Transcript PowerPoint - 埼玉医科大学総合医療センター 内分泌・糖尿病内科

Journal Club
Aune D, Keum N, Giovannucci E, Fadnes LT, Boffetta P, Greenwood DC,
Tonstad S7, Vatten LJ, Riboli E, Norat T.
Whole grain consumption and risk of cardiovascular disease, cancer, and all
cause and cause specific mortality: systematic review and dose-response metaanalysis of prospective studies.
BMJ. 2016 Jun 14;353:i2716. doi: 10.1136/bmj.i2716.
Nauck M, Rizzo M, Johnson A, Bosch-Traberg H, Madsen J, Cariou B.
Once-Daily Liraglutide Versus Lixisenatide as Add-on to Metformin in Type 2
Diabetes: A 26-Week Randomized Controlled Clinical Trial.
Diabetes Care. 2016 Jun 16. pii: dc152479. [Epub ahead of print]
2016年7月7日 8:30-8:55
８階 医局
埼玉医科大学 総合医療センター 内分泌・糖尿病内科
Department of Endocrinology and Diabetes,
Saitama Medical Center, Saitama Medical University
松田 昌文
Matsuda, Masafumi
1Department
of Public Health and General Practice, Faculty of Medicine, Norwegian University of
Science and Technology, Trondheim, Norway
2Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London,
London, UK
3Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA
4Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA
5Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital
and Harvard Medical School, Boston, MA, USA
6Centre for International Health, Department of Global Public Health and Primary Care and
Department of Clinical Dentistry, University of Bergen, Bergen, Norway
7The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
8Biostatistics Unit, Centre for Epidemiology and Biostatistics, University of Leeds, Leeds, UK
9Section of Preventive Cardiology, Department of Endocrinology, Morbid Obesity and Preventive
Medicine, Oslo University Hospital Ullevål, Oslo, Norway
BMJ. 2016 Jun 14;353:i2716. doi: 10.1136/bmj.i2716.
Objective To quantify the dose-response relation
between consumption of whole grain and specific
types of grains and the risk of cardiovascular
disease, total cancer, and all cause and cause
specific mortality.
Data sources PubMed and Embase searched up
to 3 April 2016.
Study selection Prospective studies reporting
adjusted relative risk estimates for the association
between intake of whole grains or specific types
of grains and cardiovascular disease, total cancer,
all cause or cause specific mortality.
Data synthesis Summary relative risks and 95%
confidence intervals calculated with a random
effects model.
Fig 1 | Flow chart of study selection
Fig 2 | Forest plot for
consumption of whole grains (per
90 g/day) and risk of coronary
heart disease, with graph
illustrating non-linear response
Fig 3 | Forest plot for
consumption of whole grains
(per 90 g/day) and risk of stroke,
with graph illustrating non-linear
response
Fig 4 | Forest plot for consumption of
whole grains (per 90 g/day) and risk of
cardiovascular disease, with graph
illustrating non-linear response
Fig 5 | Forest plot for
consumption of whole grains
(per 90 g/day) and risk of total
cancer, with graph illustrating
non-linear response
Fig 6 | Forest plot for consumption of
whole grains (per 90 g/day) and risk of
all cause mortality, with graph illustrating
non-linear response
Fig 7 | Forest plot for
consumption of whole grains
(per 90 g/day) and risk of
mortality from respiratory
disease, with graph
illustrating non-linear
response
Fig 8 | Forest plot for
consumption of whole grains
(per 90 g/day) and risk of
mortality from diabetes, with
graph illustrating non-linear
response
Fig 9 | Forest plot for
consumption of whole grains
(per 90 g/day) and risk of
mortality from infectious
diseases, with graph illustrating
non-linear response
Fig 10 | Forest plot for
consumption of whole grains
(per 90 g/day) and risk of
mortality from diseases of
nervous system, with graph
illustrating non-linear response
Fig 11 | Forest plot for
consumption of whole grains
(per 90 g/day) and risk of
mortality from noncardiovascular, non-cancer
causes, with graph illustrating
non-linear response
Results 45 studies (64 publications) were included. The summary relative risks
per 90 g/day increase in whole grain intake (90 g is equivalent to three
servings—for example, two slices of bread and one bowl of cereal or one and a
half pieces of pita bread made from whole grains) was 0.81 (95% confidence
interval 0.75 to 0.87; I2=9%, n=7 studies) for coronary heart disease, 0.88 (0.75
to 1.03; I2=56%, n=6) for stroke, and 0.78 (0.73 to 0.85; I2=40%, n=10) for
cardiovascular disease, with similar results when studies were stratified by
whether the outcome was incidence or mortality. The relative risks for morality
were 0.85 (0.80 to 0.91; I2=37%, n=6) for total cancer, 0.83 (0.77 to 0.90;
I2=83%, n=11) for all causes, 0.78 (0.70 to 0.87; I2=0%, n=4) for respiratory
disease, 0.49 (0.23 to 1.05; I2=85%, n=4) for diabetes, 0.74 (0.56 to 0.96;
I2=0%, n=3) for infectious diseases, 1.15 (0.66 to 2.02; I2=79%, n=2) for
diseases of the nervous system disease, and 0.78 (0.75 to 0.82; I2=0%, n=5)
for all non-cardiovascular, non-cancer causes. Reductions in risk were
observed up to an intake of 210-225 g/day (seven to seven and a half servings
per day) for most of the outcomes. Intakes of specific types of whole grains
including whole grain bread, whole grain breakfast cereals, and added bran, as
well as total bread and total breakfast cereals were also associated with
reduced risks of cardiovascular disease and/or all cause mortality, but there
was little evidence of an association with refined grains, white rice, total rice, or
total grains.
Conclusions This meta-analysis provides further
evidence that whole grain intake is associated
with a reduced risk of coronary heart disease,
cardiovascular disease, and total cancer, and
mortality from all causes, respiratory diseases,
infectious diseases, diabetes, and all noncardiovascular, non-cancer causes. These
findings support dietary guidelines that
recommend increased intake of whole grain to
reduce the risk of chronic diseases and
premature mortality.
Message
全粒穀物の摂取と疾患リスクの関連を検討した
前向き研究45件を対象に、システマティックレ
ビューと用量反応メタ解析で相対リスクを評価。
全粒穀物の摂取量が1日90g増加すると、冠動脈
疾患発症の相対リスクが0.81（95％ CI, 0.75 0.87; I2＝9％）、心血管疾患発症が0.78（同
0.73 - 0.85; 40％）低下した。全癌死0.85（同
0.80 - 0.91; 37％）、全死因死亡0.83（同0.77
- 0.90; 83％）、呼吸器疾患死0.78（同0.70 0.87; 0％）、感染症死0.74（同0.56 - 0.96;
0％）などの相対リスクも低下した。
https://www.m3.com/clinical/journal/16586
1Division of Diabetology, St. Josef Hospital, Ruhr-University Bochum,
Bochum, Germany
2Biomedical Department of Internal Medicine and Medical Specialties,
University of Palermo, Palermo, Italy
3Department of Diabetes and Endocrinology, Southmead Hospital,
Bristol, U.K.
4Novo Nordisk A/S, Søborg, Denmark
5Department of Endocrinology, l’Institut du Thorax, Nantes University
Hospital, Nantes, France
OBJECTIVE To compare the efficacy and safety
of liraglutide versus lixisenatide as add-on to
metformin in patients with type 2 diabetes not
achieving adequate glycemic control on
metformin alone.
RESEARCH DESIGN AND METHODS In this
26-week, randomized, parallel-group, open-label
trial, 404 patients were randomized 1:1 to
liraglutide 1.8 mg or lixisenatide 20 µg as add-on
to metformin. Liraglutide was administered once
daily at any time of the day. Lixisenatide was
administered once daily within 1 h prior to the
morning or evening meal.
Figure 1—Time course of HbA (A), FPG (B), body weight (C), SMPG (D), and lipase (E) from week 0 to week 26. Values
are mean estimates (6SEM). These end points were analyzed using a mixed model for repeated measurements, with
treatment and country as fixed factors and baseline value as covariate, all nested within visit. Group mean estimates
are adjusted according to the observed baseline distribution. Normal range for lipase: 16–63 units/L. ETD, estimated
1c
RESULTS At week 26, liraglutide reduced HbA1c (primary end
point) more than lixisenatide (estimated treatment difference
−0.62% [95% CI −0.8; −0.4]; P < 0.0001), with more patients
reaching HbA1c <7% (53 mmol/mol) and ≤6.5% (48 mmol/mol)
versus lixisenatide (74.2% and 54.6% for liraglutide vs. 45.5% and
26.2% for lixisenatide; P < 0.0001 for both). Liraglutide reduced
fasting plasma glucose more than lixisenatide (estimated
treatment difference −1.15 mmol/L [95% CI −1.5; −0.8]; P <
0.0001). Liraglutide provided greater reduction in mean 9-point
self-measured plasma glucose (P < 0.0001). However,
postprandial glucose increments were smaller with lixisenatide for
the meal directly after injection compared with liraglutide (P <
0.05), with no differences between treatments across all meals.
Both drugs promoted similar body weight decrease (−4.3 kg for
liraglutide, −3.7 kg for lixisenatide; P = 0.23). The most common
adverse events in both groups were gastrointestinal disorders.
Greater increases in pulse, lipase, and amylase were observed
with liraglutide. Hypoglycemic episodes were rare and similar
between the two treatments.
CONCLUSIONS At the dose levels studied,
liraglutide was more effective than lixisenatide as
add-on to metformin in improving glycemic control.
Body weight reductions were similar. Both
treatments were well tolerated, with low risk of
hypoglycemia and similar gastrointestinal adverse
event profiles.
Message
Lixisenatideのプロモーションは可能なの
か？？？
日本ではLiraglutideは0.9mgまでなので、１日
１回使用ではLixisenatideがよい可能性はある
が？？？
週１回製剤の存在もある。