Metabolism:降糖药对痴呆风险的影响

2020-05-23 MedSci原创 MedSci原创

该分析表明接受DPP-4抑制剂治疗的2型糖尿病患者患痴呆症的风险最低,其次是接受二甲双胍和噻唑烷二酮治疗的患者,而采用胰岛素治疗的患病风险最高。

痴呆症在2型糖尿病患者中更为普遍,但关于降糖药对该关联的影响知之甚少。近日,代谢性疾病领域权威杂志Metabolism-Clinical and Experimental上发表了一篇研究文章,这项研究旨在评估了2型糖尿病患者中各种降糖药对痴呆风险的影响。

研究人员从PubMed、Embase、Cochrane对照试验中央注册中心(CENTRAL)和ClinicalTrials.gov数据库中检索了相关研究,检索中包括了九种降糖药。研究人员通过网络荟萃分析和荟萃分析合并数据。

该分析共选择了9项研究,共计530355名受试者进行网络荟萃分析,并选择了17项研究共计1258879名受试者进行了荟萃分析。由于缺乏相关数据,该分析排除了胰高血糖素样肽1(GLP-1)类似物和钠依赖性葡萄糖转运蛋白2(SGLT-2)抑制剂。与未使用降糖药治疗相比,使用二肽基肽酶-4(DPP-4)抑制剂、二甲双胍、噻唑烷二酮和磺酰脲与痴呆症的风险降低相关(DPP-4抑制剂的风险比[HR]为0.54;95%置信区间[CI]为0.38-0.74,二甲双胍的HR为0.75;95%CI为0.63-0.86;磺酰脲的HR为0.85;95%CI为0.73-0.98;噻唑烷二酮的HR为0.70;95%CI为0.55-0.89)。但是,节点分解分析显示磺酰脲类药物的直接和间接估计值不一致(P=0.042)。与胰岛素相比,DPP-4抑制剂、二甲双胍、噻唑烷二酮和磺酰脲对糖尿病患者的痴呆风险有显著影响(分别有HR为0.35;95%CI为0.20-0.59,HR为0.48;95%CI为0.30-0.77,HR为0.45;95%CI为0.29-0.73;HR为0.55;95%CI为0.34-0.88)。与不使用降糖药治疗相比,DPP-4抑制剂还显示出对阿尔茨海默氏痴呆风险具有保护作用(HR为0.48; 95%CI为0.25-0.92)。荟萃分析表明,使用二甲双胍和DPP-4抑制剂治疗对痴呆风险具有保护作用(HR为0.86; 95%CI为0.74-1.00; HR为0.65;95%CI为0.55-0.76)。进一步的分析表明,胰岛素与阿尔茨海默氏症痴呆的风险增加有关(HR为1.60;95%CI为1.12-3.26)。只有两项病例对照研究提到了GLP-1类似物和SGLT-2抑制剂,合并的OR没有发现与痴呆症相关的证据(GLP-1类似物:0.71;95%CI为0.46-1.10和SGLT-2抑制剂:0.74;95%CI为0.47-1.15)。

该分析表明接受DPP-4抑制剂治疗的2型糖尿病患者患痴呆症的风险最低,其次是接受二甲双胍和噻唑烷二酮治疗的患者,而采用胰岛素治疗的患病风险最高。为了越来越关注痴呆的保护作用,需要进一步的具体临床研究来评估GLP-1类似物和SGLT-2抑制剂对痴呆风险的影响。

原始出处:

Jian-Bo Zhou,et al.Impact of antidiabetic agents on dementia risk: A Bayesian network meta-analysis.Metabolism-Clinical and Experimental.2020.https://www.metabolismjournal.com/article/S0026-0495(20)30129-3/fulltext

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    2021-02-19 guojianrong
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    2021-01-14 一闲
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    2020-05-25 闆锋旦
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    2020-05-23 junJUN

    老年人痴呆何药可用??

    0

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    2020-05-23 lovetcm

    胰岛素为什么风险最高?长效会不会更是如此

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1888144, encodeId=05e518881443c, content=<a href='/topic/show?id=d56611584ec' target=_blank style='color:#2F92EE;'>#Meta#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11584, encryptionId=d56611584ec, topicName=Meta)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d8f4110, createdName=guojianrong, createdTime=Fri Feb 19 20:16:24 CST 2021, time=2021-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1896660, encodeId=1fa018966609e, content=<a href='/topic/show?id=4a391158248' target=_blank style='color:#2F92EE;'>#MET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11582, encryptionId=4a391158248, topicName=MET)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=18fc139, createdName=一闲, createdTime=Thu Jan 14 17:16:24 CST 2021, time=2021-01-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1270916, encodeId=99fc12e0916ec, content=<a href='/topic/show?id=4066981e99e' target=_blank style='color:#2F92EE;'>#降糖药#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98179, encryptionId=4066981e99e, topicName=降糖药)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Mon May 25 02:16:24 CST 2020, time=2020-05-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1316749, encodeId=ba631316e495e, content=<a href='/topic/show?id=d3d0e121576' target=_blank style='color:#2F92EE;'>#痴呆风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71215, encryptionId=d3d0e121576, topicName=痴呆风险)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a98f453, createdName=pcw106, createdTime=Mon May 25 02:16:24 CST 2020, time=2020-05-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1577227, encodeId=bd7815e722778, content=<a href='/topic/show?id=d86d1159e36' target=_blank style='color:#2F92EE;'>#Metabolism#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11597, encryptionId=d86d1159e36, topicName=Metabolism)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1a6516392333, createdName=1249859em43(暂无昵称), createdTime=Mon May 25 02:16:24 CST 2020, time=2020-05-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1598060, encodeId=b4d715980601f, content=<a href='/topic/show?id=6c6f1e62c5' target=_blank style='color:#2F92EE;'>#ABO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1762, encryptionId=6c6f1e62c5, topicName=ABO)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b6c918580135, createdName=闆锋旦, createdTime=Mon May 25 02:16:24 CST 2020, time=2020-05-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1048621, encodeId=84611048621b1, content=老年人痴呆何药可用??, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=junJUN, createdTime=Sat May 23 14:16:24 CST 2020, time=2020-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=600235, encodeId=d299600235ed, content=胰岛素为什么风险最高?长效会不会更是如此, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sat May 23 11:42:54 CST 2020, time=2020-05-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=600234, encodeId=364660023431, content=都是老化衰老过程, beContent=null, objectType=article, channel=null, level=null, likeNumber=1, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sat May 23 11:42:16 CST 2020, time=2020-05-23, status=1, ipAttribution=)]
    2020-05-23 lovetcm

    都是老化衰老过程

    0

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