Meta-analysis of seven heterogeneous studies on liraglutide add-on therapy in patients with type 2 diabetes mellitus treated with insulin.

Autor: Shibuki K; Department of Pharmacy, Tokyo University of Science, 2641 Yamazaki, Noda, 278-8510, Japan. Electronic address: katsuya.shibuki@alumni.tus.ac.jp., Shimada S; Department of Pharmacy, Tokyo University of Science, 2641 Yamazaki, Noda, 278-8510, Japan. Electronic address: shimada@rs.tus.ac.jp., Aoyama T; Department of Pharmacy, Tokyo University of Science, 2641 Yamazaki, Noda, 278-8510, Japan. Electronic address: t-aoyama@rs.tus.ac.jp.
Jazyk: angličtina
Zdroj: Diabetes & metabolic syndrome [Diabetes Metab Syndr] 2022 Apr; Vol. 16 (4), pp. 102474. Date of Electronic Publication: 2022 Mar 28.
DOI: 10.1016/j.dsx.2022.102474
Abstrakt: Background and Aims: Clinical trials indicate the efficacy of add-on therapy using incretin-related drugs to treat type 2 diabetes mellitus (DM) inadequately controlled by insulin. However, heterogeneity exists among these studies. Baseline body mass index (BMI) accounts for the heterogeneity of add-on therapy with dipeptidyl peptidase-4 (DPP-4) inhibitors and the associated higher BMI with a lower efficacy. The efficacy of add-on therapy with glucagon-like peptide-1 (GLP-1) receptor agonists remains unclear.
Methods: We performed a meta-analysis of randomized controlled trials of ≥12 weeks reporting the endpoint of adjusted mean change in hemoglobin A1c levels (AMΔHbA1c) or hypoglycemia incidence. Patients with type 2 DM treated with insulin alone or with metformin for at least 8 weeks before the study treatment were included. The intervention group received liraglutide co-administered with insulin or a fixed-dose combination. The control group received a placebo or insulin. Covariates included five baseline parameters (HbA1c, fasting plasma glucose, BMI, type 2 DM duration, and treatment duration).
Results: Seven studies (2067 patients) were selected. AMΔHbA1c was -1.00% (95% confidence interval [CI]: -1.21 to -0.78, I 2  = 74.7%). The odds ratio for hypoglycemia incidence was 0.97 (95% CI: 0.50-1.87, I 2  = 81.9%). Covariates did not account for the heterogeneity in AMΔHbA1c or hypoglycemia incidence.
Conclusions: Liraglutide add-on therapy reduced HbA1c levels without increasing hypoglycemia incidence, independent of BMI, in insulin non-responders with type 2 DM. GLP-1 receptor agonists may be more suitable than DPP-4 inhibitors for add-on therapy in patients with high BMI.
Registration Number: PROSPERO #CRD42021178888.
Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare.
(Copyright © 2022 Diabetes India. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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