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Meta-analysis of the impact of alpha-glucosidase inhibitors on incident diabetes and cardiovascular outcomes.
Cardiovascular Diabetology ( IF 9.3 ) Pub Date : 2019-10-17 , DOI: 10.1186/s12933-019-0933-y
Ruth L Coleman 1 , Charles A B Scott 1 , Zhihui Lang 2 , M Angelyn Bethel 1 , Jaakko Tuomilehto 3, 4, 5 , Rury R Holman 1
Affiliation  

BACKGROUND Alpha-glucosidase inhibitors (AGIs) have been shown to reduce incident type 2 diabetes but their impact on cardiovascular (CV) disease remains controversial. We sought to identify the overall impact of AGIs with respect to incident type 2 diabetes in individuals with impaired glucose tolerance (IGT), and CV outcomes in those with IGT or type 2 diabetes. METHODS We used PubMed and SCOPUS to identify randomized controlled trials reporting the incidence of type 2 diabetes and/or CV outcomes that had compared AGIs with placebo in populations with IGT or type 2 diabetes, with or without established CV disease. Eligible studies were required to have ≥ 500 participants and/or ≥ 100 endpoints of interest. Meta-analyses of available trial data were performed using random effects models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident type 2 diabetes and CV outcomes. RESULTS Of ten trials identified, three met our inclusion criteria for incident type 2 diabetes and four were eligible for CV outcomes. The overall HR (95% CI) comparing AGI with placebo for incident type 2 diabetes was 0.77 (0.67-0.88), p < 0.0001, and for CV outcomes was 0.98 (0.89-1.10), p = 0.85. There was little to no heterogeneity between studies, with I2 values of 0.03% (p = 0.43) and 0% (p = 0.79) for the two outcomes respectively. CONCLUSIONS Allocation of people with IGT to an AGI significantly reduced their risk of incident type 2 diabetes by 23%, whereas in those with IGT or type 2 diabetes the impact on CV outcomes was neutral.

中文翻译:

对α-葡萄糖苷酶抑制剂对糖尿病和心血管疾病的影响进行荟萃分析。

背景技术已经显示出α-葡糖苷酶抑制剂(AGI)可以减少2型糖尿病的发病率,但是它们对心血管(CV)疾病的影响仍然是有争议的。我们试图确定AGI对糖耐量受损(IGT)患者中2型糖尿病的整体影响以及IGT或2型糖尿病患者的CV结果。方法我们使用PubMed和SCOPUS来识别报告2型糖尿病和/或CV结果发生率的随机对照试验,该试验已将AGI与安慰剂在IGT或2型糖尿病人群中进行了比较。合格的研究必须有≥500名参与者和/或≥100名感兴趣的终点。使用随机效应模型对可用试验数据进行荟萃分析,以计算2型糖尿病和CV事件的危险比(HRs)和95%置信区间(CIs)。结果在确定的十项试验中,三项符合我们对2型糖尿病事件的纳入标准,四项符合CV预后。比较AGI和安慰剂治疗的2型糖尿病的总HR(95%CI)为0.77(0.67-0.88),p <0.0001,而CV结果为0.98(0.89-1.10),p = 0.85。研究之间几乎没有异质性,两个结果的I2值分别为0.03%(p = 0.43)和0%(p = 0.79)。结论将IGT患者分配给AGI可将其发生2型糖尿病的风险显着降低23%,而在具有IGT或2型糖尿病的患者中,对CV结果的影响是中性的。
更新日期:2019-10-17
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