{"title":"不同降糖药对2型糖尿病β细胞功能的影响：系统综述和网络荟萃分析","authors":"ZhiFeng Guo, LingHong Huang, ZhengRong Jiang, XueFeng Bai, ZiTong Wang, HuiBin Huang","doi":"10.1186/s40001-025-02368-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Aim: </strong>This study compared the effects of hypoglycaemic drugs on beta-cell function among type 2 diabetes mellitus (T2DM) patients through a network meta-analysis of randomized controlled trials (RCTs).</p><p><strong>Methods: </strong>We searched the PubMed, EMBASE, and Cochrane Library databases for RCTs of different hypoglycaemic drugs as T2DM treatment from database inception to December 1, 2024. The primary outcome was homeostasis model assessment-β (HOMA-β), and the secondary outcome was glycated haemoglobin (HbA1c). Direct and indirect evidence types were combined to calculate weighted mean difference (WMD) and 95% confidence interval (CI) values for the change in (△) HOMA-β and △HbA1c, and to determine surface under the cumulative ranking curve (SUCRA) values.</p><p><strong>Results: </strong>A total of 58 RCTs involving 16,345 T2DM patients were incorporated into this network meta-analysis. The mean patient age was 66.70 years, and 54.14% were male. For improving HOMA-β, the top treatments were glimepiride + rosiglitazone (WMD = 81.83, 95% CI 45.85-117.82) and glibenclamide + rosiglitazone (WMD = 79.51, 95% CI 40.66-118.36). Acarbose (WMD = 60.90, 95% CI 27.56-94.25) ranked third as monotherapy. For reducing HbA1c, glibenclamide + rosiglitazone was the most efficacious treatment (WMD = - 2.48, 95% CI - 3.67 to - 1.29), followed by metformin + exenatide (WMD = - 1.77, 95% CI - 2.25 to - 1.29) and liraglutide (WMD = - 1.77, 95% CI - 2.33 to - 1.21). The treatment with the highest SUCRA value for HOMA-β improvement was glimepiride + rosiglitazone (95.1%), followed by glibenclamide + rosiglitazone (94.9%). For HbA1c improvement, glibenclamide + rosiglitazone had the highest SUCRA value (97.6%).</p><p><strong>Conclusions: </strong>The combination of glimepiride/glibenclamide and rosiglitazone was the most effective hypoglycaemic regimen for protecting beta-cell function and improving glycaemic control in T2DM treatment, possibly due to control of HbA1c and glycotoxicity.</p>","PeriodicalId":11949,"journal":{"name":"European Journal of Medical Research","volume":"30 1","pages":"121"},"PeriodicalIF":4.8000,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11843998/pdf/","citationCount":"0","resultStr":"{\"title\":\"Effects of different hypoglycaemic drugs on beta-cell function in type 2 diabetes mellitus: a systematic review and network meta-analysis.\",\"authors\":\"ZhiFeng Guo, LingHong Huang, ZhengRong Jiang, XueFeng Bai, ZiTong Wang, HuiBin Huang\",\"doi\":\"10.1186/s40001-025-02368-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aim: </strong>This study compared the effects of hypoglycaemic drugs on beta-cell function among type 2 diabetes mellitus (T2DM) patients through a network meta-analysis of randomized controlled trials (RCTs).</p><p><strong>Methods: </strong>We searched the PubMed, EMBASE, and Cochrane Library databases for RCTs of different hypoglycaemic drugs as T2DM treatment from database inception to December 1, 2024. The primary outcome was homeostasis model assessment-β (HOMA-β), and the secondary outcome was glycated haemoglobin (HbA1c). Direct and indirect evidence types were combined to calculate weighted mean difference (WMD) and 95% confidence interval (CI) values for the change in (△) HOMA-β and △HbA1c, and to determine surface under the cumulative ranking curve (SUCRA) values.</p><p><strong>Results: </strong>A total of 58 RCTs involving 16,345 T2DM patients were incorporated into this network meta-analysis. The mean patient age was 66.70 years, and 54.14% were male. For improving HOMA-β, the top treatments were glimepiride + rosiglitazone (WMD = 81.83, 95% CI 45.85-117.82) and glibenclamide + rosiglitazone (WMD = 79.51, 95% CI 40.66-118.36). Acarbose (WMD = 60.90, 95% CI 27.56-94.25) ranked third as monotherapy. 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引用次数: 0
摘要
目的：本研究通过随机对照试验（RCTs）的网络荟萃分析，比较降糖药对2型糖尿病（T2DM）患者β细胞功能的影响。方法：检索PubMed、EMBASE和Cochrane图书馆数据库，从数据库建立到2024年12月1日，检索不同降糖药作为T2DM治疗的随机对照试验。主要终点是稳态模型评估-β (HOMA-β)，次要终点是糖化血红蛋白（HbA1c）。结合直接和间接证据类型，计算（△）HOMA-β和△HbA1c变化的加权平均差值（WMD）和95%置信区间（CI）值，并确定累积排序曲线下的曲面（SUCRA）值。结果：共有58项随机对照试验，涉及16345例T2DM患者被纳入该网络荟萃分析。患者平均年龄66.70岁，男性占54.14%。改善HOMA-β的最佳治疗方案为格列美脲+罗格列酮（WMD = 81.83, 95% CI 45.85 ~ 117.82）和格列本脲+罗格列酮（WMD = 79.51, 95% CI 40.66 ~ 118.36）。阿卡波糖（WMD = 60.90, 95% CI 27.56-94.25）在单药治疗中排名第三。对于降低HbA1c，格列本脲+罗格列酮是最有效的治疗方法（WMD = - 2.48, 95% CI - 3.67至- 1.29），其次是二甲双胍+艾塞那肽（WMD = - 1.77, 95% CI - 2.25至- 1.29）和利拉鲁肽（WMD = - 1.77, 95% CI - 2.33至- 1.21）。改善HOMA-β的SUCRA值最高的治疗是格列美脲+罗格列酮（95.1%），其次是格列本脲+罗格列酮（94.9%）。对于改善HbA1c，格列本脲+罗格列酮的SUCRA值最高（97.6%）。结论：格列美脲/格列本脲联合罗格列酮是T2DM治疗中保护β细胞功能和改善血糖控制最有效的降糖方案，可能与控制糖化血红蛋白和糖毒性有关。
Effects of different hypoglycaemic drugs on beta-cell function in type 2 diabetes mellitus: a systematic review and network meta-analysis.
Aim: This study compared the effects of hypoglycaemic drugs on beta-cell function among type 2 diabetes mellitus (T2DM) patients through a network meta-analysis of randomized controlled trials (RCTs).
Methods: We searched the PubMed, EMBASE, and Cochrane Library databases for RCTs of different hypoglycaemic drugs as T2DM treatment from database inception to December 1, 2024. The primary outcome was homeostasis model assessment-β (HOMA-β), and the secondary outcome was glycated haemoglobin (HbA1c). Direct and indirect evidence types were combined to calculate weighted mean difference (WMD) and 95% confidence interval (CI) values for the change in (△) HOMA-β and △HbA1c, and to determine surface under the cumulative ranking curve (SUCRA) values.
Results: A total of 58 RCTs involving 16,345 T2DM patients were incorporated into this network meta-analysis. The mean patient age was 66.70 years, and 54.14% were male. For improving HOMA-β, the top treatments were glimepiride + rosiglitazone (WMD = 81.83, 95% CI 45.85-117.82) and glibenclamide + rosiglitazone (WMD = 79.51, 95% CI 40.66-118.36). Acarbose (WMD = 60.90, 95% CI 27.56-94.25) ranked third as monotherapy. For reducing HbA1c, glibenclamide + rosiglitazone was the most efficacious treatment (WMD = - 2.48, 95% CI - 3.67 to - 1.29), followed by metformin + exenatide (WMD = - 1.77, 95% CI - 2.25 to - 1.29) and liraglutide (WMD = - 1.77, 95% CI - 2.33 to - 1.21). The treatment with the highest SUCRA value for HOMA-β improvement was glimepiride + rosiglitazone (95.1%), followed by glibenclamide + rosiglitazone (94.9%). For HbA1c improvement, glibenclamide + rosiglitazone had the highest SUCRA value (97.6%).
Conclusions: The combination of glimepiride/glibenclamide and rosiglitazone was the most effective hypoglycaemic regimen for protecting beta-cell function and improving glycaemic control in T2DM treatment, possibly due to control of HbA1c and glycotoxicity.
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European Journal of Medical Research publishes translational and clinical research of international interest across all medical disciplines, enabling clinicians and other researchers to learn about developments and innovations within these disciplines and across the boundaries between disciplines. The journal publishes high quality research and reviews and aims to ensure that the results of all well-conducted research are published, regardless of their outcome.
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