Network Meta-analysis of the Therapeutic Effects of Hypoglycemic Drugs and Intensive Lifestyle Modification on Impaired Glucose Tolerance
In the Guidelines for the Prevention and Control of Type 2 Diabetes in China (2017 edition), intensive lifestyle interventions are recommended for preventing the progression of impaired glucose tolerance (IGT) to type 2 diabetes mellitus. Acarbose and metformin can also be considered if intensive li...
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| Veröffentlicht in: | Clinical therapeutics 2021-09, Vol.43 (9), p.1524-1556 |
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| description | In the Guidelines for the Prevention and Control of Type 2 Diabetes in China (2017 edition), intensive lifestyle interventions are recommended for preventing the progression of impaired glucose tolerance (IGT) to type 2 diabetes mellitus. Acarbose and metformin can also be considered if intensive lifestyle modification has been ineffective for 6 months. But the effects of intensive lifestyle modification and glucose-lowering drug interventions that work best in the population with IGT are unclear. This network meta-analysis assessed the effectiveness of intensive lifestyle modification, acarbose, and metformin in treating populations with IGT.
We systematically searched both Chinese- and English-language databases, including China Knowledge, the Cochrane Library, Embase, PubMed, VIP, and Wanfang, for articles published between database inception and September 2019. Randomized, controlled clinical trials in patients with IGT treated with acarbose, metformin, and intensive lifestyle modification were assessed for eligibility. The data from all included studies were evaluated by 2 reviewers independently in accordance with the Cochrane Handbook for Systematic Reviews of Intervention version 6.0. A network meta-analysis was performed by using R software version 3.6.1.
The data from 53 randomized controlled trials were included in the review, with a sample size of 21,208 patients. Compared with the control group, the use of acarbose, metformin, and/or intensive lifestyle modification was associated with reduced rates of progression to diabetes (relative risks [RRs] [95% credible intervals]: acarbose, 0.37 [0.29–0.47]; metformin, 0.39 [0.30–0.50]; intensive lifestyle modification, 0.61 [0.50–0.73]). The surface under the cumulative ranking (SUCRA) value of acarbose was 88.35%, supporting that acarbose was more effective in reducing the rate of progression to diabetes compared with controls. With acarbose, metformin, and intensive lifestyle modification, the rates of achieving a normal glucose level were increased by RR = 2.1, 1.7, and 1.2, respectively when compared with control group. The SUCRA value of acarbose was 99.69%, supporting the optimal effect of acarbose in achieving a normal blood glucose level.
In this meta-analysis in patients with IGT, compared with controls, acarbose and metformin were associated with decreased rates of progression to diabetes and increased rates of achieving a normal glucose level. Acarbose use was associated with an increased |
| doi_str_mv | 10.1016/j.clinthera.2021.07.014 |
| format | Article |
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We systematically searched both Chinese- and English-language databases, including China Knowledge, the Cochrane Library, Embase, PubMed, VIP, and Wanfang, for articles published between database inception and September 2019. Randomized, controlled clinical trials in patients with IGT treated with acarbose, metformin, and intensive lifestyle modification were assessed for eligibility. The data from all included studies were evaluated by 2 reviewers independently in accordance with the Cochrane Handbook for Systematic Reviews of Intervention version 6.0. A network meta-analysis was performed by using R software version 3.6.1.
The data from 53 randomized controlled trials were included in the review, with a sample size of 21,208 patients. Compared with the control group, the use of acarbose, metformin, and/or intensive lifestyle modification was associated with reduced rates of progression to diabetes (relative risks [RRs] [95% credible intervals]: acarbose, 0.37 [0.29–0.47]; metformin, 0.39 [0.30–0.50]; intensive lifestyle modification, 0.61 [0.50–0.73]). The surface under the cumulative ranking (SUCRA) value of acarbose was 88.35%, supporting that acarbose was more effective in reducing the rate of progression to diabetes compared with controls. With acarbose, metformin, and intensive lifestyle modification, the rates of achieving a normal glucose level were increased by RR = 2.1, 1.7, and 1.2, respectively when compared with control group. The SUCRA value of acarbose was 99.69%, supporting the optimal effect of acarbose in achieving a normal blood glucose level.
In this meta-analysis in patients with IGT, compared with controls, acarbose and metformin were associated with decreased rates of progression to diabetes and increased rates of achieving a normal glucose level. Acarbose use was associated with an increased rate of achieving a normal glucose level, while intensive lifestyle modification was not.</description><identifier>ISSN: 0149-2918</identifier><identifier>EISSN: 1879-114X</identifier><identifier>DOI: 10.1016/j.clinthera.2021.07.014</identifier><identifier>PMID: 34452739</identifier><language>eng</language><publisher>BRIDGEWATER: Elsevier Inc</publisher><subject>Acarbose ; Acarbose - therapeutic use ; Bias ; Body mass index ; Cardiovascular disease ; Clinical trials ; Diabetes ; Diabetes mellitus ; Diabetes mellitus (non-insulin dependent) ; Diabetes Mellitus, Type 2 - drug therapy ; Disease prevention ; Drugs ; Glucose ; Glucose Intolerance - drug therapy ; Glucose tolerance ; Handbooks ; Health risks ; Humans ; Hypoglycemia ; Hypoglycemic Agents - therapeutic use ; Hypoglycemic drugs ; impaired glucose tolerance ; intensive lifestyle modifications ; Intervention ; Life Sciences & Biomedicine ; Life Style ; Lifestyles ; Literature reviews ; Meta-analysis ; Metformin ; Metformin - therapeutic use ; Monte Carlo simulation ; Network Meta-Analysis ; Patients ; Pharmacology & Pharmacy ; Population ; Risk assessment ; Science & Technology ; Software</subject><ispartof>Clinical therapeutics, 2021-09, Vol.43 (9), p.1524-1556</ispartof><rights>2021 The Authors</rights><rights>Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.</rights><rights>2021. The Authors</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>3</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000718006700011</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c448t-346c747ccd676f8e7ad3aec1fc087a4f87f57ba61d8acff038196664ab37ac683</citedby><cites>FETCH-LOGICAL-c448t-346c747ccd676f8e7ad3aec1fc087a4f87f57ba61d8acff038196664ab37ac683</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2593865862?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,39263,46000,64390,64392,64394,72474</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34452739$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zhang, Yue</creatorcontrib><creatorcontrib>Fu, Yuyan</creatorcontrib><creatorcontrib>Mu, Yi Ming</creatorcontrib><creatorcontrib>Huang, Yushi</creatorcontrib><creatorcontrib>Xuan, Jianwei</creatorcontrib><title>Network Meta-analysis of the Therapeutic Effects of Hypoglycemic Drugs and Intensive Lifestyle Modification on Impaired Glucose Tolerance</title><title>Clinical therapeutics</title><addtitle>CLIN THER</addtitle><addtitle>Clin Ther</addtitle><description>In the Guidelines for the Prevention and Control of Type 2 Diabetes in China (2017 edition), intensive lifestyle interventions are recommended for preventing the progression of impaired glucose tolerance (IGT) to type 2 diabetes mellitus. Acarbose and metformin can also be considered if intensive lifestyle modification has been ineffective for 6 months. But the effects of intensive lifestyle modification and glucose-lowering drug interventions that work best in the population with IGT are unclear. This network meta-analysis assessed the effectiveness of intensive lifestyle modification, acarbose, and metformin in treating populations with IGT.
We systematically searched both Chinese- and English-language databases, including China Knowledge, the Cochrane Library, Embase, PubMed, VIP, and Wanfang, for articles published between database inception and September 2019. Randomized, controlled clinical trials in patients with IGT treated with acarbose, metformin, and intensive lifestyle modification were assessed for eligibility. The data from all included studies were evaluated by 2 reviewers independently in accordance with the Cochrane Handbook for Systematic Reviews of Intervention version 6.0. A network meta-analysis was performed by using R software version 3.6.1.
The data from 53 randomized controlled trials were included in the review, with a sample size of 21,208 patients. Compared with the control group, the use of acarbose, metformin, and/or intensive lifestyle modification was associated with reduced rates of progression to diabetes (relative risks [RRs] [95% credible intervals]: acarbose, 0.37 [0.29–0.47]; metformin, 0.39 [0.30–0.50]; intensive lifestyle modification, 0.61 [0.50–0.73]). The surface under the cumulative ranking (SUCRA) value of acarbose was 88.35%, supporting that acarbose was more effective in reducing the rate of progression to diabetes compared with controls. With acarbose, metformin, and intensive lifestyle modification, the rates of achieving a normal glucose level were increased by RR = 2.1, 1.7, and 1.2, respectively when compared with control group. The SUCRA value of acarbose was 99.69%, supporting the optimal effect of acarbose in achieving a normal blood glucose level.
In this meta-analysis in patients with IGT, compared with controls, acarbose and metformin were associated with decreased rates of progression to diabetes and increased rates of achieving a normal glucose level. Acarbose use was associated with an increased rate of achieving a normal glucose level, while intensive lifestyle modification was not.</description><subject>Acarbose</subject><subject>Acarbose - therapeutic use</subject><subject>Bias</subject><subject>Body mass index</subject><subject>Cardiovascular disease</subject><subject>Clinical trials</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>Diabetes Mellitus, Type 2 - drug therapy</subject><subject>Disease prevention</subject><subject>Drugs</subject><subject>Glucose</subject><subject>Glucose Intolerance - drug therapy</subject><subject>Glucose tolerance</subject><subject>Handbooks</subject><subject>Health risks</subject><subject>Humans</subject><subject>Hypoglycemia</subject><subject>Hypoglycemic Agents - therapeutic use</subject><subject>Hypoglycemic drugs</subject><subject>impaired glucose tolerance</subject><subject>intensive lifestyle modifications</subject><subject>Intervention</subject><subject>Life Sciences & Biomedicine</subject><subject>Life Style</subject><subject>Lifestyles</subject><subject>Literature reviews</subject><subject>Meta-analysis</subject><subject>Metformin</subject><subject>Metformin - therapeutic use</subject><subject>Monte Carlo simulation</subject><subject>Network Meta-Analysis</subject><subject>Patients</subject><subject>Pharmacology & Pharmacy</subject><subject>Population</subject><subject>Risk assessment</subject><subject>Science & Technology</subject><subject>Software</subject><issn>0149-2918</issn><issn>1879-114X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>HGBXW</sourceid><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqNkdFuFCEUhonR2LX6CkrijYmZEWYYYC6btbabbPWmJt4RljlU1plhBabNPIJvLdtd98IbTUggh-8_B_4foTeUlJRQ_mFbmt6N6TsEXVakoiURJaHsCVpQKdqCUvbtKVrkSltULZVn6EWMW0JI3TbVc3RWM9ZUom4X6NdnSA8-_MA3kHShR93P0UXsLc7N8e1-wA6m5Ay-tBZMery6nnf-rp8NDLn-MUx3Eeuxw6sxwRjdPeC1sxDT3AO-8Z2zzujk_IjzWg077QJ0-KqfjI95hO_zjNHAS_TM6j7Cq-N-jr5-urxdXhfrL1er5cW6MIzJVNSMG8GEMR0X3EoQuqs1GGoNkUIzK4VtxEZz2kltrCW1pC3nnOlNLbThsj5H7w59d8H_nPIz1eCigb7XI_gpqqrhnDAiJMvo27_QrZ9C9mhPtbXkjeRVpsSBMsHHGMCqXXCDDrOiRO3TUlt1Skvt01JEqJxNVr4-9p82A3Qn3Z94MiAPwANsvI3GQTbqhOU8BZWEcJFPlC5derR56acxZen7_5dm-uJAQ3b-3kFQR0WXwzJJdd798ze_AdA3zU8</recordid><startdate>202109</startdate><enddate>202109</enddate><creator>Zhang, Yue</creator><creator>Fu, Yuyan</creator><creator>Mu, Yi Ming</creator><creator>Huang, Yushi</creator><creator>Xuan, Jianwei</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>BLEPL</scope><scope>DTL</scope><scope>HGBXW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202109</creationdate><title>Network Meta-analysis of the Therapeutic Effects of Hypoglycemic Drugs and Intensive Lifestyle Modification on Impaired Glucose Tolerance</title><author>Zhang, Yue ; Fu, Yuyan ; Mu, Yi Ming ; Huang, Yushi ; Xuan, Jianwei</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c448t-346c747ccd676f8e7ad3aec1fc087a4f87f57ba61d8acff038196664ab37ac683</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Acarbose</topic><topic>Acarbose - therapeutic use</topic><topic>Bias</topic><topic>Body mass index</topic><topic>Cardiovascular disease</topic><topic>Clinical trials</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Diabetes mellitus (non-insulin dependent)</topic><topic>Diabetes Mellitus, Type 2 - drug therapy</topic><topic>Disease prevention</topic><topic>Drugs</topic><topic>Glucose</topic><topic>Glucose Intolerance - drug therapy</topic><topic>Glucose tolerance</topic><topic>Handbooks</topic><topic>Health risks</topic><topic>Humans</topic><topic>Hypoglycemia</topic><topic>Hypoglycemic Agents - therapeutic use</topic><topic>Hypoglycemic drugs</topic><topic>impaired glucose tolerance</topic><topic>intensive lifestyle modifications</topic><topic>Intervention</topic><topic>Life Sciences & Biomedicine</topic><topic>Life Style</topic><topic>Lifestyles</topic><topic>Literature reviews</topic><topic>Meta-analysis</topic><topic>Metformin</topic><topic>Metformin - therapeutic use</topic><topic>Monte Carlo simulation</topic><topic>Network Meta-Analysis</topic><topic>Patients</topic><topic>Pharmacology & Pharmacy</topic><topic>Population</topic><topic>Risk assessment</topic><topic>Science & Technology</topic><topic>Software</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zhang, Yue</creatorcontrib><creatorcontrib>Fu, Yuyan</creatorcontrib><creatorcontrib>Mu, Yi Ming</creatorcontrib><creatorcontrib>Huang, Yushi</creatorcontrib><creatorcontrib>Xuan, Jianwei</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Web of Science - 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Academic</collection><jtitle>Clinical therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zhang, Yue</au><au>Fu, Yuyan</au><au>Mu, Yi Ming</au><au>Huang, Yushi</au><au>Xuan, Jianwei</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Network Meta-analysis of the Therapeutic Effects of Hypoglycemic Drugs and Intensive Lifestyle Modification on Impaired Glucose Tolerance</atitle><jtitle>Clinical therapeutics</jtitle><stitle>CLIN THER</stitle><addtitle>Clin Ther</addtitle><date>2021-09</date><risdate>2021</risdate><volume>43</volume><issue>9</issue><spage>1524</spage><epage>1556</epage><pages>1524-1556</pages><issn>0149-2918</issn><eissn>1879-114X</eissn><abstract>In the Guidelines for the Prevention and Control of Type 2 Diabetes in China (2017 edition), intensive lifestyle interventions are recommended for preventing the progression of impaired glucose tolerance (IGT) to type 2 diabetes mellitus. Acarbose and metformin can also be considered if intensive lifestyle modification has been ineffective for 6 months. But the effects of intensive lifestyle modification and glucose-lowering drug interventions that work best in the population with IGT are unclear. This network meta-analysis assessed the effectiveness of intensive lifestyle modification, acarbose, and metformin in treating populations with IGT.
We systematically searched both Chinese- and English-language databases, including China Knowledge, the Cochrane Library, Embase, PubMed, VIP, and Wanfang, for articles published between database inception and September 2019. Randomized, controlled clinical trials in patients with IGT treated with acarbose, metformin, and intensive lifestyle modification were assessed for eligibility. The data from all included studies were evaluated by 2 reviewers independently in accordance with the Cochrane Handbook for Systematic Reviews of Intervention version 6.0. A network meta-analysis was performed by using R software version 3.6.1.
The data from 53 randomized controlled trials were included in the review, with a sample size of 21,208 patients. Compared with the control group, the use of acarbose, metformin, and/or intensive lifestyle modification was associated with reduced rates of progression to diabetes (relative risks [RRs] [95% credible intervals]: acarbose, 0.37 [0.29–0.47]; metformin, 0.39 [0.30–0.50]; intensive lifestyle modification, 0.61 [0.50–0.73]). The surface under the cumulative ranking (SUCRA) value of acarbose was 88.35%, supporting that acarbose was more effective in reducing the rate of progression to diabetes compared with controls. With acarbose, metformin, and intensive lifestyle modification, the rates of achieving a normal glucose level were increased by RR = 2.1, 1.7, and 1.2, respectively when compared with control group. The SUCRA value of acarbose was 99.69%, supporting the optimal effect of acarbose in achieving a normal blood glucose level.
In this meta-analysis in patients with IGT, compared with controls, acarbose and metformin were associated with decreased rates of progression to diabetes and increased rates of achieving a normal glucose level. Acarbose use was associated with an increased rate of achieving a normal glucose level, while intensive lifestyle modification was not.</abstract><cop>BRIDGEWATER</cop><pub>Elsevier Inc</pub><pmid>34452739</pmid><doi>10.1016/j.clinthera.2021.07.014</doi><tpages>33</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Acarbose Acarbose - therapeutic use Bias Body mass index Cardiovascular disease Clinical trials Diabetes Diabetes mellitus Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 2 - drug therapy Disease prevention Drugs Glucose Glucose Intolerance - drug therapy Glucose tolerance Handbooks Health risks Humans Hypoglycemia Hypoglycemic Agents - therapeutic use Hypoglycemic drugs impaired glucose tolerance intensive lifestyle modifications Intervention Life Sciences & Biomedicine Life Style Lifestyles Literature reviews Meta-analysis Metformin Metformin - therapeutic use Monte Carlo simulation Network Meta-Analysis Patients Pharmacology & Pharmacy Population Risk assessment Science & Technology Software |
| title | Network Meta-analysis of the Therapeutic Effects of Hypoglycemic Drugs and Intensive Lifestyle Modification on Impaired Glucose Tolerance |
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