PLOS ONE：强化降糖或使肥胖糖尿病患者获益

　　一项覆盖9项随机对照研究、59 197例受试者的Meta分析提示，对于体质指数（BMI）>30 kg/m2的糖尿病患者，与标准降糖方案相比，强化降糖方案可有效降低卒中发生风险。（PLoS One. 2013,8:e54465）

　　在被纳入的59 197例受试者中，2037例罹患卒中。分析结果显示，在整个受试人群中，与标准降糖方案相比，强化降糖方案对卒中并无预防作用（RR=0.96，P=0.445）。然而，在分层分析中，对于BMI>30 kg/m2的糖尿病患者，强化降糖方案有卒中预防优势（RR=0.86，P=0.041）。

与肥胖糖尿病相关的拓展阅读：

• 肥胖糖尿病患者减肥手术表现优于药物治疗
• NEJM:减肥手术治疗肥胖糖尿病患者更胜一筹
• 肥胖糖尿病患者：减重手术优于传统内科治疗
• 两项最新研究告诉我们，在肥胖糖尿病患者中减重手术“打败”标准内科疗法
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Efficacy of Intensive Control of Glucose in Stroke Prevention: A Meta-Analysis of Data from 59197 Participants in 9 Randomized Controlled Trials

Background

The efficacy of treatments that lower glucose in reducing the risk of incident stroke remains unclear. We therefore did a systematic review and meta-analysis to evaluate the efficacy of intensive control of glucose in the prevention of stroke.

Methodology/Principal Findings

We systematically searched Medline, EmBase, and the Cochrane Library for trials published between 1950 and June, 2012. We included randomized controlled trials that reported on the effects of intensive control of glucose on incident stroke compared with standard care. Summary estimates of relative risk (RR) reductions were calculated with a random effects model, and the analysis was further stratified by factors that could affect the treatment effects. Of 649 identified studies, we included nine relevant trials, which provided data for 59197 patients and 2037 events of stroke. Overall, intensive control of glucose as compared to standard care had no effect on incident stroke (RR, 0.96; 95%CI 0.88–1.06; P = 0.445). In the stratified analyses, a beneficial effect was seen in those trials when body mass index (BMI) more than 30 (RR, 0.86; 95%CI: 0.75–0.99; P = 0.041). No other significant differences were detected between the effect of intensive control of glucose and standard care when based on other subset factors.

Conclusions/Significance

Our study indicated intensive control of glucose can effectively reduce the risk of incident stroke when patients with BMI more than 30.