| Objective:To systematically evaluate the effects of SGLT-2 inhibitors on insulin resistance in overweight and obese type 2 diabetic patients.Methods:This paper adopts the method of Meta-analysis.According to Cochrane system assessment scheme for inclusion criteria(covers the research objective and type,outcome indicators,interventions),exclusion criteria and retrieval strategy to be formulated.And a comprehensive search was conducted according to the key words such as SGLT-2 inhibitor,sodium glucose transporter 2 inhibitor,type 2 diabetes,body mass index,obesity overweight,insulin resistance.The literature search deadline is November 2019 without language limit.The computer retrieves the relevant database.According to the inclusion criteria,two system reviewers independently screened the literature,extracted data from qualifying research articles,and then cross-checked them.Review Manager 5.3 was used for meta-analysis.The intervention group consisted of those using SGLT-2 inhibitors,and all other interventions including placebo were used as the control group.The outcomes measured were: HbA1 c,FPG,body weight,islet cell function index(HOMA-β),systolic blood pressure(SBP)and diastolic blood pressure(DBP),plasma low-density lipoprotein(LDL),high-density lipoprotein(HDL),and triglyceride(TC).Results:A total of 10 RCTs were included in this meta-analysis,with a total of 2,019 subjects and 10 articles published in English.The results showed a significant decrease hemoglobin a1c(HbA1c)in the experimental group,with a combined effect size of[WMD=-0.59,(-0.78,-0.39,P<0.00001)].The FPG reduction in the experimental group was also significantly higher than that in the control group [WMD=-1.25,(-1.43,-1.07),P<0.00001].The experimental group was better than the control group in improving islet cell function as measured by HOMA-β [WMD=11.07,(7.54,14.60),P< 0.00001].Compared to the control group,weight loss was greater in the experimental group[WMD=11.07,(7.54,14.60),P<0.00001].Blood pressure indices(SBP and DBP)werealso significantly reduced in the experimental group compared to the control group,with effect sizes of [WMD=-3.71,(-4.41,-3.01),P<0.00001] and [WMD=-1.66,(-2.42,-0.91),P<0.0001] respectively.Serum triglycerides(TC)was significantly better in the experimental group [WMD=-9.43,(-18.50,-0.36),P=0.04],as was serum HDL[WMD=2.93,(1.88,3.98),P<0.00001].There was no significant difference between the experimental group and the control group in lowering LDL index,and the combined effect size was [WMD=3.5,(-2.28,9.28),P=0.23].In terms of adverse reactions,the risk of urinary tract infection in the experimental group was significantly higher that in the control group,and the combined effect size was [RR=1.55,(1.08,2.21),P=0.02].The risk of adverse hypoglycemia was not significantly different from that in the control group,and the combined effect size was [RR=1.18,(0.79,1.76),P=0.43].Conclusion:For overweight or obese patients with type 2 diabetes,the sglt-2 inhibitor group can reduce HbA1 c and FPG,improve the function of pancreatic islet cells,and have the effect of lowering blood pressure and weight,reducing TC and increasing HDL.Therefore,for overweight and obese patients with type 2 diabetes,sglt-2 inhibitors significantly improve insulin resistance,providing a more reasonable drug choice.Inadequacies sglt-2 inhibitors increased the risk of urinary tract infection,but did not increase the risk of hypoglycemic adverse reactions. |
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