included estimated absolute effects of treatment per 1000 patients treated for five years for patients at very low risk (no cardiovascular risk factors), low risk (three or more cardiovascular risk factors), moderate risk (cardiovascular disease), high risk (chronic kidney disease), and very high risk (cardiovascular disease and kidney disease). A guideline panel provided oversight of the systematic review. Results 764 trials including 421 346 patients proved eligible. All results refer to the addition of SGLT-2 inhibitors and GLP-1 receptor agonists to existing diabetes treatment. Both classes of drugs lowered all cause mortality, cardiovascular mortality, non-fatal myocardial infarction, and kidney failure (high certainty evidence). Notable differences were found between the two agents: SGLT-2 inhibitors reduced admission to hospital for heart failure more than GLP-1 receptor agonists, and GLP-1 receptor agonists reduced non-fatal stroke more than SGLT-2 inhibitors (which appeared to have no effect). SGLT-2 inhibitors caused genital infection (high certainty), whereas GLP-1 receptor agonists might cause severe gastrointestinal events (low certainty). Low certainty evidence suggested that SGLT-2 inhibitors and GLP-1 receptor agonists might lower body weight. Little or no evidence was found for the effect of SGLT-2 inhibitors or GLP-1 receptor agonists on limb amputation, blindness, eye disease, neuropathic pain, or health related quality of life. The absolute benefits of these drugs vary substantially across patients from low to very high risk of cardiovascular and renal outcomes (eg, SGLT-2 inhibitors resulted in 3 to 40 fewer deaths in 1000 patients over five years; see interactive decision support tool ( https://magicevidence.org/match-it/200820dist/#!/ ) for all outcomes. Conclusions In patients with type 2 diabetes, SGLT-2 inhibitors and GLP-1 receptor agonists reduced cardiovascular and renal outcomes, with some differences in benefits and harms. Absolute benefits are determined by individual risk profiles of patients, with clear implications for clinical practice, as reflected in the BMJ Rapid Recommendations directly informed by this systematic review. Systematic review registration PROSPERO CRD42019153180.
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
Mason完成签到,获得积分10
1秒前
1秒前
CHSLN完成签到 ,获得积分10
4秒前
Lotus完成签到,获得积分10
5秒前
8秒前
徐徐完成签到 ,获得积分10
10秒前
楚襄谷完成签到 ,获得积分10
11秒前
U9A发布了新的文献求助10
11秒前
Dongjie发布了新的文献求助10
15秒前
lh完成签到 ,获得积分10
16秒前
共享精神应助Thinkol采纳,获得10
21秒前
小zz完成签到 ,获得积分10
26秒前
壮观的海豚完成签到 ,获得积分10
28秒前
儒雅的蜜粉完成签到,获得积分10
28秒前
Dabiel1213完成签到,获得积分10
30秒前
32秒前
guoxihan完成签到,获得积分10
35秒前
科研通AI5应助U9A采纳,获得10
35秒前
Thinkol发布了新的文献求助10
35秒前
NovermberRain完成签到,获得积分10
38秒前
胡燕完成签到 ,获得积分10
40秒前
往前走别回头完成签到,获得积分10
41秒前
43秒前
阳光火车完成签到 ,获得积分10
44秒前
淡然以柳完成签到 ,获得积分10
45秒前
梦在远方完成签到 ,获得积分10
47秒前
隐形松完成签到 ,获得积分10
48秒前
醉清风完成签到 ,获得积分10
49秒前
安静严青完成签到 ,获得积分10
49秒前
故意的小猫咪关注了科研通微信公众号
50秒前
51秒前
畅快的念烟完成签到,获得积分10
56秒前
小太阳完成签到 ,获得积分10
1分钟前
完美世界应助耿教授采纳,获得10
1分钟前
昔昔完成签到 ,获得积分10
1分钟前
echo完成签到 ,获得积分10
1分钟前
1分钟前
WN完成签到,获得积分10
1分钟前
U9A发布了新的文献求助10
1分钟前
感动依霜完成签到 ,获得积分10
1分钟前
高分求助中
A new approach to the extrapolation of accelerated life test data 1000
Cognitive Neuroscience: The Biology of the Mind 1000
Technical Brochure TB 814: LPIT applications in HV gas insulated switchgear 1000
Immigrant Incorporation in East Asian Democracies 600
Nucleophilic substitution in azasydnone-modified dinitroanisoles 500
不知道标题是什么 500
A Preliminary Study on Correlation Between Independent Components of Facial Thermal Images and Subjective Assessment of Chronic Stress 500
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 3968559
求助须知:如何正确求助?哪些是违规求助? 3513358
关于积分的说明 11167368
捐赠科研通 3248732
什么是DOI,文献DOI怎么找? 1794465
邀请新用户注册赠送积分活动 875065
科研通“疑难数据库(出版商)”最低求助积分说明 804664