Comparison of cardiovascular and metabolic outcomes in people with type 2 diabetes on insulin versus non-insulin glucose-lowering therapies (GLTs): A systematic review and meta-analysis of clinical trials

作者：Anyanwagu U; Mamza J; Donnelly R; Idris I^*

来源：Diabetes Research and Clinical Practice, 2016, 121: 69-85.

DOI：10.1016/j.diabres.2016.09.002

• Insulin
• Non-insulin
• Metabolic
• Cardiovascular
• Meta-analysis

Objectives: To compare the cardiovascular and metabolic outcomes of Insulin versus non-insulin glucose lowering therapy (GLT).
Methods: We included randomised control trials (RCTs) which randomised patients aged >18 years with Type 2 Diabetes (T2D) to insulin vs non-insulin GLT. We used risk ratios (RR), risk difference (RD) and odds ratios (OR) with 95% confidence interval (95%CI) to analyse the treatment effects of dichotomous outcomes and mean differences (with 95% CI) for continuous outcomes.
Results: We included 18 RCTs with 19,300 participants. There was no significant difference in the risk of all-cause mortality and CV events between the groups (RR = 1.01; 95%CI: 0.96-1.06; p = 0.69). In 16 trials, insulin showed greater efficacy in glycaemic control (mean diff = -0.20; 95% CI: -0.28 to -0.11) but the proportion achieving HbA1c level of either <= 7.0% or 7.4% (53 or 57 mmol/mol) was similar in both (OR = 1.55; 95% CI = 0.92-2.62). The non-insulin group had a significant reduction in weight (mean diff = -3.41; 95% CI: -4.50 to -2.32) and an increase in the proportion of adverse events (54.7% vs 45.3%, p = 0.044), but the insulin group showed an (RR = 1.90; 95% CI: 1.44-2.51) increased risk of hypoglycaemia.
Conclusion: There was no difference in the risk of all-cause mortality and adverse cardiovascular (CV) events between Insulin and non-insulin GLTs. Insulin was associated with superior reduction in HbA1c; least reduction in weight and higher risk of hypoglycaemia. Both showed similar proportion of patients achieving HbA1c target. Non-insulin GLTs were associated with a higher risk in reported adverse drug events.

• 出版日期2016-11