单位：[1]Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China[2]Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, UK[3]National Clinical Research Center of Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China首都医科大学附属北京友谊医院[4]Department of Mathematics and Statistics, University of Maryland Baltimore County, Baltimore, MD 21250, USA[5]Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA 02215, USA[6]Primary Care Unit, School of Clinical Medicine, University of Cambridge, Cambridge, CB1 8RN, UK[7]Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing, China[8]Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada[9]Department of Endocrinology and Metabolism, People’s Hospital, Peking University, Beijing, China
As a new class of antidiabetic drug, incretin-based therapies, which include dipeptidyl peptidase-4 inhibitors (DPP-4Is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs), have raised concerns about symptoms of withdrawal in patients with type 2 diabetes mellitus (T2DM), such as dizziness and headache. To systematically evaluate whether incretin-based therapies may lead to dizziness and headache in patients with T2DM compared to other traditional antidiabetic drugs or placebo. We searched Medline, Embase, the Cochrane library, and clinicaltrials.gov from inception through June 23, 2017, to identify randomized controlled trials of the safety of DPP-4Is or GLP-1 RAs versus placebo or other antidiabetic drugs in T2DM patients. We used the network meta-analysis under the frequentist framework to compare the association between multiple antidiabetic drugs and dizziness and headache. A total of 233 clinical trials with nine treatments and 147,710 patients were included: two incretin-based therapies, one placebo, and six traditional antidiabetic drugs (metformin, insulin, sulfonylurea, thiazolidinediones, alpha-glucosidase inhibitor, and sodium-glucose co-transporter 2). Compared to insulin, thiazolidinediones, or placebo, GLP-1 RAs statistically significantly increased the risk of dizziness (odds ratios [ORs]: 1.92, 1.57, and 1.40, respectively) and headache (ORs: 1.34, 1.41, and 1.18, respectively). DPP-4Is increased the risk of headache (OR: 1.22, 95% confidence interval [CI]: 1.02 to 1.46; moderate quality) and dizziness (OR: 1.46, 95% CI: 1.05 to 2.03; moderate quality) compared to insulin. Of the incretin-based therapies, DPP-4Is had a lower risk of dizziness than GLP-1 RAs (OR: 0.76, 95% CI: 0.67 to 0.87; high quality). Ranking probability analysis indicated that GLP-1 RAs may have the greatest risk of both dizziness and headache among the nine treatments (22.5% and 23.4%, respectively), whereas DPP-4Is were in the middle (46.2% and 45.0%, respectively). Incretin-based therapies increase the risk of dizziness and headache compared to insulin, thiazolidinediones, and placebo.
基金：
National Natural Science Foundation of ChinaNational Natural Science Foundation of China (NSFC) [81302508, 71673003]
第一作者单位：[1]Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
通讯作者：
通讯机构：[*1]Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
推荐引用方式(GB/T 7714)：
Le Gao,Shuqing Yu,Andrea Cipriani,et al.Neurological Manifestation of Incretin-Based Therapies in Patients with Type 2 Diabetes: A Systematic Review and Network Meta-Analysis[J].AGING and DISEASE.2019,10(6):1311-1319.doi:10.14336/AD.2019.0303.
APA：
Le Gao,Shuqing Yu,Andrea Cipriani,Shanshan Wu,Yi Huang...&Feng Sun.(2019).Neurological Manifestation of Incretin-Based Therapies in Patients with Type 2 Diabetes: A Systematic Review and Network Meta-Analysis.AGING and DISEASE,10,(6)
MLA：
Le Gao,et al."Neurological Manifestation of Incretin-Based Therapies in Patients with Type 2 Diabetes: A Systematic Review and Network Meta-Analysis".AGING and DISEASE 10..6(2019):1311-1319
