钠-葡萄糖协同转运蛋白2抑制剂与胰高血糖素样肽1受体激动剂在老年2型糖尿病患者中的疗效和安全性比较：一项荟萃分析。

Comparative effectiveness and safety of sodium-glucose cotransporter 2 inhibitors vs glucagon-like peptide 1 receptor agonists in elderly patients with type 2 diabetes mellitus: a meta-analysis.

作者信息

Wang Yao, Wu Haoming, Yang Jingxian, Ma Jun, Li Hongling, He Xinyu, Xiao Yibo, Pan Yan

机构信息

Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu University, Chengdu, Sichuan, China.

College of Pharmacy, Chengdu University, Chengdu, Sichuan, China.

出版信息

Front Endocrinol (Lausanne). 2025 Aug 26;16:1486655. doi: 10.3389/fendo.2025.1486655. eCollection 2025.

OBJECTIVE

This systematic review aimed to evaluate the cardiovascular effectiveness and safety of initiating sodium-glucose cotransporter 2 inhibitors (SGLT2i) in comparison to glucagon-like peptide 1 receptor agonists (GLP-1RA) among elderly patients with diabetes.

METHODS

A comprehensive search of the PubMed, Embase, and Web of Science databases was conducted up to March 2024. The summary standard mean differences and odds ratios were calculated.

RESULTS

Twelve studies of eleven articles were included in the analysis. Older patients receiving SGLT2i had a greater incidence of euglycemic ketoacidosis (EKA) (OR 1.622, 95% CI 1.276-2.062, p = 0.000) and genitourinary infection (GUI) (OR 3.59, 95% CI 3.31-3.89, p = 0.00) than did those receiving GLP-1RA, and the opposite was true for acute kidney injury (AKI) (OR 0.902, 95% CI 0.854 - 0.952, p = 0.00). However, no significant differences were detected for major adverse cardiovascular events (MACE) (OR 1.04, 95% CI 0.95-1.13, p = 0.386), hospitalization for heart failure (HHF) (OR 0.98 95% CI 0.83-1.16, p = 0.825), myocardial infarction (MI) (OR 1.09, 95% CI 0.94-1.26, p = 0.265), stroke (OR 1.22, 95% CI 1.02-1.45, p = 0.028), total adverse events (AEs), (OR 0.98, 95% CI 0.83-1.16, p = 0.825), serious AEs (OR 1.02, 95% CI 0.94 -1.11, p = 0.594), fractures (OR 1.07, 95% CI 0.92-1.24, p = 0.394) or hypoglycemia (OR 0.95, 95% CI 0.88-1.02, p = 0.141).

CONCLUSION

In conclusion, although SGLT2i increase the risk of EKA and GUI and GLP-1RA decrease the risk of AKI, SGLT2i are at comparable risk of MACE, HHF, MI, stroke, hypoglycemia, and fracture to GLP-1RA.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024518348.

目的

本系统评价旨在评估在老年糖尿病患者中，与胰高血糖素样肽1受体激动剂（GLP-1RA）相比，起始使用钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）的心血管有效性和安全性。

方法

截至2024年3月，对PubMed、Embase和Web of Science数据库进行了全面检索。计算汇总标准平均差和比值比。

结果

纳入分析的11篇文章中有12项研究。与接受GLP-1RA的患者相比，接受SGLT2i的老年患者发生正常血糖性酮症酸中毒（EKA）（比值比1.622，95%置信区间1.276 - 2.062，p = 0.000）和泌尿生殖系统感染（GUI）（比值比3.59，95%置信区间3.31 - 3.89，p = 0.00）的发生率更高，而急性肾损伤（AKI）的情况则相反（比值比0.902，95%置信区间0.854 - 0.952，p = 0.00）。然而，在主要不良心血管事件（MACE）（比值比1.04，95%置信区间0.95 - 1.13，p = 0.386）、因心力衰竭住院（HHF）（比值比0.98，95%置信区间0.83 - 1.16，p = 0.825）、心肌梗死（MI）（比值比1.09，95%置信区间0.94 - 1.26，p = 0.265）、中风（比值比1.22，95%置信区间1.02 - 1.45，p = 0.028）、总不良事件（AE）（比值比0.98，95%置信区间0.83 - 1.16，p = 0.825）、严重不良事件（比值比1.02，95%置信区间0.94 - 1.11，p = 0.594）、骨折（比值比1.07，95%置信区间0.92 - 1.24，p = 0.394）或低血糖（比值比0.95，95%置信区间0.88 - 1.02，p = 0.141）方面未检测到显著差异。