BACKGROUND Sodium-glucose cotransporter 2(SGLT2)inhibitors are widely used for the tr-eatment of type 2 diabetes(T2D).AIM To evaluate the influence of SGLT2 inhibitors on homeostasis model assessment of insulin resist...BACKGROUND Sodium-glucose cotransporter 2(SGLT2)inhibitors are widely used for the tr-eatment of type 2 diabetes(T2D).AIM To evaluate the influence of SGLT2 inhibitors on homeostasis model assessment of insulin resistance(HOMA-IR)andβ-cell function(HOMA-β)in patients with T2D in a meta-analysis.METHODS Randomized controlled trials(RCTs)comparing SGLT2 inhibitors to placebo in T2D patients,with a minimum treatment duration of 12 weeks,were searched using the PubMed,EMBASE,and Cochrane Library databases.Risk of bias was assessed using the Cochrane Risk of Bias Tool,and the certainty of evidence was evaluated using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)system.Changes in HOMA-IR and HOMA-βwere the outcomes analyzed.Meta-analyses were performed using a random-effects model by incorporating the potential influences of heterogeneity.RESULTS Of 1388 articles identified,24 RCTs met the inclusion criteria.23 of the included studies were double-blind RCTs with low risk of bias.Pooled results including 2272 patients showed that SGLT2 inhibitors significantly reduced HOMA-IR compared to placebo[mean difference(MD)=-0.81,95%confidence interval(CI):-1.11 to-0.52,P<0.001;I2=82%],indicating reduced insulin resistance.Addi-tionally,meta-analysis with 2845 patients suggested that SGLT2 inhibitors significantly increased HOMA-β(MD=7.90,95%CI:5.44-10.37,P<0.001;I2=74%)compared to placebo in patients with T2D,indicating improvedβ-cell function.Based on GRADE assessment,the certainty of evidence was rated moderate for both outcomes due to heterogeneity.Subgroup analyses showed that HOMA-βincreased more substantially in non-Asian studies than in Asian studies(P for subgroup difference<0.01).Subgroup analyses according to the individual medications of SGLT2 inhibitors all showed significant improvement of HOMA-IR and HOMA-β(P all<0.05).No significant publication bias was detected(P for Egger’s test all>0.05).CONCLUSION SGLT2 inhibitors are associated with improvements in insulin resistance andβ-cell function in patients with T2D,although the certainty of evidence is moderate due to heterogeneity.展开更多
BACKGROUND Although epidemiological data on non-alcoholic fatty liver disease in China are available,data on cardiometabolic risk factors have not been addressed under the metabolic dysfunction-associated steatotic li...BACKGROUND Although epidemiological data on non-alcoholic fatty liver disease in China are available,data on cardiometabolic risk factors have not been addressed under the metabolic dysfunction-associated steatotic liver disease(MASLD)consensus.AIM To synthesize the epidemiological characteristics of MASLD/metabolic dysfunction-associated steatohepatitis(MASH),especially their associated cardiometabolic risk factors in China.METHODS We searched EMBASE,MEDLINE,Central Cochrane,CNKI,and Wangfan for studies from January 1,2013 to December 31,2023.Studies involving individuals with MASLD/MASH in China that reported epidemiological outcomes were included.Meta-analysis was performed to assess the prevalence of MASLD/MASH.Exploratory outcomes included extrahepatic comorbidities and genetic variants related to MASLD.RESULTS In total,561 studies involving 6632718 participants were included in this analysis.The prevalence of MASLD and MASH and the annual incidence of MASLD were 30.4%[95%confidence interval(CI):29.4-31.3],6.7%(95%CI:2.2-13.4),and 37 cases per 1000 person-years(95%CI:28-47),respectively.In addition,the prevalence rates of MASLD in individuals with dyslipidemia,obesity,and hypertension were 59.9%(95%CI:52.6-67.0),53.9%(95%CI:47.9-59.9),and 44.3%(95%CI:41.1-47.6),respectively.The prevalence of lean MASLD(body mass index<24 kg/m2)was 12.0%(95%CI:10.0-14.0),and 21.7%of the total MASLD population in China had lean MASLD.CONCLUSION This study provides a comprehensive overview of the epidemiology and disease burden of MASLD/MASH in China,providing additional evidence for optimizing MASLD/MASH management in China and a reference for the global understanding of MASLD/MASH epidemiology.展开更多
文摘BACKGROUND Sodium-glucose cotransporter 2(SGLT2)inhibitors are widely used for the tr-eatment of type 2 diabetes(T2D).AIM To evaluate the influence of SGLT2 inhibitors on homeostasis model assessment of insulin resistance(HOMA-IR)andβ-cell function(HOMA-β)in patients with T2D in a meta-analysis.METHODS Randomized controlled trials(RCTs)comparing SGLT2 inhibitors to placebo in T2D patients,with a minimum treatment duration of 12 weeks,were searched using the PubMed,EMBASE,and Cochrane Library databases.Risk of bias was assessed using the Cochrane Risk of Bias Tool,and the certainty of evidence was evaluated using the Grading of Recommendations,Assessment,Development and Evaluation(GRADE)system.Changes in HOMA-IR and HOMA-βwere the outcomes analyzed.Meta-analyses were performed using a random-effects model by incorporating the potential influences of heterogeneity.RESULTS Of 1388 articles identified,24 RCTs met the inclusion criteria.23 of the included studies were double-blind RCTs with low risk of bias.Pooled results including 2272 patients showed that SGLT2 inhibitors significantly reduced HOMA-IR compared to placebo[mean difference(MD)=-0.81,95%confidence interval(CI):-1.11 to-0.52,P<0.001;I2=82%],indicating reduced insulin resistance.Addi-tionally,meta-analysis with 2845 patients suggested that SGLT2 inhibitors significantly increased HOMA-β(MD=7.90,95%CI:5.44-10.37,P<0.001;I2=74%)compared to placebo in patients with T2D,indicating improvedβ-cell function.Based on GRADE assessment,the certainty of evidence was rated moderate for both outcomes due to heterogeneity.Subgroup analyses showed that HOMA-βincreased more substantially in non-Asian studies than in Asian studies(P for subgroup difference<0.01).Subgroup analyses according to the individual medications of SGLT2 inhibitors all showed significant improvement of HOMA-IR and HOMA-β(P all<0.05).No significant publication bias was detected(P for Egger’s test all>0.05).CONCLUSION SGLT2 inhibitors are associated with improvements in insulin resistance andβ-cell function in patients with T2D,although the certainty of evidence is moderate due to heterogeneity.
文摘BACKGROUND Although epidemiological data on non-alcoholic fatty liver disease in China are available,data on cardiometabolic risk factors have not been addressed under the metabolic dysfunction-associated steatotic liver disease(MASLD)consensus.AIM To synthesize the epidemiological characteristics of MASLD/metabolic dysfunction-associated steatohepatitis(MASH),especially their associated cardiometabolic risk factors in China.METHODS We searched EMBASE,MEDLINE,Central Cochrane,CNKI,and Wangfan for studies from January 1,2013 to December 31,2023.Studies involving individuals with MASLD/MASH in China that reported epidemiological outcomes were included.Meta-analysis was performed to assess the prevalence of MASLD/MASH.Exploratory outcomes included extrahepatic comorbidities and genetic variants related to MASLD.RESULTS In total,561 studies involving 6632718 participants were included in this analysis.The prevalence of MASLD and MASH and the annual incidence of MASLD were 30.4%[95%confidence interval(CI):29.4-31.3],6.7%(95%CI:2.2-13.4),and 37 cases per 1000 person-years(95%CI:28-47),respectively.In addition,the prevalence rates of MASLD in individuals with dyslipidemia,obesity,and hypertension were 59.9%(95%CI:52.6-67.0),53.9%(95%CI:47.9-59.9),and 44.3%(95%CI:41.1-47.6),respectively.The prevalence of lean MASLD(body mass index<24 kg/m2)was 12.0%(95%CI:10.0-14.0),and 21.7%of the total MASLD population in China had lean MASLD.CONCLUSION This study provides a comprehensive overview of the epidemiology and disease burden of MASLD/MASH in China,providing additional evidence for optimizing MASLD/MASH management in China and a reference for the global understanding of MASLD/MASH epidemiology.
