治疗2型糖尿病的年龄和性别差异:网络元分析
Peter Hanlon1, Elaine Butterly1, Lili Wei1
1School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland.
JAMA
|February 3, 2025
概括
- 葡萄糖携带体2 (SGLT2) 抑制剂和葡萄糖类-1 (GLP-1) 受体激活剂可减少2型糖尿病中的心血管事件. 疗效因年龄而异,SGLT2抑制剂在老年人中具有更强的心脏保护作用,GLP- 1激动剂在年轻人中具有更强的心脏保护作用.
科学领域:
- 内分泌学和新陈代谢
- 心血管疾病研究
- 药理学
背景情况:
- - 葡萄糖携带体2 (SGLT2) 抑制剂,葡萄糖类-1 (GLP-1) 受体激活剂和二基酶4 (DPP4) 抑制剂是2型糖尿病高血糖症的确立治疗方法.
- 在减少主要心血管不良事件 (MACE) 方面,SGLT2抑制剂和GLP-1受体激动剂已显示出益处.
- 然而,患者年龄和性别对这些药物类别的疗效的影响仍然不完全理解.
研究的目的:
- 调查SGLT2抑制剂,GLP-1受体激动剂和DPP4抑制剂在2型糖尿病成年人的疗效是否受到年龄或性别的影响.
- 对血糖控制 (HbA1c) 和心血管结果 (MACE) 的年龄和性别治疗相互作用进行分析.
主要方法:
- 在MEDLINE,Embase和临床试验注册表中进行了系统的搜索,直到2022年11月,并于2024年8月进行了更新.
- 包括随机临床试验,比较SGLT2抑制剂,GLP-1受体激动剂或DPP4抑制剂与安慰剂或活跃的对照剂.
- 使用多级网络元回归模型分析了个体参与者数据和汇总数据,以评估年龄 × 治疗和性别 × 治疗的相互作用.
主要成果:
- 分析了103项试验 (报告HbA1c) 和6项试验 (报告MACE) 的个人参与者数据.
- 随着年龄的增长,SGLT2抑制剂的HbA1c降低较小,但对老年人来说MACE降低较大.
- 在单一治疗和双重治疗中,GLP- 1受体激动剂显示HbA1c随年龄的增加而降低,但在年轻人中具有更强的心脏保护作用.
- 在双重治疗中,DPP4抑制剂在老年人中略有降低HbA1c.
- 对于SGLT2抑制剂或GLP-1受体激活剂,没有观察到一致的性别与治疗相互作用.
结论:
- 在2型糖尿病中,SGLT2抑制剂和GLP-1受体激活剂有效地降低MACE,其效果取决于年龄.
- 在老年患者中,SGLT2抑制剂显得更有心脏保护作用,而GLP-1受体激动剂在年轻患者中显示出更大的益处.
- 这些发现强调了选择这些药物用于降低2型糖尿病心血管风险时考虑年龄的重要性.
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