二甲双胍和罗格列酮联用治疗2型糖尿病的系统评价_《中国循证医学杂志》

作者：

张俊英 ^1,2 , 马彬 ¹ , 杨克虎 ¹ ,  程卫东 ²

1. 兰州大学循证医学中心，兰州大学基础医学院（兰州 730000）；2. 兰州大学中西医结合研究所（兰州 730000）;

关键词：

2 型糖尿病二甲双胍罗格列酮系统评价

DOI：

10.7507/1672-2531.20090082

视频：

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摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的　系统评价二甲双胍联合罗格列酮治疗2 型糖尿病（T2DM）的疗效及安全性。
方法　应用Cochrane 系统评价方法，计算机检索Cochrane 图书馆（2008 年第4 期）、PubMed（1966 ～ 2008.10）、EMbase（1974 ～ 2008.10）、CBM（1978 ～ 2008.10）、VIP（1989 ～ 2008.10）、CNKI（1994 ～ 2008.10）、万方数据库（1997 ～ 2008.10），收集以二甲双胍联合罗格列酮（RSG/MET 组）与单用二甲双胍（MET 组）比较治疗T2DM 的
随机对照试验（RCT），根据Cochrane Handbook 5.0 质量评价标准评价，用RevMan 5.0 软件进行统计学分析。
结果　共纳入11 个RCT，合计2 917 例患者。Meta 分析结果显示：RSG+MET 组较MET 组能更有效地改善糖化
血红蛋白水平［WMD= – 0.44%，95%CI（– 0.70，– 0.17），P=0.001］、空腹血糖水平［WMD= – 1.03 mmol/L，95%CI（– 1.85，– 0.75）］，提高胰岛素敏感性和β 细胞功能；在胃肠道反应发生率方面RSG+MET 组低于MET 组，但水肿发
生率高于MET 组［RR=0.82，95%CI（0.71，0.94）；RR=3.27，95%CI（1.80，5.91）］。在体重指数、至少发生一次任何不良事件的患者例数和低血糖方面两组差异无统计学意义。
结论　RSG+MET组较单用MET能更有效地控制血糖，提高胰岛索敏感性和β 细胞功能，且可以降低胃肠道反应的发生率。

引用本文： 张俊英,马彬,杨克虎,程卫东. 二甲双胍和罗格列酮联用治疗2型糖尿病的系统评价. 中国循证医学杂志, 2009, 09(4): 437-445. doi: 10.7507/1672-2531.20090082 复制

1.	World Health Organization. Types of Diabetes. Available from URL:http://www.who.int/diabetesactiononline/diabetes/basics/en/index1.html.
2.	世界卫生组织. 糖尿病. Available from URL: http://www.who.int/mediacentre/factsheets/fs312/zh/index.html.
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13.	Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care, 2000, 23(1): 57-63.
14.	Rosenstock J, Rood J, Cobitz A, et al. Initial treatment with rosiglitazone/metformin fixed-dose combination therapy compared with monotherapy with either rosiglitazone or metformin in patients with uncontrolled type 2 diabetes. Diabetes Obes Metab, 2006, 8(6): 650-660.
15.	Stewart MW, Cirkel DT, Furuseth K, et al. Effect of metformin plus roziglitazone compared with metformin alone on glycaemic control in well-controlled Type 2 diabetes. Diabet Med, 2006, 23(10): 1069-1078.
16.	Bailey CJ, Bagdonas A, Rubes J, et al. Rosiglitazone/metformin fixed-dose combination compared with uptitrated metformin alone in type 2 diabetes mellitus: a 24-week, multicenter, randomized, double-blind, parallel-group study. Clin Ther, 2005, 27(10): 1548-1561.
17.	Weissman P, Goldstein BJ, Rosenstock J, et al. Effects of rosiglitazone added to submaximal doses of metformin compared with dose escalation of metformin in type 2 diabetes: the EMPIRE Study. Curr Med Res Opin, 2005, 21(12): 2029-2035.
18.	Gómez-Perez FJ, Fanghänel-Salmón G, Antonio Barbosa J, et al. Efficacy and safety of rosiglitazone plus metformin in Mexicans withtype 2 diabetes. Diabetes Metab Res Rev, 2002, 18(2): 127-134.
19.	Fonseca V, Rosenstock J, Patwardhan R, et al. Effect of metformin and rosiglitazone combination therapy in patients with type 2 diabetes mellitus: a randomized controlled trial. JAMA, 2000, 283(13): 1695-1702.
20.	Negro R, Mangieri T, Dazzi D, et al. Rosiglitazone effects on blood pressure and metabolic parameters in nondipper diabetic patients. Diabetes Res Clin Pract, 2005, 70(1): 20-25.
21.	杜其玲, 刘承芬, 唐红英. 二甲双胍和罗格列酮治疗新诊2型糖尿病的疗效比较. 中外健康文摘?医药学刊, 2007, 4(12): 4-5.
22.	韩书宏, 胡海科, 张翼飞, 等. 罗格列酮与二甲双胍联用治疗2型糖尿病疗效观察. 四川医学, 2007, 28(1): 51-52.23 热阳古丽?沙塔尔, 阿孜古力?胡达拜地. 文迪雅联合二甲双胍治疗2型糖尿病的疗效观察. 中华临床医学研究杂志, 2007, 13(9): 1219.
23.	王淑芳, 曲晓红, 赵颖. 罗格列酮和二甲双胍治疗新发2型糖尿病的疗效比较. 中国糖尿病杂志, 2006, 14(6): 415-416.
24.	-110.

1. World Health Organization. Types of Diabetes. Available from URL:http://www.who.int/diabetesactiononline/diabetes/basics/en/index1.html.
2. 世界卫生组织. 糖尿病. Available from URL: http://www.who.int/mediacentre/factsheets/fs312/zh/index.html.
3. International Diabetes Federation (2005): Global Guidelines for type 2 diabetes. Available from URL: http://www.idf.org/webdata/docs/GGT2D%2009%20Oral%20therapy.pdf.
4. Bailey CJ, Del Prato S, Eddy D, et al. Earlier intervention in type 2 diabetes: the case for achieving early and sustained glycaemic control. Int J Clin Pract, 2005, 59(11): 1309-1316.
5. Garber AJ. Using dose-response characteristics of therapeutics agents for treatment decisions in type 2 diabetes. Diabetes Obes Metab, 2000, 2(3): 139-147.
6. Inzucchi SE, Maggs DG, Spollett GR, et al. Efficacy and metabolic effects of metformin and troglitazone in type II diabetes mellitus. N Engl J Med, 1998, 338(13): 867-872.
7. Davidson MB, Peters AL. An overview of metformin in the treatment of type 2 diabetes mellitus. Am J Med, 1997, 102(1):.
8. Diamant M, Heine RJ. Thiazolidinediones in type 2 diabetes mellitus: current clinical evidence. Drugs, 2003, 63(13): 1373-1405.
9. Stewart MW, Cirkel DT, Furuseth K, et al. Effect of metformin plus roziglitazone compared with metformin alone on glycaemic control in well-controlled Type 2 diabetes. Diabet Med, 2006, 23(10): 1069-1078.
10. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med, 1998, 15(7): 539-553.
11. American Diabetes Association. Standards of medical care in diabetes--2007. Diabetes Care, 2007, 30(Suppl 1): S4-S41.
12. Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia, 1985, 28(7): 412-419.
13. Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care, 2000, 23(1): 57-63.
14. Rosenstock J, Rood J, Cobitz A, et al. Initial treatment with rosiglitazone/metformin fixed-dose combination therapy compared with monotherapy with either rosiglitazone or metformin in patients with uncontrolled type 2 diabetes. Diabetes Obes Metab, 2006, 8(6): 650-660.
15. Stewart MW, Cirkel DT, Furuseth K, et al. Effect of metformin plus roziglitazone compared with metformin alone on glycaemic control in well-controlled Type 2 diabetes. Diabet Med, 2006, 23(10): 1069-1078.
16. Bailey CJ, Bagdonas A, Rubes J, et al. Rosiglitazone/metformin fixed-dose combination compared with uptitrated metformin alone in type 2 diabetes mellitus: a 24-week, multicenter, randomized, double-blind, parallel-group study. Clin Ther, 2005, 27(10): 1548-1561.
17. Weissman P, Goldstein BJ, Rosenstock J, et al. Effects of rosiglitazone added to submaximal doses of metformin compared with dose escalation of metformin in type 2 diabetes: the EMPIRE Study. Curr Med Res Opin, 2005, 21(12): 2029-2035.
18. Gómez-Perez FJ, Fanghänel-Salmón G, Antonio Barbosa J, et al. Efficacy and safety of rosiglitazone plus metformin in Mexicans withtype 2 diabetes. Diabetes Metab Res Rev, 2002, 18(2): 127-134.
19. Fonseca V, Rosenstock J, Patwardhan R, et al. Effect of metformin and rosiglitazone combination therapy in patients with type 2 diabetes mellitus: a randomized controlled trial. JAMA, 2000, 283(13): 1695-1702.
20. Negro R, Mangieri T, Dazzi D, et al. Rosiglitazone effects on blood pressure and metabolic parameters in nondipper diabetic patients. Diabetes Res Clin Pract, 2005, 70(1): 20-25.
21. 杜其玲, 刘承芬, 唐红英. 二甲双胍和罗格列酮治疗新诊2型糖尿病的疗效比较. 中外健康文摘?医药学刊, 2007, 4(12): 4-5.
22. 韩书宏, 胡海科, 张翼飞, 等. 罗格列酮与二甲双胍联用治疗2型糖尿病疗效观察. 四川医学, 2007, 28(1): 51-52.23 热阳古丽?沙塔尔, 阿孜古力?胡达拜地. 文迪雅联合二甲双胍治疗2型糖尿病的疗效观察. 中华临床医学研究杂志, 2007, 13(9): 1219.
23. 王淑芳, 曲晓红, 赵颖. 罗格列酮和二甲双胍治疗新发2型糖尿病的疗效比较. 中国糖尿病杂志, 2006, 14(6): 415-416.
24. -110.

《中国循证医学杂志》

二甲双胍和罗格列酮联用治疗2型糖尿病的系统评价

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《中国循证医学杂志》

二甲双胍和罗格列酮联用治疗2型糖尿病的系统评价

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