The Efficacy And Safety Of Once Weekly GLP-1 Analogue And Insulin Glargine On T2dm Patients :A Meta-analysis

Objective:To assess the efficacy and safety of once weekly GLP-1 analogue and insulin glargine within type 2 diabetes mellitus patients poorly controlled by antidiabetic drugs.Method:The data of this study were obtained from CNKI,CBM,VIP,Wan Fang,Pubmed,Embase and Cochrane using specific search terms“glucagon-like peptide 1,once weekly exenatide,albiglutide,dulaglutide,insulin glargine” from inception to June 2016.Literatures relating comparison of once weekly GLP-1 and insulin glargine were extracted.Mean change of Hb A1 c,FPG,2h PG,weight,incidence of hypoglycemia,gastrointestinal and injection-site reaction were collected from each study before quality assessment with the cochrane risk of bias score and pooled in analysis using Revman 5.3 for WMD or RR.An I2 of more than 50% indicate high heterogeneity,statistical significance was assumed at the P?0.05 level.Results:6 RCTs with 3112 patients were included in the study.Results show that the mean change of Hb A1 c and weight for patients in once weekly GLP-1 analogue group were-0.23%(95%CI:-0.43 to-0.02,P<0.05)and-2.49kg(95%CI:-3.25 to-1.73,P<0.05)decrease respectively,while FPG was 0.73mmol/L(95%CI:0.13 to 1.32,P<0.05)increase compared to glargine group.Once weekly GLP-1 analogue was associated with increased risk for gastrointestinal reaction(RR:3.18,95%CI:2.42~4.17,P<0.05)and injection-site reaction(RR : 7.25,95%CI : 3.01 ~ 17.48,P <0.05).However with decreased risk for hypoglycemia(RR:0.62,95%CI:0.43 to 0.89,P<0.05)and severe hypoglycemia(RR:0.47,95%CI:0.22 to 0.99,P=0.05)events,besides,the incidence of other severe adverse events is rare.Conclusion:Once weekly GLP-1analogue have an effective control for blood glucose,with weight loss and low hypoglycemia risk.Further prospective clinical trials are expected to fully evaluate the long-term effectiveness and safety of these therapies within the type 2 diabetes mellitus treatment paradigm.