Meta Analysis Of Gliclazide And Glipizide In Treatment Of Type 2 Diabetes

Objective: Using the meta analysis and the cost effectiveness analysis to evaluate the efficacy and safety of gliclazide and glipizide in treatment of type 2 diabetes can provide economical and rational evidence for clinical.Methods: Retrieve randomized controlled trials of glipizide and gliclazide in treatment of type 2 diabetes from Wanfang Data knowledge service platform, VIP journals integrated service platform,the Chinese Medical Association journals database and Medline which were published from inception to December 2014.Two reviewers screened the literature according to the inclusion criteria, the Review Manager 5 software was applied to meta analysis the studies were included, and analysis the heterogeneity of combined calculation, sensitivity and publication bias, and use a random effects model according to the need to calculate.Results: A total of 11 studies were included, the grade of studies’ quality are C. The results of meta analysis which used Review Manager 5 software: ①The difference of the total effective rate between gliclazide and glipizide in treatment of type 2 diabetes was not statistically significant [P > 0.05, OR combined =1.41, 95%CI=(0.72, 2.75)]; The comparison results of sensitivity analysis that used the M-H method, fixed effect model and random effect model and fixed effect model of Peto method showed small changes, the sensitivity is low, the stability of results is high; The funnel plot of the publication bias analysis showed that the left and the right were essential symmetrical, can think of the publication bias possibility is little.②The difference of the marked improvement rate between gliclazide and glipizide in treatment of type 2 diabetes was not statistically significant [P > 0.05, OR combined =1.01,95%CI=(0.59,1.72)]; The comparison results of sensitivity analysis that used the M-H method, fixed effect model and random effect model and fixed effect model of Peto method showed small changes, the sensitivity is low, the stability of results is high; The funnel plot of the publication bias analysis showed that the left and the right were essential symmetrical, can think of the publication bias possibility is little.③The difference of the incidence of adverse reaction between gliclazide and glipizide in treatment of type 2 diabetes was not statistically significant [P > 0.05, OR combined =1.27,95%CI=(0.62,2.59)]; The comparison results of sensitivity analysis that used the M-H method, fixed effect model and random effect model and fixed effect model of Peto method showed large changes, the sensitivity is high, the stability of results is low, Still can’t think that the incidence rate of adverse reaction between two drugs was not statistically significant; The funnel plot of the publication bias analysis showed that the left and the right were essential symmetrical, can think of the publication bias possibility is little.④The difference of the average decrease of fasting plasma glucose(FPG) between gliclazide and glipizide in treatment of type 2 diabetes was not statistically significant[P>0.05,OR combined =-0.34,95%CI=(-0.87,0.20)].⑤The difference of the therapeutic outcome of fasting plasma glucose(FPG) between gliclazide and glipizide in treatment of type 2 diabetes was statistically significant[P<0.05,OR combined =0.33,95%CI=(0.13,0.52)], the fasting plasma glucose level after treatment of glipizide was lower than that of gliclazide, curative effect of glipizide was better than that of gliclazide.⑥The difference of the therapeutic outcome of 2 hour postprandial glucose(2h PG) between gliclazide and glipizide in treatment of type 2 diabetes was not statistically significant[P>0.05,OR combined =0.04,95%CI=(-0.24,0.32)].⑦The difference of the therapeutic outcome of glycosylated hemoglobin A1c(Hb A1c) between gliclazide and glipizide in treatment of type 2 diabetes was not statistically significant[P<0.05,OR combined =0.25,95%CI=(0.05,0.45)], the Hb A1 c level after treatment of glipizide was lower than that of gliclazide, curative effect of glipizide was better than that of gliclazide.⑧The curative effect and the cost of treatment of gliclazide and glipizide in treatment of type 2 diabetes were compared, results showed that glipizide was better than gliclazide about the therapeutic outcome of fasting plasma glucose and glycosylated hemoglobin A1 c, other aspects of curative effect are similar, but glipizide had lower cost in the treatment.Conclusion: the results of meta analysis showed that the difference of the total effective rate, the marked improvement rate, the incidence of adverse reaction, the average decrease of fasting plasma glucose, 2 hour postprandial plasma glucose and so on between gliclazide and glipizide in treatment of type 2 diabetes was not statistically significant, the therapeutic outcome of fasting plasma glucose and glycosylated hemoglobin A1 c of glipizide was better than that of gliclazide, glipizide was more economic and reasonable than gliclazide in pharmacoeconomics.