2型糖尿病成人启动GLP-1受体激动剂、SGLT-2抑制剂、替尔泊肽和非奈利酮的价值观、偏好与治疗负担：系统评价。
完整摘要 · 中文译文
目的：总结关于成人2型糖尿病患者在考虑启动胰高血糖素样肽-1受体激动剂（GLP-1 RA）、钠-葡萄糖协同转运蛋白-2抑制剂（SGLT-2i）、非奈利酮或替尔泊肽治疗时的价值观、偏好及感知治疗负担的现有证据。 设计：系统评价。 数据来源：检索Medline、Embase、Scopus、Web of Science和Cochrane Central Register of Controlled Trials，时间范围从各数据库建库至2025年1月7日（更新此前一项捕获截至2020年5月23日文献的系统评价）。 纳入标准：纳入报告了成人2型糖尿病患者价值观、偏好或治疗负担，并将GLP-1 RA、SGLT-2i、替尔泊肽或非奈利酮的启动治疗彼此之间或与其他降糖治疗进行比较的定量或定性研究。 数据提取与综合：配对的评价员独立筛选研究、提取数据并评估偏倚风险。使用GRADE评价证据确定性。研究结果采用叙述性综合。 结果：共纳入34项研究（15 656例患者），其中17项为自2021年上次评价以来新增的研究（8360例患者）。在新纳入的研究中，10项评价了GLP-1 RA，7项评价了SGLT-2i，1项评价了替尔泊肽；没有研究评价非奈利酮（由于若干研究比较了多个药物类别，这些类别并非互斥）。在所有比较中，患者一致报告降糖疗效、心血管风险降低以及用药方案的简便性为 给药方便性作为优先考虑因素。通常偏好每日一次的口服方案和使用简便装置的每周一次注射治疗。体重下降受到重视，但通常次于血糖和心血管获益。SGLT-2i 和 GLP-1 RA 通常比二肽基肽酶 4 抑制剂（DPP-4i）、噻唑烷二酮类药物和胰岛素更受偏好，但在 SGLT-2i 与 GLP-1 RA 之间未出现一致的偏好。在一项研究中，替尔泊肽比司美格鲁肽更受青睐，主要原因是糖化血红蛋白降幅更大且低血糖风险更低。所有比较的证据确定性均为低或极低。 结论：2 型糖尿病成年人在降糖治疗中优先考虑治疗效果和便利性。当前证据不支持 SGLT-2i 与 GLP-1 RA 之间存在明确偏好，且缺乏非奈利酮的数据。这些发现强调了根据患者个体优先事项进行共同决策的重要性。 PROSPERO 注册号：CRD42023429170。
完整摘要 · 英文原文
OBJECTIVES: To summarise existing evidence regarding the values, preferences, and perceived treatment burden of adults with type 2 diabetes when considering initiation of glucagon-like peptide-1 receptor agonists (GLP-1 RA), sodium-glucose cotransporter-2 inhibitors (SGLT-2i), finerenone, or tirzepatide. DESIGN: Systematic review. DATA SOURCES: Medline, Embase, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were searched from database inception to 7 January 2025 (updating a previous systematic review that captured literature up to 23 May 2020). ELIGIBILITY CRITERIA: Quantitative or qualitative studies were included if they reported patient reported values, preferences, or treatment burden among adults with type 2 diabetes and compared initiation of GLP-1 RA, SGLT-2i, tirzepatide, or finerenone with each other or with other glucose-lowering treatments. DATA EXTRACTION AND SYNTHESIS: Paired reviewers independently screened studies, extracted data, and assessed risk of bias. Certainty of evidence was evaluated using GRADE. Findings were synthesised narratively. RESULTS: Thirty four studies (15 656 patients) were included, 17 of which were new since the previous 2021 review (8360 patients). Of the newly included studies, 10 evaluated GLP-1 RA, seven evaluated SGLT-2i, and one evaluated tirzepatide; no studies evaluated finerenone (because several studies compared multiple drug classes, these categories are not mutually exclusive). Across comparisons, patients consistently reported glycaemic efficacy, cardiovascular risk reduction, and simplicity of administration as their priorities. Oral once-daily regimens and once-weekly injectable treatments with easy-to-use devices were generally preferred. Weight loss was valued but was typically secondary to glycaemic and cardiovascular benefits. SGLT-2i and GLP-1 RA were often preferred over dipeptidyl peptidase 4-inhibitors (DPP-4i), thiazolidinediones, and insulins, but no consistent preference emerged for SGLT-2i over GLP-1 RA. Tirzepatide was favoured over semaglutide in a single study, largely due to greater haemoglobin A1c reduction and lower hypoglycaemia risk. Certainty of evidence for all comparisons was low or very low certainty. CONCLUSION: Adults with type 2 diabetes prioritise treatment effectiveness and convenience among glucose-lowering treatments. Current evidence does not support a clear preference between SGLT-2i and GLP-1 RA, and data for finerenone are absent. These findings underscore the importance of shared decision making informed by individual patient priorities. PROSPERO REGISTRATION: CRD42023429170.