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Diabetologia Jan 2020A healthy lifestyle has been widely recommended for the prevention and management of type 2 diabetes. However, no systematic review has summarised the relationship... (Meta-Analysis)
Meta-Analysis Review
Combined lifestyle factors and risk of incident type 2 diabetes and prognosis among individuals with type 2 diabetes: a systematic review and meta-analysis of prospective cohort studies.
AIMS/HYPOTHESIS
A healthy lifestyle has been widely recommended for the prevention and management of type 2 diabetes. However, no systematic review has summarised the relationship between combined lifestyle factors (including, but not limited to, smoking, alcohol drinking, physical activity, diet and being overweight or obese) and incident type 2 diabetes and risk of health outcomes among diabetic individuals.
METHODS
EMBASE and PubMed were searched up to April 2019 without language restrictions. References included in articles in relevant publications were also screened. Cohort studies investigating the combined associations of at least three lifestyle factors with incident type 2 diabetes and health outcomes among diabetic individuals were included. Reviewers were paired and independently screened studies, extracted data and evaluated study quality. Random-effects models were used to calculate summary HRs. Heterogeneity and publication bias tests were also conducted.
RESULTS
Compared with participants considered to have the least-healthy lifestyle, those with the healthiest lifestyle had a 75% lower risk of incident diabetes (HR 0.25 [95% CI 0.18, 0.35]; 14 studies with approximately 1 million participants). The associations were largely consistent and significant among individuals from different socioeconomic backgrounds and baseline characteristics. Among individuals with type 2 diabetes (10 studies with 34,385 participants), the HRs (95% CIs) were 0.44 (0.33, 0.60) for all-cause death, 0.51 (0.30, 0.86) for cardiovascular death, 0.69 (0.47, 1.00) for cancer death and 0.48 (0.37, 0.63) for incident cardiovascular disease when comparing the healthiest lifestyle with the least-healthy lifestyle.
CONCLUSIONS/INTERPRETATION
Adoption of a healthy lifestyle is associated with substantial risk reduction in type 2 diabetes and long-term adverse outcomes among diabetic individuals. Tackling multiple risk factors, instead of concentrating on one certain lifestyle factor, should be the cornerstone for reducing the global burden of type 2 diabetes.
Topics: Cardiovascular Diseases; Diabetes Mellitus, Type 2; Female; Humans; Life Style; Male; Prospective Studies; Risk Factors
PubMed: 31482198
DOI: 10.1007/s00125-019-04985-9 -
International Journal of Environmental... Oct 2022As the population recovers from the coronavirus disease 2019 (COVID-19) pandemic, a subset of individuals is emerging as post-coronavirus disease (post-COVID) patients... (Review)
Review
As the population recovers from the coronavirus disease 2019 (COVID-19) pandemic, a subset of individuals is emerging as post-coronavirus disease (post-COVID) patients who experience multifactorial long-term symptoms several weeks after the initial recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The aim of this systematic review is to present the latest scientific reports that evaluate changes in glucose levels, blood pressure readings and lipid profiles after recovery from COVID-19 to verify the hypothesis that new-onset diabetes mellitus, arterial hypertension and dyslipidaemia are a possible sequela of a COVID-19 infection. The open access databases PubMed and Google Scholar were searched. Articles investigating patients with residual clinical signs and biochemical alteration indicating diabetes, hypertension and dyslipidaemia at least a month after recovering from COVID-19 were included. It has been shown that a select number of patients were diagnosed with new-onset diabetes, arterial hypertension and dyslipidaemia after COVID-19 infection. Alterations in glucose levels, blood pressure and lipid profiles months after initial infection shows the importance of considering diabetes mellitus, arterial hypertension and dyslipidaemia as part of the multifactorial diagnostic criteria post-COVID to better provide evidence-based clinical care.
Topics: Humans; COVID-19; SARS-CoV-2; Diabetes Mellitus; Hypertension; Dyslipidemias; Glucose; Lipids
PubMed: 36293857
DOI: 10.3390/ijerph192013280 -
BMJ (Clinical Research Ed.) May 2020To estimate and compare progression rates to type 2 diabetes mellitus (T2DM) in women with gestational diabetes mellitus (GDM) and healthy controls. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To estimate and compare progression rates to type 2 diabetes mellitus (T2DM) in women with gestational diabetes mellitus (GDM) and healthy controls.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
Medline and Embase between January 2000 and December 2019, studies published in English and conducted on humans.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Observational studies investigating progression to T2DM. Inclusion criteria were postpartum follow-up for at least 12 months, incident physician based diagnosis of diabetes, T2DM reported as a separate outcome rather than combined with impaired fasting glucose or impaired glucose tolerance, and studies with both a group of patients with GDM and a control group.
RESULTS
This meta-analysis of 20 studies assessed a total of 1 332 373 individuals (67 956 women with GDM and 1 264 417 controls). Data were pooled by random effects meta-analysis models, and heterogeneity was assessed by use of the I statistic. The pooled relative risk for the incidence of T2DM between participants with GDM and controls was estimated. Reasons for heterogeneity between studies were investigated by prespecified subgroup and meta-regression analyses. Publication bias was assessed by funnel plots and, overall, studies were deemed to have a low risk of bias (P=0.58 and P=0.90). The overall relative risk for T2DM was almost 10 times higher in women with previous GDM than in healthy controls (9.51, 95% confidence interval 7.14 to 12.67, P<0.001). In populations of women with previous GDM, the cumulative incidence of T2DM was 16.46% (95% confidence interval 16.16% to 16.77%) in women of mixed ethnicity, 15.58% (13.30% to 17.86%) in a predominantly non-white population, and 9.91% (9.39% to 10.42%) in a white population. These differences were not statistically significant between subgroups (white mixed populations, P=0.26; white non-white populations, P=0.54). Meta-regression analyses showed that the study effect size was not significantly associated with mean study age, body mass index, publication year, and length of follow-up.
CONCLUSIONS
Women with a history of GDM appear to have a nearly 10-fold higher risk of developing T2DM than those with a normoglycaemic pregnancy. The magnitude of this risk highlights the importance of intervening to prevent the onset of T2DM, particularly in the early years after pregnancy.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42019123079.
Topics: Diabetes Mellitus, Type 2; Diabetes, Gestational; Disease Progression; Female; Humans; Incidence; Postpartum Period; Pregnancy; Risk Factors
PubMed: 32404325
DOI: 10.1136/bmj.m1361 -
Journal of Medical Virology Nov 2022Viral infections may increase the risk of developing type 1 diabetes (T1D), and recent reports suggest that Coronavirus Disease 2019 (COVID-19) might have increased the... (Meta-Analysis)
Meta-Analysis Review
Viral infections may increase the risk of developing type 1 diabetes (T1D), and recent reports suggest that Coronavirus Disease 2019 (COVID-19) might have increased the incidence of pediatric T1D and/or diabetic ketoacidosis (DKA). Therefore, this meta-analysis aims to estimate the risk of global pediatric new-onset T1D, DKA, and severe DKA before and after the COVID-19 pandemic. A systematic search of MEDLINE/PubMed, CINAHL, Scopus, and EMBASE was conducted for articles published up to March 2022. A random-effects meta-analysis was performed to compare the relative risk of T1D and DKA among pediatric patients with T1D between the COVID-19 pre-pandemic and pandemic periods. We also compared glucose and HbA1c values in children who were newly diagnosed with T1D before and after the COVID-19 pandemic. The global incidence rate of T1D in the 2019 period was 19.73 per 100 000 children and 32.39 per 100 000 in the 2020 period. Compared with pre-COVID-19 pandemic, the number of worldwide pediatric new-onset T1D, DKA, and severe DKA during the first year of the COVID-19 pandemic increased by 9.5%, 25%, and 19.5%, respectively. Compared with pre-COVID-19 pandemic levels, the median glucose, and HbA1c values in newly diagnosed T1D children after the COVID-19 pandemic increased by 6.43% and 6.42%, respectively. The COVID-19 pandemic has significantly increased the risk of global pediatric new-onset T1D, DKA, and severe DKA. Moreover, higher glucose and HbA1c values in newly diagnosed T1D children after the COVID-19 pandemic mandates targeted measures to raise public and physician awareness.
Topics: COVID-19; Child; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Glucose; Glycated Hemoglobin; Humans; Incidence; Pandemics
PubMed: 35831242
DOI: 10.1002/jmv.27996 -
The Journal of Clinical Endocrinology... May 2022Thyroid hormones are important regulators of glucose metabolism, and studies investigating the association between thyroid function and type 2 diabetes incidence have... (Meta-Analysis)
Meta-Analysis
CONTEXT
Thyroid hormones are important regulators of glucose metabolism, and studies investigating the association between thyroid function and type 2 diabetes incidence have shown conflicting results.
OBJECTIVE
We aimed to combine the evidence from prospective studies addressing the association between thyroid function and type 2 diabetes risk.
METHODS
We systematically searched in Embase, Medline (Ovid), Web of Science, Cochrane, and Google Scholar for prospective studies assessing the association of thyroid function and incident type 2 diabetes. Data extraction was performed using a standardized protocol by 2 independent reviewers. We assessed study quality using the Newcastle-Ottawa Scale and pooled hazard ratios (HRs) and 95% CI using random-effects models.
RESULTS
From the 4574 publications identified, 7 met our inclusion criteria and were included in the qualitative synthesis. Six publications were included in the meta-analysis. Studies assessed hypothyroidism (6 studies), hyperthyroidism (5 studies), thyrotropin (TSH) in the reference range (4 studies), and free thyroxine (FT4) in the reference range (3 studies) in relation to incident type 2 diabetes. The pooled HR for the risk of type 2 diabetes was 1.26 (95% CI, 1.05-1.52) for hypothyroidism, 1.16 (95% CI, 0.90-1.49) for hyperthyroidism, 1.06 (95% CI, 0.96-1.17) for TSH in the reference range, and 0.95 (95% CI, 0.91-0.98) for FT4 in the reference range.
CONCLUSION
Current evidence suggests an increased type 2 diabetes risk in people with hypothyroidism and lower FT4 levels in the reference range. Further population-based studies are needed to address this association given the limited evidence.
Topics: Diabetes Mellitus, Type 2; Humans; Hyperthyroidism; Hypothyroidism; Prediabetic State; Prospective Studies; Thyrotropin; Thyroxine
PubMed: 35137143
DOI: 10.1210/clinem/dgac006 -
Brain and Behavior Feb 2021To provide an estimate of the effect of interventions on comorbid depressive disorder (MDD) or subthreshold depression in type 1 and type 2 diabetes. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To provide an estimate of the effect of interventions on comorbid depressive disorder (MDD) or subthreshold depression in type 1 and type 2 diabetes.
METHODS
Systematic review and meta-analysis. We searched PubMed, PsycINFO, Embase, and the Cochrane Library for randomized controlled trials evaluating the outcome of depression treatments in diabetes and comorbid MDD or subthreshold symptoms published before August 2019 compared to care as usual (CAU), placebo, waiting list (WL), or active comparator treatment as in a comparative effectiveness trial (CET). Primary outcomes were depressive symptom severity and glycemic control. Cohen's d is reported.
RESULTS
Forty-three randomized controlled trials (RCTs) were selected, and 32 RCTs comprising 3,543 patients were included in the meta-analysis. Our meta-analysis showed that, compared to CAU, placebo or WL, all interventions showed a significant effect on combined outcome 0,485 (95% CI 0.360; 0.609). All interventions showed a significant effect on depression. Pharmacological treatment, group therapy, psychotherapy, and collaborative care had a significant effect on glycemic control. High baseline depression score was associated with a greater reduction in HbA c and depressive outcome. High baseline HbA c was associated with a greater reduction in HbA c.
CONCLUSION
All treatments are effective for comorbid depression in type 1 diabetes and type 2 diabetes. Over the last decade, new interventions with large effect sizes have been introduced, such as group-based therapy, online treatment, and exercise. Although all interventions were effective for depression, not all treatments were effective for glycemic control. Effective interventions in comorbid depressive disorder may not be as effective in comorbid subthreshold depression. Baseline depression and HbA c scores modify the treatment effect. Based on the findings, we provide guidance for treatment depending on patient profile and desired outcome, and discuss possible avenues for further research.
Topics: Depression; Depressive Disorder; Diabetes Mellitus, Type 1; Humans; Psychotherapy; Psychotherapy, Group; Randomized Controlled Trials as Topic
PubMed: 33274609
DOI: 10.1002/brb3.1981 -
Frontiers in Endocrinology 2021We performed a meta-analysis of observational studies to evaluate the association between the presence of sarcopenia and HbA1c, prediabetes, diabetes and diabetic... (Meta-Analysis)
Meta-Analysis
AIM
We performed a meta-analysis of observational studies to evaluate the association between the presence of sarcopenia and HbA1c, prediabetes, diabetes and diabetic complications.
METHOD
The PubMed, Embase, Cochrane and Web of Science databases were searched from inception to May 2021. We included full-text English language articles that reported the prevalence of sarcopenia in patients with and without diabetes. Quality assessment was performed according to the Newcastle- Ottawa scale for observational studies.
RESULTS
Sixteen studies were included in the meta-analysis. Three studies showed that high HbA1c levels lead to loss of muscle mass, and one study involving prediabetes showed that people with prediabetes had lower muscle mass, strength, and performance than non-diabetic population. Seven studies showed that people with diabetes had a higher risk of sarcopenia than those without diabetes (combined OR: 2.09, 95% CI:1.62-2.70). The remaining five studies suggested that diabetic complications increased the risk of sarcopenia (combined OR: 2.09,95% CI:1.62-2.70).
CONCLUSION
High HbA1c levels, prediabetes, diabetes and diabetes complications were associated with an increased risk of sarcopenia. Therapeutic strategies addressed to avoid the conversion of IGT to diabetes and to optimize glycemic control are warranted to prevent or arrest sarcopenia in the diabetic population.
Topics: Diabetes Mellitus; Glycated Hemoglobin; Humans; Observational Studies as Topic; Risk Factors; Sarcopenia
PubMed: 35002965
DOI: 10.3389/fendo.2021.782391 -
Renal Failure Dec 2023The safety of sodium-glucose co-transporter 2 (SGLT2) inhibitors in elderly patients with diabetic kidney disease (DKD) is still controversial. This study aimed to... (Meta-Analysis)
Meta-Analysis Review
Comparative safety of sodium-glucose co-transporter 2 inhibitors in elderly patients with type 2 diabetes mellitus and diabetic kidney disease: a systematic review and meta-analysis.
The safety of sodium-glucose co-transporter 2 (SGLT2) inhibitors in elderly patients with diabetic kidney disease (DKD) is still controversial. This study aimed to analyze the safety of SGLT2 inhibitors in elderly patients with type 2 diabetes mellitus (T2DM) and DKD. We systematically searched PubMed, Embase, Web of Science, and the Cochrane Library from inception to March 2023. Randomized controlled trials (RCTs) were included. Data including patient characteristics and interesting outcomes were extracted, and the dichotomous data and continuous variables were evaluated using risk ratio (RR) with 95% confidence intervals (CIs) and mean difference (MD) with 95% CIs, respectively. A total of 14 RCTs with 59874 participants were finally included. There were 38,252 males (63.9%) and 21,622 females (36.1%). The patients' mean age was > 64.6 years. SGLT2 inhibitors could delay the further decline of estimated glomerular filtration rate (eGFR) when eGFR ≥ 60 ml/min/1.73m (MD: 2.36; 95%CI [1.15-3.57]). SGLT2 inhibitors in elderly patients with eGFR < 60 ml/min/1.73m (RR: 0.86; 95%CI [0.67-1.11]) may have a relatively increased risk of acute kidney injury compared to eGFR ≥ 60 ml/min/1.73m. SGLT2 inhibitors increased the incidence of genital mycotic infections (RR: 3.47; 95%CI [2.97-4.04]) and diabetic ketoacidosis (RR: 2.25; 95%CI [1.57-3.24]). Except for genital mycotic infections and diabetic ketoacidosis, other adverse reactions were few, indicating that SGLT2 inhibitors are relatively safe for elderly patients with T2DM and DKD. Safety and renoprotection may be diminished when SGLT2 inhibitors are used in elderly patients with eGFR < 60 ml/min/1.73m.
Topics: Male; Female; Humans; Aged; Middle Aged; Sodium-Glucose Transporter 2 Inhibitors; Diabetic Nephropathies; Diabetic Ketoacidosis; Diabetes Mellitus, Type 2; Symporters; Glucose; Sodium; Hypoglycemic Agents
PubMed: 37246403
DOI: 10.1080/0886022X.2023.2217287 -
Revista Medica de Chile Nov 2019Background Affordable interventions to improve metabolic control of Type 2-Diabetes Mellitus are increasingly necessary. Aim To review systematically the existing... (Meta-Analysis)
Meta-Analysis
Background Affordable interventions to improve metabolic control of Type 2-Diabetes Mellitus are increasingly necessary. Aim To review systematically the existing literature on the effects of psychological interventions on Type-2 Diabetes Mellitus compensation. Material and Methods We performed a systematic literature review and meta-analysis on the effectiveness of psychological interventions implemented for Type-2 Diabetes Mellitus patients. Research included the following electronic databases: PubMed, Bireme, Web of Science, SciELO, Embase, EBSCOhost, SCOPUS, Psychology Database. Results Most studies showed a decrease in the level of glycated hemoglobin after interventions, which applied different initiatives complementary to standard medical treatment. Mainly, these interventions encompassed training for self-monitoring and control of diabetes based on cognitive behavioral psychology, counseling, self-assessment and physical-spiritual work based on transpersonal psychology. Conclusions Psychological tools could be an adjunct to the standard medical treatment for patients with Type-2 Diabetes Mellitus, reducing glycated hemoglobin levels and improving self-regulation, disease awareness and adherence from the self-efficacy perception perspective.
Topics: Diabetes Mellitus, Type 2; Humans; Psychotherapy
PubMed: 32186603
DOI: 10.4067/S0034-98872019001101423 -
Worldviews on Evidence-based Nursing Feb 2023Conventional wisdom affirmed that diabetes was irreversible, but current research shows that lifestyle interventions may achieve diabetes remission among patients with... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Conventional wisdom affirmed that diabetes was irreversible, but current research shows that lifestyle interventions may achieve diabetes remission among patients with type 2 diabetes mellitus. Recently, many original studies have examined the effectiveness of lifestyle interventions. However, great heterogeneity in intervention approaches resulted in inconsistent intervention effects.
AIMS
The aim of this study was to determine the effectiveness of lifestyle interventions for diabetes remission among patients with type 2 diabetes mellitus.
METHODS
PubMed, CINAHL, Embase, Web of Science Core Collection, and Cochrane Library were searched for relevant articles from their inceptions to March 26, 2021. Reference lists and a relevant journal were searched manually as well. Both randomized controlled trials and quasi-experimental studies were included. The quantitative data extracted from the selected studies included diabetes remission rate, weight, and quality of life score. The risk of bias was assessed by the Cochrane and Joanna Briggs Institute's tool. RevMan version 5.3. was used to carry out the meta-analysis.
RESULTS
This systematic review included 12 studies involving 3997 patients with type 2 diabetes mellitus. Lifestyle interventions included in the studies were mainly divided into diet-only interventions and diet combined with physical activity interventions. Among them, there were three types of diet: (1) low-energy diet, (2) low carbohydrate diet, and (3) Mediterranean diet. Moderate-intensity aerobic and resistance physical activity, walking, and maintaining habitual physical activity were the three types of physical activity interventions employed in the included studies. The results indicated that lifestyle interventions were effective for achieving diabetes remission, reducing weight, and improving quality of life in patients with type 2 diabetes mellitus.
LINKING EVIDENCE TO ACTION
Lifestyle interventions were associated with significant effects on diabetes remission, reducing weight, and improving quality of life. As an important part of lifestyle interventions, diet and physical activity have a significant effect on blood glucose and weight control in patients with type 2 diabetes mellitus. It is therefore suggested that the contents of lifestyle interventions should focus on diet and physical activity.
Topics: Humans; Diabetes Mellitus, Type 2; Quality of Life; Life Style; Exercise; Blood Glucose
PubMed: 36480153
DOI: 10.1111/wvn.12608