降糖药价值的综合评价讲解.ppt

Summary Background Whether intensive control of glucose reduces macrovascular events and all-cause mortality in individuals with type 2 diabetes mellitus is unclear. We undertook a meta-analysis of randomised controlled trials to determine whether intensive treatment is benefi cial. Methods We selected fi ve prospective randomised controlled trials of 33 040 participants to assess the eff ect of an intensive glucose-lowering regimen on death and cardiovascular outcomes compared with a standard regimen. We gathered information about events of non-fatal myocardial infarction, coronary heart disease (fatal and non-fatal myocardial infarction), stroke, and all-cause mortality, and did a random-eff ects meta-analysis to obtain summary eff ect estimates for the clinical outcomes with use of odds ratios calculated from the raw data of every trial. Statistical heterogeneity across trials was assessed with the χ2 and I2 statistics. Findings The fi ve trials provided information on 1497 events of non-fatal myocardial infarction, 2318 of coronary heart disease, 1127 of stroke, and 2892 of all-cause mortality during about 163 000 person-years of follow-up. The mean haemoglobin A1c concentration (HbA1c) was 0·9% lower for participants given intensive treatment than for those given standard treatment. Intensive glycaemic control resulted in a 17% reduction in events of non-fatal myocardial infarction (odds ratio 0·83, 95% CI 0·75–0·93), and a 15% reduction in events of coronary heart disease (0·85, 0·77–0·93). Intensive glycaemic control had no signifi cant eff ect on events of stroke (0·93, 0·81–1·06) or all-cause mortality (1·02, 0·87–1·19). Interpretation Overall, intensive compared with standard glycaemic control signifi cantly reduces coronary events without an increased risk of death. However, the optimum mechanism, speed, and extent of HbA1c reduction might be diff erent in diff ering populations. * 2007年5月21日，《新英格兰医学杂志》发表了一篇对42项随访时间至少24周的罗格列酮随机对照临床研究的荟萃分析。 分析结果显示，罗格列酮增加2