| Background:type 2 diabetes(T2DM)and the incidence of nonalcoholic fatty liver(NAFLD)are mutually risk factors,and have independent correlation.At present,in addition to classical antidiabetic drugs,glucagon-like peptide-1(GLP-1)receptor agonists and sodium glucose cotransporter 2(SGLT2)inhibitors are also two novel antidiabetic drugs for T2DM patients with NAFLD.However,due to the small sample size of each study,it is impossible to accurately judge the treatment effect in the population and compare the results with the current insulin-based treatment.Therefore,this study analyzed the efficacy of the above two types of drugs on T2DM patients with NAFLD through meta-analysis and mesh meta-analysis,and preliminatively compared the drugs with the best therapeutic effect among several drugs.Methods:Efficacy of SGLT-2i in the treatment of patients with non-alcoholic fatty liver disease complicated with type 2 diabetes mellitus Using "SGLT-2i","diabetes mellitus(T2DM)","non-alcoholic fatty liver disease(NAFLD)","empagliflozin","Dapagliflozin" and "topagliflozin" as search words,Pub Med,Web of science,Cochrane Library and other databases were searched from the establishment of the database to June 2022.After literature screening and quality evaluation,R4.1.3software was used to analyze the data.The efficacy of GLP-1 receptor agonist in the treatment of type 2 diabetes mellitus patients with non-alcoholic fatty liver disease "GLP-1","T2DM","Non-alcoholic fatty liver disease","Exenatide","lixisenatide","Liraglutide","Albiglutide" and "Dulaglutide" were searched in the above databases,and the data were analyzed.In the last part,the efficacy data of different treatment methods in the above literatures were extracted,and the comparative efficacy of GLP-1 agonists,SGLT-2i drugs and insulin-based treatment methods in patients with non-alcoholic fatty liver disease complicated with type 2 diabetes mellitus was analyzed by mesh meta-analysis.Result:(1)Efficacy of SGLT-2i in patients with non-alcoholic fatty liver disease combined with type 2 diabetes: a total of 12 articles with a total of 718 patients were included.(1)Compared with the control group,the HbA1c of the experimental group was not significantly improved(SMD=-0.23,95CI:-0.99,0.53).Subgroup analysis of the effects of different types of SGLT-2 inhibitors on HbA1c in patients with NAFLD and T2DM showed that various types of drugs did not significantly improve it,and the results were consistent with the overall analysis;(2)the experimental group did not significantly improve AST compared with the control group(SMD =-0.76,95CI:-1.55,0.02),subgroup analysis of the effect of different types of SGLT-2 inhibitors on AST showed that empagliflozin had an improvement effect on AST in patients(SMD=-1.04,95%CI:-2.06,-0.02),the other two drugs did not significantly improve it;(3)the experimental group did not significantly improve ALT compared with the control group(SMD=-0.35,95CI:-1.20,0.49),subgroup analysis of different types of SGLT-2 inhibitors The results of the effect on ALT in patients with NAFLD and T2DM showed that various types of drugs did not significantly improve it;(4)the experimental group did not significantly improve γ-GGT compared with the control group(SMD=-0.19,95CI:-0.39,0.02),and the subgroup analysis was different The effect of SGLT-2 inhibitors on γ-GGT in patients with NAFLD and T2DM showed that various types of drugs did not significantly improve it.(2)Efficacy of GLP-1 receptor agonists in patients with nonalcoholic fatty liver disease combined with type 2 diabetes: a total of 17 articles were included,with a total of 2266 patients.(1)Compared with the control group,the experimental group had a significant improvement in Hb A1c(SMD=-0.90,95CI:-1.39,-0.41).Subgroup analysis of the effects of different types of GLP-1 receptor agonists on HbA1c in patients with NAFLD and T2DM showed that Liraglutide had a significant effect on HbA1c.The patient’s HbA1c was significantly improved(SMD=-0.94,95%CI:-1.52,-0.35),and other types of drugs did not significantly improve it;(2)the experimental group was not significantly improved compared with the control group(SMD=-0.24,95CI:-0.61,0.13),subgroup analysis of the effect of different types of GLP-1receptor agonists on AST in patients with NAFLD and T2DM showed that Exenatide significantly improved AST(SMD=-0.57,95%CI(-0.88,-0.27)),other types of drugs did not significantly improve it;(3)the experimental group was significantly improved compared with the control group(SMD=-0.67,95CI:-0.95,-0.38)),the subgroup analysis was different The effect of type GLP-1 receptor agonists on ALT in patients with NAFLD and T2DM.The results show that Liraglutide and Exenatide can significantly improve ALT in patients(SMD(liraglutide)=-0.57,95%CI:-0.94,-0.20,SMD(Exenatide))=-0.81,95%CI:-1.34,-0.29),Dulaglutide has no obvious improvement effect on it;(4)the experimental group has a significant improvement inγ-GGT compared with the control group(SMD=-0.72,95%CI:-1.08,-0.37),subgroup analysis of the effects of different types of GLP-1 receptor agonists onγ-GGT in patients with NAFLD and T2DM showed that Exenatide and Liraglutide significantly improved γ-GGT(SMD(Exenatide)=-0.76,95%CI:-1.21,-0.31,SMD(liraglutide)=-0.94,95%CI:-1.51,-0.36),Dulaglutide did not significantly improve it.(3)Comparative efficacy of GLP-1 receptor agonists,SGLT-2i drugs,and insulin-based therapy in patients with non-alcoholic fatty liver disease combined with type 2 diabetes: seven interventions were included,the frequency of liraglutide use was higher.(1)the results of reducing HbA1c levels for each drug,except liraglutide(SMD=-0.23,95%CI:-0.43,-0.011)was more effective than insulin-based treatment.In addition to being effective,the results of other drugs in reducing HbA1c levels were not statistically different.Ranking the levels of HbA1c reduction of each drug,tofogliflozin>dapagliflozin>Insulin-based therapy>empagliflozin>Exenatide>liraglutide>dulaglutide;(2)the results of reducing the AST level of each drug,except for Exenatide(SMD=-7.0,95%CI:-14,-0.38)was more effective than insulin-based therapy,and there was no statistically significant difference in the results of other drugs in reducing AST levels.For each drug,Dulaglutide > tofogliflozin >Insulin-based therapy > liraglutide > dapagliflozin > empagliflozin > Exenatide;(3)the results of reducing ALT levels of each drug,except for Exenatide(SMD=-15,95%CI:-24,-6.4),which is more effective than insulin-based therapy,there is no statistical difference in the results of reducing ALT levels for other drugs Significance,the order of reducing ALT level of each drug is tofogliflozin>Insulin-based therapy>liraglutide>dapagliflozin>dulaglutide>empagliflozin>Exenatide。Conclusion:GLP-1 receptor agonists are more effective than SGLT-2 inhibitors in the treatment of patients with type 2 diabetes mellitus combined with nonalcoholic fatty liver disease.The effect of liraglutide was more obvious than the other.For different directions,the GLP-1 inhibitor agonist Exenatide has more obvious improvement on AST and ALT,while liraglutide has more obvious improvement on HbA1c. |
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