不同时长运动联合二甲双胍对2型糖尿病血糖控制效果的meta分析

目的 探讨不同时长运动疗法联合二甲双胍治疗对2型糖尿病患者血糖控制的不同疗效。方法 计算机检索 PubMed、EMbase、Elsevier、CNKI、WanFang Data、Web of Science等数据库，检索相关随机对照试验（RCTs），采用RevMan 5.3 软件进行meta分析。结果 共纳入10个 RCTs，包括974例患者。meta分析结果显示，与单纯二甲双胍治疗相比，运动疗法联合二甲双胍治疗2～3个月后，空腹血糖（FBG）显著下降（SMD = - 1.61，95%CI: - 2.68～- 0.53，P = 0.003），糖化血红蛋白（HbA1c）明显降低（SMD = - 1.41，95%CI: - 1.75～- 1.07，P＜0.001），空腹胰岛素（FINS）含量降低至更接近于正常范围（SMD = - 1.14，95%CI: - 2.15～- 0.13，P = 0.03）；胰岛素抵抗指数（HOMA - IR）（SMD = - 0.75，95%CI:- 1.32～- 0.18，P = 0.010）与餐后两小时血糖（2hPBG）明显降低（SMD = - 1.42，95%CI:- 2.46～- 0.39，P = 0.007）；运动疗法联合二甲双胍治疗6个月后，FBG（SMD = - 0.74，95%CI: - 1.97～0.49，P = 0.24）及2hPBG（SMD = - 1.24，95%CI: - 2.23～- 0.26，P = 0.01）的控制效果未表现出显著差异。结论 2～3个月运动联合二甲双胍治疗在控制血糖、减低胰岛素抵抗方面比单纯二甲双胍治疗效果更为显著，而干预时长延长至6个月时，运动联合二甲双胍治疗在糖尿病患者血糖控制上的叠加效应消失。由于纳入的文章数目及质量有限，上述结论还需更多高质量研究进一步论证。

Effects of metformin with exercise training of different duration on blood glucose control in type 2 diabetes: a meta-analysis

To investigate the different efficacy of different concurrent exercise therapy combined with metformin treatment on glycemic control in patients with type 2 diabetes mellitus. Methods PubMed, Elsevier, EMbase, Web of Science, WanFang Data and CNKI databases were searched to collect relevant randomized controlled trials(RCTs). Metaanalysis was performed with the use of RevMan 5.3 software. Results In total 10 RCTs involving 974 patients were included.The results of meta-analysis showed that after 2-3 months of treatment, compared with metformin alone, fasting blood glucose(FBG)(SMD=-1.61, 95%CI:-2.68 to-0.53, P=0.003) and glycosylated hemoglobin(HbA1 c)(SMD=-1.41, 95%CI:-1.75 to-1.07, P<0.001) decreased significantly during the 2-3 months of combination therapy, and the latter therapy could reduce the content of fasting insulin(FINS) closer to the normal range than simple treatment(SMD=-1.14, 95%CI:-2.15 to-0.13,P =0.03); at the same time, there was a significantly decrease with the combined intervention that was comparable with metformin alone in insulin resistance index(HOMA-IR)(SMD=-0.75, 95%CI:-1.32 to-0.18, P=0.010) and 2 h postprandial blood glucose(2 hPBG)(SMD=-1.42, 95%CI:-2.46 to-0.39, P=0.007) during the 2-3 months of treatment. After 6 months,the control effect of combined intervention on FBG(SMD=-0.74, 95%CI:-1.97 to 0.49, P=0.24) and 2 hPBG(SMD=-1.24,95%CI:-2.23 to-0.26, P=0.01) was not significantly better than that of simple treatment. Conclusion Two to three months of exercise combined with metformin therapy is more effective than metformin alone in controlling blood glucose and reducing insulin resistance, while the superimposed effect of exercise combined with metformin therapy on glycemic control in diabetic patients disappears when the length of intervention is extended to 6 months. Due to the limited number and quality of included articles, these findings need to be further supported by more high-quality studies.