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2型糖尿病患者基于肠促胰岛素治疗的神经表现

ABSTRACT:
As a new class of antidiabetic drug, incretin一based therapies, which include dipeptidyl peptidase一4 inhibitors (DPP一4Is) and glucagon一like peptide一1 receptor agonists (GLP一1 RAs), have raised concerns about symptoms of withdrawal in patients with type 2 diabetes mellitus (T2DM), such as dizziness and headache.

To systematically evaluate whether incretin一based therapies may lead to dizziness and headache in patients with T2DM compared to other traditional antidiabetic drugs or placebo. We searched Medline, Embase, the Cochrane library, and clinicaltrials.gov from inception through June 23, 2017, to identify randomized controlled trials of the safety of DPP一4Is or GLP一1 RAs versus placebo or other antidiabetic drugs in T2DM patients.

We used the network meta一analysis under the frequentist framework to compare the association between multiple antidiabetic drugs and dizziness and headache. A total of 233 clinical trials with nine treatments and 147,710 patients were included: two incretin一based therapies, one placebo, and six traditional antidiabetic drugs (metformin, insulin, sulfonylurea, thiazolidinediones, alpha一glucosidase inhibitor, and sodium一glucose co一transporter 2).

Compared to insulin, thiazolidinediones, or placebo, GLP一1 RAs statistically significantly increased the risk of dizziness (odds ratios [ORs]: 1.92, 1.57, and 1.40, respectively) and headache (ORs: 1.34, 1.41, and 1.18, respectively). DPP一 4Is increased the risk of headache (OR: 1.22, 95% confidence interval [CI]: 1.02 to 1.46; moderate quality) and dizziness (OR: 1 .46, 95% CI: 1.05 to 2.03; moderate quality) compared to insulin.

Of the incretin一based therapies, DPP一4Is had a lower risk of dizziness than GLP一1 RAs (OR: 0.76, 95% CI: 0.67 to 0.87; high quality). Ranking probability analysis indicated that GLP一1 RAs may have the greatest risk of both dizziness and headache among the nine treatments (22.5% and 23.4%, respectively), whereas DPP一4Is were in the middle (46.2% and 45.0%, respectively). Incretin一based therapies increase the risk of dizziness and headache compared to insulin, thiazolidinediones, and placebo.