Medications for adults with type 2 diabetes: a living systematic review and network meta-analysis

作者：Kailei Nong, Britta Tendal Jeppesen, Qingyang Shi, Thomas Agoritsas, Gordon H. Guyatt, Heath White, Yiyuan Gao, Arnav Agarwal, Helen Macdonald, Xinyu Zou, Tanya Millard, Oliver Schnell, Nikolaus Marx, Frank C. Brosius, Steve McDonald, Matthew Quigley, Xin Tian, Qinlin Fan, Barbara White, Yunhe Mao, Xiaohui Pan, Changhai Liu, Chunjuan Zhai, Chi Yuan, Qiang Li, Jing An, Yu Gan, Yanyan Wang, Yinghui Jin, Feng Sun, Zhiming Zhu, Lars Rydén, Eberhard Standl, Tari Turner, Per Olav Vandvik, Sheyu Li · 发表于：BMJ · 年份：2025 · DOI：10.1136/bmj-2024-083039 · 被引用次数：39 · 研究领域：Diabetes Treatment and Management、Bariatric Surgery and Outcomes、Chronic Kidney Disease and Diabetes

OBJECTIVE: To provide up-to-date evidence on key benefits, harms, and uncertainties regarding medications for adults with type 2 diabetes. DESIGN: Living systematic review and network meta-analysis (NMA), using frequentist random effects and GRADE (grading of recommendations, assessment, development and evaluation) approaches. Updates are planned at least two times a year. DATA SOURCES: Medline and Embase, searched up to 31 July 2024 for the current iteration. STUDY SELECTION: Randomised controlled trials of at least 24 weeks comparing one or more medications with standard treatment, placebo, or each other. RESULTS: The systematic review and NMA includes 493 168 participants from 869 trials (adding 53 trials since October 2022) reporting data for 13 drug classes (63 drugs) and 26 outcomes of interest. Regarding benefits, moderate to high certainty evidence confirms the well established cardiovascular and kidney benefits of sodium-glucose cotransporter-2 (SGLT-2) inhibitors, glucagon-like peptide-1 receptor agonists (GLP-1RAs), and finerenone (the last for patients with established chronic kidney disease). The most effective drugs in reducing body weight were tirzepatide (mean difference (MD) -8.63 kg (95% confidence interval -9.34 to -7.93); moderate certainty) and orforglipron (MD -7.87 kg (-10.24 to -5.50); low certainty), followed by eight other GLP-1RAs (high to moderate certainty). Absolute benefits of medications vary substantially depending on the baseline risk of card...