| Objective:To systematically evaluate the efficacy and safety of semaglutide(glucagon-like peptide 1 receptor agonists,GLP-1RA)in the treatment of type 2diabetes mellitus(T2DM)and to assess its long-term efficacy with Markov model.Methods:The randomized controlled trials(RCT)of semaglutide treatment in patients with Type 2 diabetes mellitus were searched from Pubmed,Embase,The Cochrane Library,The Clinical Trials.gov Website and Chinese national knowledge infrastructure,Wanfang Medical Network,VIP database,manual search related magazines and retrospective references,evaluation of literature quality,extraction of basic literature information and data.Revman 5.3 software was used to analyze efficacy and safety indicators,and the Markov model was established to evaluate long-term efficacy by Tree Age Pro 2011 software.Results:9 RCTs including 5 556 subjects met the inclusion criteria.For efficacy:Meta-analysis showed that semaglutide significantly reduced the subject’s main efficacy index glycated hemoglobin(Hb A1c)[MD=-1.08,95%CI(-1.34,-0.83),P<0.000 01] compared with the control group,significantly increased the Hb A1 c compliance rate(Hb A1c<7.0%)[OR = 6.18,95% CI(3.63,10.5),P<0.00001],significantly reduced fasting plasma glucose[MD=-1.36,95%CI(-1.87,-0.86),P<0.000 01],significantly reduced post-meal plasma glucose [MD=-1.18,95% CI(-1.62,-0.74),P<0.000 01],significantly reduced Secondary efficacy index body weight[MD=-4.36,95%CI(-5.36,-3.66),P<0.000 01],significantly increased weight loss compliance rate(weight loss>5%)[OR=9.13,95%CI(5.74,14.51),P<0.00001];Significantly reduced systolic blood pressure[MD=-2.94,95%CI(-3.86,-2.20),P<0.00001],but did not affect diastolic blood pressure[MD=-0.45,95%CI(-1.05,-0.15),P=0.15].For safety,Compared with the control group,the sumaglutide significantly increased the incidence of adverse reactions of gastrointestinal disorders [OR=2.41,95%CI(1.42,4.09),P<0.00001],the incidence of serious adverse reactions [OR=0.97,95%CI(0.83,1.14),P=0.75],incidence of hypoglycemia[OR=0.91,95%CI(0.74,1.12),P=0.09],incidence of pancreatitis and cholelithiasis [OR=1.59,95%CI(0.92,2.76,P=0.10],incidence of diabetic retinopathy[OR=1.47,95%CI(0.99,2.17),P=0.06],tumor incidence [OR=1.18,95%CI(0.96,1.45),P=0.12],no significant difference.The results of the Markov model showed that,semaglutide reduced the mortality of patients with T2 DM from 6.6% to 4% in the natural state,and reduced the complication rate from 22.7% to 9.7% after 10 years of treatment.Conclusion:Semaglutide was associated with better glycaemic control and better reductions in bodyweight than control group,and reduce cardiovascular risk factors in patients with type 2 diabetes,while not increasing the risk of hypoglycemia.The main adverse reaction is gastrointestinal disorders,but well tolerated,long-term use can effectively reduce the incidence of diabetes complications and mortality. |
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