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胰高血糖素样肽-1受体激动剂对2型糖尿病血脂的

Purpose: The goal of this study was to assess the effect of glucagon-like peptide-1 receptor agonists (GLP- 1 RAs) on lipid profiles in patients with type 2 diabetes.

Methods: The MEDLINE, Embase, Cochrane Li- brary, and ClinicalTrials.gov databases were searched from inception through October 31, 2013. Random- ized controlled trials with available data were selected if they compared GLP-1 RAs with placebo and tradi- tional antidiabetic drugs with a duration Z8 weeks. The weighted mean difference for changes in lipid profiles was estimated by using the random effects model, and a network meta-analysis was performed to supplement direct comparisons.

Findings: Thirty-five trials with 13 treatments were included in the analysis. GLP-1 RAs decreased HDL-C with a range of 0.06 mmol/L (95% CI, 0.11 to 0.01) to 0.13 mmol/L (95% CI, 0.17 to 0.10) compared with thiazolidinediones, whereas thiazolidinediones were associated with a significant increase in HDL-C com- pared with placebo (0.09 mmol/L [95% CI, 0.06 to 0.12]). A significant reduction in LDL-C was detected for all GLP-1 RAs versus placebo (range, 0.08 to 0.16 mmol/L), insulin (range, 0.10 to 0.19 mmol/L), and thiazolidinediones (range, 0.16 to 0.24 mmol/L). Exenatide, liraglutide 1.8 mg once daily, and taspoglu- tide decreased total cholesterol with a range of 0.16 mmol/L (95% CI, 0.26 to 0.06) to 0.27 mmol/L (95% CI, 0.41 to 0.12) versus placebo and thiazoli- dinediones (range, 0.26 to 0.37 mmol/L). The de- creased effect was more evident in exenatide long-acting release and liraglutide 1.8 mg once daily. A significant reduction in triglyceride levels was observed with lir- aglutide 1.8 mg once daily (0.30 mmol/L [95% CI, 0.49 to 0.11]) and taspoglutide 20 mg once weekly (0.17 mmol/L [95% CI, 0.31 to 0.01]) versus placebo.

Implications: GLP-1 RAs were associated with mod- est reductions in LDL-C, total cholesterol, and triglycer- ides but no significant improvement in HDL-C. Further evidence is needed to determine if improvements in lipid profiles might translate into reductions in cardiovascular outcomes. (Clin Ther. ]]]];]:]]]]]]2015 Elsevier HS Journals, Inc. All rights reserved.