Benefits and harms of drug treatment for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials

作者：Qingyang Shi, Kailei Nong, Per Olav Vandvik, Gordon Henry Guyatt, Oliver Schnell, Lars Rydén, Nikolaus Marx, Frank Chip Brosius, Reem A. Mustafa, Arnav Agarwal, Xinyu Zou, Yunhe Mao, Aminreza Asadollahifar, Saifur Rahman Chowdhury, Chunjuan Zhai, Sana Gupta, Ya Gao, João Pedro Lima, Kenji Numata, Zhi Qiao, Qinlin Fan, Qinbo Yang, Yinghui Jin, Long Ge, Qiuyu Yang, Hongfei Zhu, Fan Yang, Zhe Chen, Xi Lü, Siyu He, Xiangyang Chen, Xiafei Lyu, Xingxing An, Yaolong Chen, Qiukui Hao, Eberhard Standl, Reed Alexander Cunningham Siemieniuk, Thomas Agoritsas, Haoming Tian, Sheyu Li · 发表于：BMJ · 年份：2023 · DOI：10.1136/bmj-2022-074068 · 被引用次数：290 · 研究领域：Diabetes Treatment and Management、Hormonal Regulation and Hypertension、Hyperglycemia and glycemic control in critically ill and hospitalized patients

OBJECTIVE: To compare the benefits and harms of drug treatments for adults with type 2 diabetes, adding non-steroidal mineralocorticoid receptor antagonists (including finerenone) and tirzepatide (a dual glucose dependent insulinotropic polypeptide (GIP)/glucagon-like peptide-1 (GLP-1) receptor agonist) to previously existing treatment options. DESIGN: Systematic review and network meta-analysis. DATA SOURCES: Ovid Medline, Embase, and Cochrane Central up to 14 October 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Eligible randomised controlled trials compared drugs of interest in adults with type 2 diabetes. Eligible trials had a follow-up of 24 weeks or longer. Trials systematically comparing combinations of more than one drug treatment class with no drug, subgroup analyses of randomised controlled trials, and non-English language studies were deemed ineligible. Certainty of evidence was assessed following the GRADE (grading of recommendations, assessment, development and evaluation) approach. RESULTS: The analysis identified 816 trials with 471 038 patients, together evaluating 13 different drug classes; all subsequent estimates refer to the comparison with standard treatments. Sodium glucose cotransporter-2 (SGLT-2) inhibitors (odds ratio 0.88, 95% confidence interval 0.83 to 0.94; high certainty) and GLP-1 receptor agonists (0.88, 0.82 to 0.93; high certainty) reduce all cause death; non-steroidal mineralocorticoid receptor antagonists, so far tested only with finere...