Comparative Effect of Glucose-Lowering Drugs for Type 2 Diabetes Mellitus on Stroke Prevention: A Systematic Review and Network Meta-Analysis.

IF 6.8 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Diabetes & Metabolism Journal Pub Date : 2024-03-01 Epub Date: 2024-01-26 DOI:10.4093/dmj.2022.0421
Ji Soo Kim, Gyeongsil Lee, Kyung-Il Park, Seung-Won Oh
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Abstract

Backgruound: There is still a lack of research on which diabetic drugs are more effective in preventing stroke. Our network metaanalysis aimed to compare cerebrovascular benefits among glucose-lowering treatments.

Methods: We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the ClinicalTrials.gov registry for clinical trials from inception through May 25, 2021. We included both prespecified cerebrovascular outcomes and cerebrovascular events reported as severe adverse events. Subgroup analyses were conducted by stroke subtype, publication type, age of patients, baseline glycosylated hemoglobin (HbA1c), duration of type 2 diabetes mellitus, and cardiovascular risks.

Results: Of 2,861 reports and 1,779 trials screened, 79 randomized controlled trials comprising 206,387 patients fulfilled the inclusion criteria. In the pairwise meta-analysis, the use of glucagon-like peptide-1 (GLP-1) agonist was associated with a lower risk of total stroke compared with placebo (relative risk [RR], -0.17; 95% confidence interval [CI], -0.27 to -0.07). In the network meta- analysis, only the use of sodium-glucose cotransporter-2 (SGLT-2) inhibitor was associated with a reduction of total stroke, compared with placebo (RR, 0.81; 95% CI, 0.67 to 0.98). In the subgroup analyses, the use of SGLT-2 inhibitor and GLP-1 agonist was associated with a lower risk of stroke in those with high HbA1c (≥8.0) and low-risk of cardiovascular disease, respectively.

Conclusion: SGLT-2 inhibitors and GLP-1 agonists were shown to be beneficial for stroke prevention in patients with type 2 diabetes mellitus.

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治疗 2 型糖尿病的降糖药物对预防中风的比较效果:系统回顾与网络元分析》。
背景:关于哪种糖尿病药物对预防中风更有效的研究仍然缺乏。我们的网络荟萃分析旨在比较各种降糖药物对脑血管的益处:我们检索了 MEDLINE、EMBASE、Cochrane Central Register of Controlled Trials 和 ClinicalTrials.gov 注册表中从开始到 2021 年 5 月 25 日的临床试验。我们纳入了预先指定的脑血管结果和作为严重不良事件报告的脑血管事件。按照中风亚型、出版物类型、患者年龄、基线糖化血红蛋白(HbA1c)、2 型糖尿病持续时间和心血管风险进行了亚组分析:在筛选出的 2,861 份报告和 1,779 项试验中,有 79 项随机对照试验符合纳入标准,其中包括 206,387 名患者。在配对荟萃分析中,与安慰剂相比,使用胰高血糖素样肽-1(GLP-1)激动剂与较低的总中风风险相关(相对风险 [RR],-0.17;95% 置信区间 [CI],-0.27 至 -0.07)。在网络荟萃分析中,与安慰剂相比,只有钠-葡萄糖共转运体-2(SGLT-2)抑制剂可降低总中风风险(相对风险 [RR],0.81;95% 置信区间 [CI],0.67 至 0.98)。在亚组分析中,SGLT-2 抑制剂和 GLP-1 激动剂的使用分别与高 HbA1c(≥8.0)和低心血管疾病风险人群中风风险的降低有关:结论:SGLT-2 抑制剂和 GLP-1 激动剂有利于 2 型糖尿病患者预防中风。
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来源期刊
Diabetes & Metabolism Journal
Diabetes & Metabolism Journal Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
10.40
自引率
6.80%
发文量
92
审稿时长
52 weeks
期刊介绍: The aims of the Diabetes & Metabolism Journal are to contribute to the cure of and education about diabetes mellitus, and the advancement of diabetology through the sharing of scientific information on the latest developments in diabetology among members of the Korean Diabetes Association and other international societies. The Journal publishes articles on basic and clinical studies, focusing on areas such as metabolism, epidemiology, pathogenesis, complications, and treatments relevant to diabetes mellitus. It also publishes articles covering obesity and cardiovascular disease. Articles on translational research and timely issues including ubiquitous care or new technology in the management of diabetes and metabolic disorders are welcome. In addition, genome research, meta-analysis, and randomized controlled studies are welcome for publication. The editorial board invites articles from international research or clinical study groups. Publication is determined by the editors and peer reviewers, who are experts in their specific fields of diabetology.
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