【】降低糖化血色素(A1C)值的前三類藥物包括雙相型胰島素(biphasic insulin)、類升糖素胜肽第一型(GLP-1)類似物以及基礎胰島素。雖然大部分口服降血糖藥物對於A1C的效果差不多,GLP-1類似物還有降低體重的額外好處,而且低血糖風險不會增加。
  作者們搜尋了至2011年12月的PubMed和Cochrane Central Register of Controlled Trials的英文隨機臨床試驗、共819篇文獻,其中70篇為全文文獻,共納入了39篇隨機控制試驗、17,860名病患。
  GLP-1類似物降低A1C的程度優於sulfonylureas (-0.20%;95%信心區間[CI] -0.34%至-0.04%)、glinides (-0.31%;95% CI,-0.61%至-0.02%)、thiazolidinediones (-0.20%;95% CI,-0.38%至- 0.00%)、α-glucosidase抑制劑(-0.36%;95% CI,-0.64%至-0.07%)以及dipeptidyl peptidase IV抑制劑(DPP-4抑制劑;-0.32%;95% CI,-0.47至-0.17%),降低A1C的程度與基礎胰島素及雙相型胰島素相當。
  比較降低A1C的程度,sulfonylureas優於DPP-4抑制劑(-0.12%;95% CI,-0.23%至-0.03%),雙相胰島素優於glinides (-0.36%;95% CI,-0.82%至-0.11%)。作者們發現,sulfonylureas、glinides、基礎胰島素與雙相胰島素治療,低血糖風險增加程度高於安慰劑。

GLP-1 Is a Good Choice for Glycemic Control

By Lara C. Pullen, PhD
Medscape Medical News

April 11, 2012 — The top 3 drugs for the reduction of glycated hemoglobin A1c (A1C) levels are biphasic insulin, glucagon-like peptide 1 (GLP-1) analogs, and basal insulin. Although most oral antidiabetic drugs had a similar effect on A1C, GLP-1 analogs had the additional advantages of weight reduction in the absence of an increased risk for hypoglycemia.

Sung-Chen Liu, MD, from the Mackay Memorial Hospital, Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei, Taiwan, and colleagues published their network meta-analysis of different treatments for diabetes online April 9 in Diabetes, Obesity and Metabolism. The meta-analysis examined the use of antidiabetic agents for the treatment of type 2 diabetes that was inadequately controlled by metformin.

The authors searched PubMed and the Cochrane Central Register of Controlled Trials for randomized controlled trials written in English through December 2011. The search identified 819 articles, 70 of which were reviewed as full-text articles. The authors included 39 randomized controlled trials involving 17,860 patients.

Previous reports indicated that A1C reductions ranged from ?0.64% for alpha-glucosidase inhibitors to ?0.97% for GLP-1 analogs. The results of this study are consistent with those of previous network meta-analyses.

GLP-1 analogs resulted in greater decrease in A1C levels compared with sulfonylureas (?0.20%; 95% confidence interval [CI], ?0.34% to ?0.04%), glinides (?0.31%; 95% CI, ?0.61% to ?0.02%), thiazolidinediones (?0.20%; 95% CI, ?0.38% to ?0.00%), α-glucosidase inhibitors (?0.36%; 95% CI, ?0.64% to ?0.07%), and dipeptidyl peptidase IV inhibitors (DPP-4 inhibitors; ?0.32%; 95% CI, ?0.47 to ?0.17%), and resulted in A1C levels comparable to basal insulin and biphasic insulin.

The decrease in A1C levels was greater for sulfonylureas compared with DPP-4 inhibitors (?0.12%; 95% CI, ?0.23% to ?0.03%), and for biphasic insulin compared with glinides (?0.36%; 95% CI, ?0.82% to ?0.11%).

The authors found that sulfonylureas, glinides, basal insulin, and biphasic insulin treatments were associated with an increased risk for hypoglycemia compared with placebo.

Patients receiving sulfonylureas, glinides, thiazolidinediones, basal insulin, and biphasic insulin gained weight, and patients receiving glucosidase inhibitors and GLP-1 analogues lost weight. The authors acknowledge that their analysis was limited by the fact that the duration of treatment was only 12 to 52 weeks.

The authors have disclosed no relevant financial relationships.

Diabetes Obes Metab. Published online April 9, 2012.

別老是坐著 少坐一點對糖尿病有好處
2016/12/9 上午 10:05:25
Metformin失敗之後 延遲強化治療常見
2016/8/31 下午 01:57:15
2016/4/13 下午 03:41:30

   1   2   3   4   5   6   7   8   9   10