BMJ研究新闻:二甲双胍——2型糖尿病治疗的一线药物

2016-04-21 MedSci MedSci原创

来自马里兰州巴尔的摩的约翰霍普金斯大学医学院的一项全面的系统回顾和荟萃分析表明,使用二甲双胍治疗2型糖尿病可改善机体的糖化血红蛋白、体重和心血管疾病死亡率,因此支持二甲双胍作为2型糖尿病治疗的一线药物,该研究结果已在线发表于Annals of Internal Medicine。

来自马里兰州巴尔的摩的约翰霍普金斯大学医学院的一项全面的系统回顾和荟萃分析表明,使用二甲双胍治疗2型糖尿病可改善机体的糖化血红蛋白、体重和心血管疾病死亡率,因此支持二甲双胍作为2型糖尿病治疗的一线药物,该研究结果已在线发表于Annals of Internal Medicine。

该研究共纳入了179项试验研究和25项观察性研究,这些研究探究了二甲双胍单药治疗或以二甲双胍为基础的联合用药治疗2型成人糖尿病的效果。该研究评估了噻唑烷二酮类药物、二甲双胍、磺脲类、二肽基肽酶IV(DPP-4)抑制剂、钠葡萄糖协同转运蛋白2(SGLT2)抑制剂、胰高血糖素样肽-1(GLP-1)受体激动剂,以及以二甲双胍为基础的联合用药的对比疗效和安全性。

研究人员发现,中等证据表明,与磺脲类药物单药治疗相比,二甲双胍单药治疗后患者心血管疾病的死亡率更低。但是,在降低全因死亡率、心血管疾病的发病率和微血管并发症上的证据却并不充分或强度很低。

研究还发现,除了DPP-4抑制剂之外,其他所有的单药治疗和以二甲双胍为基础的联合用药降低患者糖化血红蛋白值的程度相似。

二甲双胍、DPP-4抑制剂、GLP-1受体激动剂和SGLT2抑制剂的使用可降低或保持患者的体重,而磺脲类药物、噻唑烷二酮类药物和胰岛素的使用则会升高患者的体重。

此外,研究人员还注意到,低血糖常发生于磺脲类药物治疗的患者,而胃肠道不良反应事件最常见于二甲双胍和GLP-1受体激动剂治疗的患者。噻唑烷二酮类药物的使用可增加充血性心力衰竭的发生风险,而SGLT2抑制剂的使用可增加生殖器霉菌感染的发生危险。

所有的糖尿病治疗药物都存在特定的副作用,新的药物不一定比旧的更安全。最后他们得出结论:鉴于二甲双胍的益处和相对安全性,研究结果支持目前的指南,推荐它作为成人2型糖尿病治疗的一线药物。

原始出处:

Jacqui Wise. Metformin is backed as first line therapy for type 2 diabetes. BMJ 2016; 353 doi: http://dx.doi.org/10.1136/bmj.i2236 (Published 20 April 2016).

Maruther N, Tseng E, Hutfless S, et al. Diabetes medications as monotherapy or metformin-based combination therapy for type 2 diabetes. Ann Intern Med2016, doi:10.7326/M15-2650.

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    2016-07-12 gaoxiaoe
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    2016-04-26 jjzouyan

    二甲双胍是个好药

    0

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    2016-04-23 为何

    二甲最近研究挺多

    0

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    2016-04-23 西海五月

    老药新作用!

    0

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    2016-04-23 老段

    又是二甲

    0

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近期发表在J Acquir Immune Defic Syndr的研究称,正在开始或将要停用Dolutegravir的患者为保持最佳血糖控制应考虑调整二甲双胍剂量。Dolutegravir是抗艾滋病毒药物中的整合酶链转移抑制剂,为OCT2转运体蛋白抑制剂;而二甲双胍是OCT2底物。研究者进行了一项非盲三期交叉研究,探究同时服用Dolutegravir和二甲双胍时,Dolutegravir对二甲双胍

BMC Cancer:神药二甲双胍可以降低甲状腺癌风险吗?

先前有研究表明使用二甲双胍可降低癌症风险,研究者对甲状腺癌进行了一项研究,探究二甲双胍或其他抗糖尿病药物能否降低其风险。研究者使用英国的临床实践研究数据链(CPRD)进行了一项病例对照研究(1995~2014年)。纳入了第一次诊断为甲状腺癌的患者,每例患者根据年龄、性别等匹配六名对照组。校正BMI、吸烟、糖尿病后估计两者间OR和95 % CI。该研究共纳入了1229例甲状腺癌以及7374例对照组。

NEJM:二甲双胍可减少无糖尿病的肥胖妊娠女性的体重增加

肥胖与不良妊娠结局的风险增加相关。生活方式干预研究并没有显示出改善的结果。在妊娠期糖尿病患者中,二甲双胍改善胰岛素敏感性,与那些不服用二甲双胍的患者相比,体重增加减少。原始出处:Argyro Syngelaki,Kypros H. Nicolaides,Jyoti Balani,et al.Metformin versus Placebo in Obese Pregnant Women witho

BMJ:二甲双胍——2型糖尿病治疗的一线药物:are we sure?

目前推荐二甲双胍作为2型糖尿病治疗的一线降糖药物。该建议是基于英国1998年发表的一项前瞻性糖尿病研究(UKPDS 34)结果。该研究发现,患者使用二甲双胍后,其10年全因死亡率(相对风险0.64,95% CI,0.45-0.91)以及心肌梗塞(相对风险0.61,95% CI,0.41-0.89)的发生率有所降低。为避免一人死亡而需治疗的人数为14,且绝对风险降低0.07。然而,这些结果却是在一个

JCEM:长期应用二甲双胍与维生素B12缺乏相关(DPPOS研究)?

来自纽约阿尔伯特 ·爱因斯坦医学院的Crandall JP博士和同事对糖尿病预防计划(DPP)和糖尿病预防计划结果研究(Diabetes Prevention Program Research Group,DPPOS)中1073 名接受二甲双胍治疗和1082名接受安慰剂的参与者3.2 年的随访数据进行分析,以确定长期应用二甲双胍对维生素B12的影响。随后,参与者再次接受9年的非盲二甲双胍

Eur J Cancer:2型糖尿病人群使用二甲双胍可显著降低肾癌风险

已有文献报道过二甲双胍的抗癌作用,研究者对2型糖尿病患者进行了一项研究,调查二甲双胍对该类人群的肾癌风险的影响。该研究纳入了≥40岁的171753名现在使用或既往使用二甲双胍的患者,还有75499名服用其他降糖药物的患者,对参与者随访6个月。研究结果显示,随访期间二甲双胍使用组和对照组分别出现了917例和824例肾癌,发射和您个人分别为80.09/100,000人年和190.30/100,000人