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GLP-1在2型糖尿病血糖控制中的有效性和可接受性

Objective:To synthesize current evidence of the impact of Glucagon一like peptide一1 receptor agonists (GLP一1 RAs) on hypoglycemia, treatment discontinuation and glycemic level in patients with type 2 diabetes.
 
Design:Systematic review and network meta一analysis.
 
Data Sources:Literature search (Medline, Embase, the Cochrane library), website of clinical trial, bibliogra一 phies of published systematic reviews.
 
Eligibility Criteria:Randomized controlled trials with available data comparing GLP一1 RAs with placebo or tra一 ditional anti一diabetic drugs in patients with type 2 diabetes.
 
Data Synthesis:Traditional pairwise meta一analyses within DerSimonian一L _aird random effects model and network meta一analysis within a Bayesian framework were performed to calculate odds ratios for the incidence of hypoglycemia, treatment discontinuation, HbA1c<7.0% andHbA1c<6.5%. Ranking probabilities for all treatments were estimated to obtain a treatment hierarchy using the surface under the cumulative ranking curve (SUCRA) and mean ranks.

Results:78 trials with 13 treatments were included. Overall, all GLP一1 RAs except for albiglutide increased the risk of hypoglycemia when compared to placebo. Reduction in the incidence of hypoglycemia was found for all GLP一1 RAs versus insulin (except for dulaglutide) and sul一 phonylureas. For the incidence of treatment discontinuation, increase was found for exena一 tide, liraglutide, lixisenatide and taspoglutide versus placebo, insulin and sitagliptin. For glycemic level, decrease was found for all GLP一1 RAs versus placebo. Dulaglutide, exena一 tide long一acting release (exe_ lar), liraglutide and taspoglutide had significant lowering effect when compared with sitagliptin (HbA1c<7.0%) and insulin (HbA1c<6.5%). Finally, accord一 ing to SUCRAs, placebo, thiazolidinediones and albiglutide had the best decrease effect on hypoglycemia; sulphanylureas, sitagliptin and insulin decrease the incidence of treatment discontinuation most; exe_ lar and dulaglutide had the highest impact on glycemic level among 13 treatments.
 
Conclusions:Among 13 treatments, GLP一1 RAs had a significant reduction with glycemic level but a slight increase effect on hypoglycemia and treatment discontinuation. While albiglutide had the best decrease effect on hypoglycemia and treatment discontinuation among all GLP一1 RAs. However, further evidence is necessary for more conclusive inferences on mechanisms underlying the rise in hypoglycemia.