GLP-1 Analogue Versus Sulfonylureas In Patients With Type 2 Diabetes. A Systematic Review

Objective:To evaluate the efficacy and safety.of GLP-1 analogue versus sulfonylureas in patients with type 2 diabetesMethods:searched PubMed, EMBASE, Medline, Cochrane Library databases, Chongqing VIP database, Tsinghua Tongfang database, Chinese Biomedical Literature Database, Wanfang database, deadlines is march 2015. Included in the GLP-1 analogs and sulfonylurea contrast the treatment of type 2 diabetes in a randomized controlled trial, using Review Manager5.2 software for meta-analysis. Observed indicators:glycated hemoglobin,fast plasma glucose,body weight, Postprandial two-hour blood glucose,systolic blood pressure;Adverse reactions:hypoglycemia, gastrointestinal tract.Results:found 588 documents, in strict accordance with RCT inclusion and exclusion criteria were screened, and finally included thirteen randomized controlled trials to meet the requirements of a total of 5100 patients, of which there are seven studies combined with metformin therapy were compared. Meta-analysis showed that,In the aspect of curative effect: ① lower glycosylated hemoglobin,GLP-1 analogs compare with sulfonylureas no significantly differences, [SMD=-0.14,95%CI(-0.28,0.01),P=0.06], Subgroup analyses hint whether combine with metformin, or whether liraglutide or other GLP-1 analogues were no significant difference compared with sulfonylureas.②reduce fasting blood glucose, GLP-1 analogues there are no significant difference compared with sulfonylureas,, [SMD=-0.1 95%CI=(-0.27,-0.07),P=0.24], Subgroup analyses hint whether combine with metformin, or whether liraglutide or otherGLP-1 analogues were no significant difference compared with sulfonylureas.③reduce postprandial two-hour blood glucose, there was no significant difference compared with sulphonylurea, [SMD=-0.04,95%CI=(-0.13,-0.05), P=0.41]. ④lower systolic blood pressure, GLP-1 analogues are superior to sulfonylureas, [SMD=-0.22, 95%CI=(-0.30,-0.15),P< 0.00001].⑤weight loss, glp-1 analogues is more obvious than sulfonylureas, [SMD=-1.55,95%CI=(-2.51,-0.59),P=0.001], Subgroup analyses hint whether combine with metformin, no matter liraglutide or other GLP-1 analogues are superior to sulfonylureas⑥risk of hypoglycemia, GLP-1 analogues is less than sulfonylureas [RR=0.25,95%CI=(0.15,0.41),P <0.00001], Subgroup analyses hint whether combine with metformin, no matterliraglutide or otherGLP-1 analogues risk of hypoglycaemia were less than sulfonylureas. ⑦gastrointestinal adverse reactions, GLP-1 analogues more than sulfonylureas, [RR=2.10,95%CI=(1.34,3.29), P=0.001], Subgroup analyses hint when used alone glp-1 analogues and sulfonylureas, there was no significant difference between them, as are used in combination with metformin, GLP-1 analogues in the treatment of type 2 diabetes gastrointestinal adverse reaction more obvious than sulfonylureas, and liraglutide more obvious than sulfonylureas.Conclusion:For patients with type 2 diabetes, GLP-1 analogs with sulfonylurea drugs compare in terms of efficacy, the effect of reduced glycated hemoglobin,fasting blood glucose, postprandial two-hour blood glucose, systolic blood pressure is no significantly difference,weight loss is more pronounced. Safety, lower risk of hypoglycemia, but adverse gastrointestinal reactions more apparent,when combine with metformin, gastrointestinal adverse reactions are more obvious.