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Andrology Feb 2023Type 2 diabetes mellitus and pre-diabetes are associated with reduced circulating testosterone levels. However, the role of testosterone replacement therapy in these... (Review)
Review
BACKGROUND
Type 2 diabetes mellitus and pre-diabetes are associated with reduced circulating testosterone levels. However, the role of testosterone replacement therapy in these patients is still conflicting.
OBJECTIVES
To summarize and critically analyze available data on the possible effect of testosterone administration in men with glucose abnormalities.
MATERIALS AND METHODS
A comprehensive systematic review was performed. When available, meta-analytic data were preferred. To better analyze the relationship between testosterone and the pre-diabetes condition, a systematic analysis was performed and the data obtained with the latter search were used for a meta-analytic approach. Finally, clinical data derived from a consecutive series of 4682 patients seeking medical care for sexual dysfunction at the University of Florence were also considered.
RESULTS
Patients with impaired fasting glucose were characterized by a 3 nmol/L lower level of total testosterone when compared to controls. Similarly, impaired fasting glucose was associated with a 1.8-fold increased risk of hypogonadism, when compared to subjects with normal glucose levels. Waist circumference and body mass index resulted as being the best predictors of reduced total testosterone levels. Secondary hypogonadism was two times higher in subjects with impaired fasting glucose when compared to rates observed in the general population. Testosterone replacement therapy was able to improve body composition, insulin resistance, and glucose profile both in impaired fasting glucose and type 2 diabetes mellitus whereas its role on body weight, lipid profile, and sexual function was less evident.
DISCUSSION AND CONCLUSION
Weight loss and physical activities are able to improve both metabolic profile and testosterone levels. The combined approach of testosterone replacement therapy and lifestyle modifications could be suggested in symptomatic hypogonadal men to better motivate patients to perform physical activity which can eventually result in weight loss as well as metabolic profile and sexual function improvement. Whether or not these approaches can prevent the development of type 2 diabetes mellitus from pre-clinical conditions requires more studies.
Topics: Male; Humans; Testosterone; Diabetes Mellitus, Type 2; Prediabetic State; Hypogonadism; Weight Loss; Glucose; Hormone Replacement Therapy
PubMed: 36542412
DOI: 10.1111/andr.13367 -
Diabetes & Metabolism Journal Sep 2023In May 2023, the Committee of Clinical Practice Guidelines of the Korean Diabetes Association published the revised clinical practice guidelines for Korean adults with... (Review)
Review
In May 2023, the Committee of Clinical Practice Guidelines of the Korean Diabetes Association published the revised clinical practice guidelines for Korean adults with diabetes and prediabetes. We incorporated the latest clinical research findings through a comprehensive systematic literature review and applied them in a manner suitable for the Korean population. These guidelines are designed for all healthcare providers nationwide, including physicians, diabetes experts, and certified diabetes educators who manage patients with diabetes or individuals at risk of developing diabetes. Based on recent changes in international guidelines and the results of a Korean epidemiological study, the recommended age for diabetes screening has been lowered. In collaboration with the relevant Korean medical societies, recently revised guidelines for managing hypertension and dyslipidemia in patients with diabetes have been incorporated into this guideline. An abridgment containing practical information on patient education and systematic management in the clinic was published separately.
Topics: Adult; Humans; Asian People; Dyslipidemias; Prediabetic State; Republic of Korea; Societies, Medical; Diabetes Mellitus
PubMed: 37793979
DOI: 10.4093/dmj.2023.0282 -
Journal of Diabetes Investigation Oct 2023There has been conflicting evidence regarding the role of prediabetes as a risk factor of lung cancer. A systemic review and meta-analysis was conducted to determine the... (Meta-Analysis)
Meta-Analysis
AIMS/INTRODUCTION
There has been conflicting evidence regarding the role of prediabetes as a risk factor of lung cancer. A systemic review and meta-analysis was conducted to determine the relationship between prediabetes and lung cancer incidence and mortality in general adult populations.
MATERIALS AND METHODS
Observational studies relevant to the objective were found in Medline, Embase, Cochrane Library, and Web of Science. By incorporating potential heterogeneity into the model, a randomized-effects model was selected.
RESULTS
Ten cohort studies were included. People with prediabetes were associated with a mildly increased risk of lung cancer incidence compared with controls with normoglycemia (risk ratio [RR]: 1.09, 95% confidence interval [CI]: 1.01-1.18, P = 0.03; I = 79%), which was mainly observed in men rather than in women (RR: 1.07 vs 0.99, P for subgroup difference < 0.001). Prediabetes was related to a higher risk of lung cancer mortality (RR: 1.19, 95% CI: 1.02-1.39, P = 0.03; I = 52%), and the results were consistent in both men and women (P for subgroup difference = 0.67). The association between prediabetes and lung cancer incidence or mortality did not appear to be significantly affected by different definitions of prediabetes (P for subgroup difference = 0.27 and 0.37).
CONCLUSIONS
Prediabetes might be associated with a mildly increased risk of lung cancer incidence in men, but not in women. In addition, prediabetes may be related to a higher risk of lung cancer mortality in the adult population.
Topics: Male; Adult; Humans; Female; Incidence; Prediabetic State; Lung Neoplasms; Risk Factors
PubMed: 37517054
DOI: 10.1111/jdi.14057 -
Environment International Jan 2022Cadmium exposure has been associated with increased diabetes risk in several studies, though there is still considerable debate about the magnitude and shape of the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cadmium exposure has been associated with increased diabetes risk in several studies, though there is still considerable debate about the magnitude and shape of the association.
OBJECTIVE
To perform a systematic review and meta-analysis of observational studies investigating the relation between cadmium exposure and risk of type 2 diabetes and prediabetes, and to summarize data on the magnitude and shape of the association.
DATA SOURCE
After conducting an online literature search through October 1, 2021, we identified 42 eligible studies investigating the association between cadmium exposure and risk of diabetes and prediabetes.
STUDY ELIGIBILITY CRITERIA
We included studies that assessed cadmium exposure through biomarker levels; examined type 2 diabetes or prediabetes among outcomes; and reported effect estimates for cadmium exposure for meta-analysis only.
STUDY APPRAISAL AND SYNTHESIS METHODS
Studies were evaluated using ROBINS-E risk of bias tool. We quantitively assessed the relation between exposure and study outcomes using one-stage dose-response meta-analysis with a random effects meta-analytical model.
RESULTS
In the meta-analysis, comparing highest-versus-lowest cadmium exposure levels, summary relative risks (RRs) for type 2 diabetes were 1.24 (95% confidence interval 0.96-1.59), 1.21 (1.00-1.45), and 1.47 (1.01-2.13) for blood, urinary, and toenail matrices, respectively. Similarly, there was an increased risk of prediabetes for cadmium concentrations in both urine (RR = 1.41, 95% CI: 1.15-1.73) and blood (RR = 1.38, 95% CI: 1.16-1.63). In the dose-response meta-analysis, we observed a consistent linear positive association between cadmium exposure and diabetes risk, with RRs of 1.25 (0.90-1.72) at 2.0 µg/g of creatinine. Conversely for blood cadmium, diabetes risk appeared to increase only above 1 µg/L. Prediabetes risk increased up to approximately 2 µg/g creatinine above which it reached a plateau with RR of 1.42 (1.12-1.76) at 2 µg/g creatinine.
LIMITATIONS AND CONCLUSIONS
This analysis provides moderate-certainty evidence for a positive association between cadmium exposure (measured in multiple matrices) and risk of both diabetes and prediabetes.
Topics: Bias; Cadmium; Diabetes Mellitus, Type 2; Humans; Prediabetic State; Risk
PubMed: 34628255
DOI: 10.1016/j.envint.2021.106920 -
Association between magnesium concentrations and prediabetes: a systematic review and meta-analysis.Scientific Reports Dec 2021Studies on the association between serum magnesium level and prediabetes yielded inconsistent results. Therefore, the present meta-analysis was designed to examine the... (Meta-Analysis)
Meta-Analysis
Studies on the association between serum magnesium level and prediabetes yielded inconsistent results. Therefore, the present meta-analysis was designed to examine the association between serum magnesium levels and prediabetes. Online databases including PubMed, Embase, Scopus and Google Scholar were searched up to October, 2020. A total of 10 studies that reported mean and standard deviation (SD) of magnesium levels in prediabetes and healthy control group were identified. Random effects models were used to pool weighted mean differences (WMDs) of serum magnesium levels. Pooled-analysis showed that subjects with prediabetes had significantly lower serum magnesium levels compared with healthy controls (WMD = - 0.07 mmol/L; 95% CI - 0.09, - 0.05 mmol/L, P < 0.001). A significant heterogeneity observed across included studies (I = 95.6%, P < 0.001). However, different subgroup analysis did not detect the potential source of observed heterogeneity. Withdrawal of each individual study had no effect on the overall results. The present meta-analysis showed that circulating magnesium levels in people with prediabetes were significantly lower than healthy controls, confirming that magnesium deficiency may play a role in development and progression of prediabetes. Further studies with larger sample size and robust design are warranted to confirm present results.
Topics: Humans; Magnesium; Magnesium Deficiency; Prediabetic State
PubMed: 34937856
DOI: 10.1038/s41598-021-03915-3 -
Frontiers in Public Health 2021Prediabetes is a borderline glycemic status associated with both higher incidence of cardiovascular disease as well as higher risk of progression to diabetes. There is a... (Meta-Analysis)
Meta-Analysis
Prediabetes is a borderline glycemic status associated with both higher incidence of cardiovascular disease as well as higher risk of progression to diabetes. There is a rising burden of diabetes and prediabetes globally. This study aims to estimate the burden of prediabetes in Nigeria. Online searches of Google Scholar, PubMed, and Scopus were conducted and studies were selected based on predefined criteria. A total of 15 studies consisting of 14,206 individuals conducted between 2000 and 2019 were included in the meta-analysis with studies using American Diabetic Association (ADA) and World Health Organization (WHO) criteria pooled separately. The pooled prevalence of prediabetes in Nigeria was found to be 13.2% (95% CI: 5.6-23.2%, = 98.4%) using the ADA criteria and 10.4% (95% CI: 4.3-18.9%, = 99.2%) using the WHO criteria. According to the latest data by the United Nations, this translates to an estimated 15.8 and 12.5 million adult prediabetic individuals in Nigeria using the ADA and WHO criteria, respectively. The prevalence rates for women and men were similar at 12.1% (95% CI: 5-21%). The pooled prevalence rates for urban and rural settlements were also similar at 9% (95% CI: 2-22%). In conclusion, the prevalence of prediabetes in Nigeria was almost two times higher than the 7.3% estimate by the International Diabetes Federation in 2003. The similar rates of prediabetes between men and women and between urban and rural settlements points toward narrowing of cardiovascular risk burden between the two sexes and the two settlements. This represents higher future cardiovascular disease burden in the country further pressurizing the overstretched healthcare system.
Topics: Adult; Cardiovascular Diseases; Diabetes Mellitus; Female; Humans; Male; Nigeria; Prediabetic State; Prevalence
PubMed: 35004577
DOI: 10.3389/fpubh.2021.762429 -
Frontiers in Endocrinology 2024Lifestyle modification based on exercise intervention is still the primary way to delay or reverse the development of diabetes in patients with prediabetes. However,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Lifestyle modification based on exercise intervention is still the primary way to delay or reverse the development of diabetes in patients with prediabetes. However, there are still challenges in setting up a detailed exercise prescription for people with prediabetes. This study mainly ranks exercise prescriptions by comparing the improvement of glucose and lipid metabolism and the level of weight loss in patients.
METHOD
All studies on exercise intervention in prediabetes were identified by searching five electronic databases. Risk assessment and meta-analysis were performed on eligible studies.
RESULTS
Twenty-four studies involving 1946 patients with prediabetes and seven exercise intervention models were included in the final analysis. The meta-analysis showed that exercise of any type was more effective for glycemic control in prediabetes than no exercise. However, the changes in blood glucose were moderate. In prediabetes, combining moderate-intensity aerobic exercise with low-to moderate-load resistance training showed the most significant improvements in glycosylated hemoglobin (HbA1c), body mass index (BMI), body weight (BW), total cholesterol (TC), and low-density lipoprotein cholesterol (LDL) (P-score=0.82; 0.70; 0.87; 1; 0.99), low-to moderate-load resistance training showed the most significant improvements in fasting blood glucose (FBG) (P-score=0.98), the vigorous-intensity aerobic exercise showed the most significant improvements in 2-hour post-meal blood glucose (2hPG) and systolic blood pressure (SBP) (P-score=0.79; 0.78), and moderate-intensity aerobic exercise showed the most significant improvements in diastolic blood pressure (DBP) (P-score=0.78).
CONCLUSION
In summary, moderate-intensity aerobic exercise, low-to moderate-load resistance training and the combination of both have beneficial effects on glycemic control, weight loss, and cardiovascular health in patients with prediabetes. These findings provide valuable guidance for rehabilitation clinicians and patients alike to follow.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD 42021284922.
Topics: Humans; Prediabetic State; Network Meta-Analysis; Blood Glucose; Exercise; Cholesterol, LDL; Weight Loss
PubMed: 38440785
DOI: 10.3389/fendo.2024.1308959 -
European Journal of Epidemiology Jun 2023A diagnosis of diabetes mellitus and prediabetes has been associated with increased risk of Parkinson's disease (PD) in several studies, but results have not been... (Meta-Analysis)
Meta-Analysis Review
Diabetes mellitus, prediabetes and the risk of Parkinson's disease: a systematic review and meta-analysis of 15 cohort studies with 29.9 million participants and 86,345 cases.
A diagnosis of diabetes mellitus and prediabetes has been associated with increased risk of Parkinson's disease (PD) in several studies, but results have not been entirely consistent. We conducted a systematic review and meta-analysis of cohort studies on diabetes mellitus, prediabetes and the risk of PD to provide an up-to-date assessment of the evidence. PubMed and Embase databases were searched for relevant studies up to 6th of February 2022. Cohort studies reporting adjusted relative risk (RR) estimates and 95% confidence intervals (CIs) for the association between diabetes, prediabetes and Parkinson's disease were included. Summary RRs (95% CIs) were calculated using a random effects model. Fifteen cohort studies (29.9 million participants, 86,345 cases) were included in the meta-analysis. The summary RR (95% CI) of PD for persons with diabetes compared to persons without diabetes was 1.27 (1.20-1.35, I = 82%). There was no indication of publication bias, based on Egger's test (p = 0.41), Begg's test (p = 0.99), and inspection of the funnel plot. The association was consistent across geographic regions, by sex, and across several other subgroup and sensitivity analyses. There was some suggestion of a stronger association for diabetes patients reporting diabetes complications than for diabetes patients without complications (RR = 1.54, 1.32-1.80 [n = 3] vs. 1.26, 1.16-1.38 [n = 3]), vs. those without diabetes (p=0.18). The summary RR for prediabetes was 1.04 (95% CI: 1.02-1.07, I = 0%, n = 2). Our results suggest that patients with diabetes have a 27% increased relative risk of developing PD compared to persons without diabetes, and persons with prediabetes have a 4% increase in RR compared to persons with normal blood glucose. Further studies are warranted to clarify the specific role age of onset or duration of diabetes, diabetic complications, glycaemic level and its long-term variability and management may play in relation to PD risk.
Topics: Humans; Prediabetic State; Risk Factors; Parkinson Disease; Diabetes Mellitus; Cohort Studies
PubMed: 37185794
DOI: 10.1007/s10654-023-00970-0 -
Survey of Ophthalmology 2022Diabetic retinopathy is a leading cause of vision loss globally. The current diagnostic thresholds for diabetes are still based on historic data correlating glycemic... (Review)
Review
Diabetic retinopathy is a leading cause of vision loss globally. The current diagnostic thresholds for diabetes are still based on historic data correlating glycemic parameters with retinopathy; however, an excess prevalence of retinopathy has also been reported in prediabetes. We aimed to determine the reported prevalence of retinopathy in adults with prediabetes. We performed searches using MEDLINE, EMBASE, PubMed, Web of Science, CINAHL, Google Scholar and the Cochrane databases from inception to August 1, 2020. We evaluated methodological quality and certainty of the evidence using a validated risk of bias tool and GRADE, respectively. Twenty-four studies (8,759 participants with prediabetes) were included after screening 5,155 abstracts and reviewing 98 full-text records. Nineteen studies (79%) reported population-based data. Retinopathy prevalence estimates ranged between 0.3-14.1% (median 7.1%, interquartile range 2.4-9.7%), with high variance in estimates due to differing screening methods, retinopathy grading protocols and study populations. We judged this as low-certainty evidence using GRADE, downgrading for risk of bias and inconsistency. From studies that compared both populations, post hoc analysis revealed a lower median retinopathy prevalence in normal glucose tolerance (3.2%, interquartile range 0.3-7.3%) than prediabetes (6.6%, interquartile range 1.9-9.8%). These data suggest an excess prevalence of retinopathy in prediabetes.
Topics: Diabetic Retinopathy; Humans; Prediabetic State; Prevalence
PubMed: 35430245
DOI: 10.1016/j.survophthal.2022.04.002 -
The American Journal of Clinical... Sep 2023Evidence is uncertain about the association between serum 25-hydroxyvitamin D (25(OH)D) concentration and health outcomes in people with type 2 diabetes. (Meta-Analysis)
Meta-Analysis
Serum 25(OH)D Concentration, Vitamin D Supplementation, and Risk of Cardiovascular Disease and Mortality in Patients with Type 2 Diabetes or Prediabetes: a Systematic Review and Dose-Response Meta-Analysis.
BACKGROUND
Evidence is uncertain about the association between serum 25-hydroxyvitamin D (25(OH)D) concentration and health outcomes in people with type 2 diabetes.
OBJECTIVES
We aimed to assess the association between vitamin D status and all-cause mortality and cardiovascular disease in people with type 2 diabetes.
METHODS
We did a systematic search in PubMed, Scopus, CENTRAL, and Web of Science until May 2022. We selected 1) cohort studies investigating the association between serum 25(OH)D concentration and mortality or cardiovascular disease in people with type 2 diabetes or prediabetes and 2) randomized trials of vitamin D supplementation in these patients. We used random-effects pairwise meta-analyses to calculate summary relative risks (RRs) and 95% confidence intervals (CI).
RESULTS
21 cohort studies and 6 randomized trials were included. Compared with sufficient vitamin D status (≥50 nmol/L), the RR of all-cause mortality was 1.36 (95% CI: 1.23, 1.49; n = 11 studies, GRADE = moderate) for vitamin D insufficiency (25 to <50 nmol/L), and 1.58 (1.33, 1.83; n = 16, GRADE = moderate) for deficiency (<25 nmol/L). Similar findings were observed for cardiovascular mortality and morbidity but not for cancer mortality. The certainty of evidence ranged from very low to moderate. Dose-response meta-analyses indicated nonlinear associations, with the lowest risk at 25(OH)D ∼60 nmol/L for all-cause and cardiovascular mortality. Supplementation with vitamin D did not reduce the risk of all-cause mortality (RR: 0.96, 95% CI: 0.79, 1.16; risk difference per 1000 patients: 3 fewer, 95% CI: 16 fewer, 12 more; n = 6 trials with 7316 participants; GRADE = low) or the risk of cardiovascular mortality and morbidity (very low- to low-certainty evidence).
CONCLUSIONS
Vitamin D deficiency and insufficiency are associated with a higher risk of all-cause and cardiovascular mortality in patients with type 2 diabetes or prediabetes. Vitamin D deficiency should be corrected in patients with type 2 diabetes to reach normal serum 25(OH)D concentrations, preferably 60 nmol/L.
SYSTEMATIC REVIEW REGISTRATION
This systemic review was registered at PROSPERO as CRD42022326429 (=https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=326429).
Topics: Humans; Cardiovascular Diseases; Diabetes Mellitus, Type 2; Prediabetic State; Vitamin D; Vitamins; Vitamin D Deficiency; Dietary Supplements
PubMed: 37467897
DOI: 10.1016/j.ajcnut.2023.07.012