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目的评价胰升血糖素样肽-1(GLP-1)类似物与甘精胰岛素对采用口服降糖药(OADs)治疗但血糖控制不佳的T2DM患者疗效及安全性。方法采用Medline、PubMed、Embase、The National Register、Cochrane、Current Controlled Trials、中国生物医学文献数据库、中国期刊全文数据库、VIP、CNKI和万方数据库检索,查找符合标准的随机对照试验(RCTs)进行质量评价。结果最终纳入7篇RCTs,共2653例患者,其中,GLP-1类似物(包括艾塞那肽、利拉鲁肽)组1347例,甘精胰岛素组1306例。两组均可降低FPG、HbA1c水平,GLP-1类似物组降低HbA1c水平较甘精胰岛素组高,甘精胰岛素组降低FPG水平较GLP-1类似物组高(P<0.01)。GLP-1类似物组可降低体重,甘精胰岛素组可增加体重,两组比较差异有统计学意义(P<0.01)。GLP-1类似物组低血糖事件发生率较甘精胰岛素组降低43%。GLP-1类似物组胃肠道不良反应较甘精胰岛素组常见,多为恶心、呕吐,症状短暂、轻微。结论采用OADs治疗但血糖控制不佳的T2DM患者,GLP-1类似物和甘精胰岛素均可降低其FPG、HbA1c水平,但GLP-1类似物可降低体重,低血糖发生风险低,胃肠道不良反应较常见,症状短暂、轻微,是T2DM患者新的治疗选择。
Objective To evaluate the efficacy and safety of GLP-1 analogues and insulin glargine in T2DM patients treated with oral hypoglycemic agents (OADs) but with poorly controlled blood glucose. Methods The quality of RCTs was determined by searching Medline, PubMed, Embase, The National Register, Cochrane, Current Controlled Trials, Chinese Biomedical Literature Database, Chinese Journal Full-text Database, VIP, CNKI and Wanfang database. Evaluation. RESULTS: A total of 7 RCTs were enrolled in the study. A total of 2653 patients were enrolled, of whom 1347 were GLP-1 analogues (including exenatide and liraglutide), and 1306 were insulin glargine. The levels of FPG and HbA1c in GLP-1 group were lower than those in GLP-1 group, while those in GLP-1 group were lower than those in GLP-1 group (P <0.01). GLP-1 analogue group can reduce body weight, insulin glargine group can increase body weight, the difference between the two groups was statistically significant (P <0.01). The incidence of hypoglycemic events in the GLP-1 analogue group was 43% lower than in the insulin glargine group. GLP-1 analog group gastrointestinal adverse reactions are more common than insulin glargine group, mostly nausea, vomiting, short-term symptoms, minor. Conclusions Both GLP-1 analogs and insulin glargine can reduce their levels of FPG and HbA1c in T2DM patients treated with OADs but with poor glycemic control. However, GLP-1 analogues can reduce body weight, low risk of hypoglycemia, gastrointestinal Adverse reactions are more common, short-term symptoms, mild, is a new treatment option for T2DM patients.