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Diabetes & Vascular Disease Research 2023Lipoprotein a (LP(a)), an LDL-like lipoprotein, known as a risk factor for cardiovascular diseases, has a controversial association with diabetic retinopathy in patients... (Review)
Review
BACKGROUND
Lipoprotein a (LP(a)), an LDL-like lipoprotein, known as a risk factor for cardiovascular diseases, has a controversial association with diabetic retinopathy in patients with type 2 diabetes-the current systematic review aimed to critically assess the association between LP(a) and diabetic retinopathy.
METHODS
A systematic review of relevant studies was conducted after a thorough search in PubMed, Scopus, and Google Scholar electronic databases. We used English observational, case-control, and prospective cohort studies published up to August 2022, including type 2 diabetic patients as the population, diabetic retinopathy as the outcome, and LP(a) as the intervention.
RESULT
17 relevant studies, including 4688 patients with diabetes, were included in this systematic review. While in 13 studies, Lipoprotein(a) was recognized as a risk factor for diabetic retinopathy, only three studies reported no evidence of a relationship between the two. Also, another study showed a mixed outcome of the relationship between LP(a) and diabetic retinopathy.
CONCLUSION
High serum lipoprotein(a) in patients with type 2 diabetes is considered a risk factor for diabetic retinopathy. However, further large-scaled cohort studies are still required to validate this finding.
Topics: Humans; Diabetes Mellitus, Type 2; Diabetic Retinopathy; Lipoprotein(a); Prospective Studies; Risk Factors
PubMed: 38018132
DOI: 10.1177/14791641231197114 -
Journal de Mycologie Medicale Aug 2022Mucormycosis is a rare but life-threatening disease with high morbidity and mortality and is difficult to diagnose. Mucormycosis, is a severe but rare fungal infection... (Review)
Review
Mucormycosis is a rare but life-threatening disease with high morbidity and mortality and is difficult to diagnose. Mucormycosis, is a severe but rare fungal infection caused by a group of molds called mucormycetes. Diabetes, use of corticosteroids, metabolic/diabetic acidosis and Covid-19 mediated immunosuppression are reported in more than 70% of cases in mucormycosis patients. Coexisting mucormycosis, Covid-19 along with diabetes mellitus increase the likelihood of mortality. Despite its occurrence since the beginning of the pandemic, there are still unanswered concerns regarding the origin of this fungal infection and mortality rate and/or relation with diabetic patients. In this review, we describe the detailed view of causative pathogens responsible for mucormycosis, diabetes mellitus and Covid-19 association along with the morbidity cases during the latest Covid-19 crisis. In the case of mucormycosis diagnosis, imaging, histopathological confirmation, fungal culture and molecular identification methods should be considered. Once mucormycosis is diagnosed, a combined treating method consisting of antifungals administration like amphotericin B, surgical intervention is needed for the reversal of the underlying condition. Early detection of this potentially life-threatening infection and timely care is needed in lowering mortality rates.
Topics: Amphotericin B; COVID-19; Diabetes Mellitus; Diabetic Ketoacidosis; Humans; Mucormycosis
PubMed: 35219907
DOI: 10.1016/j.mycmed.2022.101257 -
Frontiers in Public Health 2020Diabetic retinopathy is a common microvascular complication in diabetic patients and is considered the main cause of visual loss worldwide. Periodontitis is a chronic...
Diabetic retinopathy is a common microvascular complication in diabetic patients and is considered the main cause of visual loss worldwide. Periodontitis is a chronic inflammatory condition, which compromises dental supporting tissues. The chronic bacterial challenge in periodontitis is a persistent source of inflammatory mediators that may be associated with insulin resistance, increasing the risk of complications of diabetes mellitus. This systematic review aimed to summarize the evidence in the association between diabetic retinopathy and periodontitis. This review was registered under the number CRD 42019142267. A search strategy in five electronic databases and a gray literature source was performed based on the PECO acronym. After data extraction, the qualitative synthesis and risk of bias analyses were performed using the Newcastle-Ottawa scale. The level of evidence of all studies taken together was evaluated through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Out of the 253 citations screened, five cross-sectional studies met the eligibility criteria and were included in the qualitative analysis, in which two were judged to be of good quality, one as fair quality, and two as poor quality. Among the included studies, a significant relationship between the severity of periodontitis (CAL > 5 mm) and the severity of diabetic retinopathy ( < ) was reported by four studies. Also, an association between both diseases in non-obese adults was found after adjustments [OR 2.206 (1.114-4.366); = 0.0232). However, the analysis of evidence by GRADE assessment was rated as low. Although the results of individual studies suggest an association between diabetic retinopathy and periodontitis, the quality of the body of evidence was judged to be low by the GRADE approach. Further studies with larger sample sizes, adequate models of cofounders' adjustments, and prospective analysis of periodontitis and diabetes conditions ought to be conducted to clarify this association.
Topics: Adult; Cross-Sectional Studies; Diabetes Mellitus; Diabetic Retinopathy; Humans; Periodontitis; Prospective Studies
PubMed: 33490007
DOI: 10.3389/fpubh.2020.550614 -
Medicine Oct 2023Being overweight or obese is closely related to adverse pregnancy outcomes and harms both pregnant women and neonates, increasing complications during pregnancy and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Being overweight or obese is closely related to adverse pregnancy outcomes and harms both pregnant women and neonates, increasing complications during pregnancy and leading to adverse pregnancy outcomes. Consequently, a meta-analysis was done to investigate exercise therapy impact on the complications and outcomes of pregnant women who are obese or overweight.
MATERIALS AND METHODS
The computer system searched PubMed, Cochrane Library, Wanfang, EMBASE, and CNKI databases. The search duration extended from the database establishment until October 2022. A thorough search was carried out for pertinent studies investigating exercise therapy impact on pregnancy complications and outcomes in obese or overweight pregnant women. The heterogeneity test was carried out using Cochrane Q and Chi-square tests. The combined findings from the meta-analysis were examined for reliability and robustness using sensitivity and publication bias analyses. All statistics used RevMan 5.3 software.
RESULTS
This meta-analysis included data from 8026 patients from 22 randomized controlled trials. The results demonstrated that exercise therapy might successfully decrease the incidence of gestational diabetes mellitus (GDM) (odds ratio [OR] = 0.85, 95% confidence interval [CI]: 0.74-0.96, P = .01) and macrosomia (OR = 0.78, 95% CI: 0.68-0.89, P < .001), and control weight gain during pregnancy (SMD = -0.2, 95% CI: -0.31 to -0.08, P < .001).
CONCLUSIONS
Exercise therapy can control weight gain during pregnancy, lower the incidence of GDM and the macrosomia rate, and improve adverse pregnancy outcomes.
Topics: Infant, Newborn; Female; Humans; Pregnancy; Overweight; Pregnancy Outcome; Pregnant Women; Fetal Macrosomia; Reproducibility of Results; Exercise; Obesity; Weight Gain; Diabetes, Gestational; Pregnancy Complications; Exercise Therapy
PubMed: 37800765
DOI: 10.1097/MD.0000000000034804 -
JAMA Ophthalmology Feb 2023Tractional retinal detachment (TRD) occurs in approximately 5% of people with proliferative diabetic retinopathy and poses a threat to vision. Pars plana vitrectomy... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Tractional retinal detachment (TRD) occurs in approximately 5% of people with proliferative diabetic retinopathy and poses a threat to vision. Pars plana vitrectomy (PPV) is the treatment of choice for TRD.
OBJECTIVE
To determine anatomic and functional outcomes of PPV for the treatment of TRD in people with diabetes (dTRD).
DATA SOURCES
MEDLINE and Embase were searched systematically from January 1, 2000, to February 20, 2022. In addition, a reference list of eligible studies were screened.
STUDY SELECTION
Eligible studies were those published in English, those reporting outcomes of PPV for dTRD, and those that included more than 25 eyes and with a minimum follow-up of 3 months.
DATA EXTRACTION AND SYNTHESIS
Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for data extraction/synthesis were followed, and the National Institute for Health quality assessment tool was used to assess risk of bias. Study eligibility was determined independently by 2 reviewers; data extraction was conducted by 1 reviewer and entries checked for accuracy by another. Data were pooled using a random-effects model.
MAIN OUTCOMES AND MEASURES
Main outcomes included rate of failure of retinal reattachment following 1 surgery and final visual acuity (VA). The association of baseline patient characteristics and surgical maneuvers with postoperative surgical outcomes was investigated.
RESULTS
Of the 406 studies identified, 38 (3839 eyes) were eligible and included for analysis. Patients had a median (IQR) age of 52.2 (49.6-55.7) years. In the studies reporting patient sex (31 of 38 studies), 1441 were female individuals (50.1%). The overall failure rate of retinal reattachment after 1 surgery was 5.9% (95% CI, 1.4%-8.3%), and the mean final VA was 0.94 (95% CI, 0.82-1.05) logMAR (approximate Snellen equivalent, 6/53; 95% CI, 6/39-6/71). People with higher preoperative VA achieved higher postoperative vision (0.66 logMAR worse final vision; 95% CI, 0.39-0.84 per 1.0 logMAR worse at baseline; P <.001). On multivariable analysis, no other patient characteristics or surgical variables had a statistically significant association with outcomes.
CONCLUSIONS AND RELEVANCE
Results of this systematic review and meta-analysis suggest that PPV was an effective strategy to achieve retinal reattachment in people with dTRD. Given that higher preoperative VA was the only factor associated with higher postoperative vision, early intervention should be considered and discussed in detail with patients. Overall, final postoperative VA remains low, and patients should be counseled on the guarded prognosis of dTRD.
Topics: Humans; Female; Middle Aged; Male; Retinal Detachment; Diabetic Retinopathy; Vitrectomy; Treatment Outcome; Retrospective Studies; Diabetes Mellitus
PubMed: 36633878
DOI: 10.1001/jamaophthalmol.2022.5817 -
Nutrients Oct 2022Diabetic retinopathy (DR) is a multifactorial neuro-microvascular disease, whose prevalence ranges from 25% to 60% of subjects affected by diabetes mellitus,... (Review)
Review
Diabetic retinopathy (DR) is a multifactorial neuro-microvascular disease, whose prevalence ranges from 25% to 60% of subjects affected by diabetes mellitus, representing the main cause of legal blindness in adults of industrialized countries. The treatment of advanced stage of DR is based on invasive and expensive therapies, while few strategies are available for the early stage or prevention. The mechanisms underlying DR involve a complex interplay between the detrimental effects of hyperglycemia, dyslipidemia, hypoxia, and oxidative stress, providing several pathways potentially targeted by nutrients and nutraceuticals. In this study, we conducted a systematic review of observational and interventional studies, evaluating the effect of nutrients and/or nutraceuticals on the risk of DR and their potential use for the treatment of patients with DR. The analysis of the 41 included studies (27 observational and 14 interventional studies) suggests a promising preventive role of some nutrients, in particular for vitamins B (i.e., B1 and B12), D, and E. However, further investigations are necessary to clarify the potential clinical application of nutraceuticals in the prevention and treatment of DR.
Topics: Adult; Humans; Diabetic Retinopathy; Dietary Supplements; Hyperglycemia; Vitamin B Complex; Nutrients; Diabetes Mellitus; Observational Studies as Topic
PubMed: 36297113
DOI: 10.3390/nu14204430 -
Ophthalmology Jan 2023This systematic review and meta-analysis summarizes evidence relating to the prevalence of diabetic retinopathy (DR) among Indigenous and non-Indigenous Australians. (Meta-Analysis)
Meta-Analysis Review
TOPIC
This systematic review and meta-analysis summarizes evidence relating to the prevalence of diabetic retinopathy (DR) among Indigenous and non-Indigenous Australians.
CLINICAL RELEVANCE
Indigenous Australians suffer disproportionately from diabetes-related complications. Exploring ethnic variation in disease is important for equitable distribution of resources and may lead to identification of ethnic-specific modifiable risk factors. Existing DR prevalence studies comparing Indigenous and non-Indigenous Australians have shown conflicting results.
METHODS
This study was conducted following Joanna Briggs Institute guidance on systematic reviews of prevalence studies (PROSPERO ID: CRD42022259048). We performed searches of Medline (Ovid), EMBASE, and Web of Science until October 2021, using a strategy designed by an information specialist. We included studies reporting DR prevalence among diabetic patients in Indigenous and non-Indigenous Australian populations. Two independent reviewers performed quality assessments using a 9-item appraisal tool. Meta-analysis and meta-regression were performed using double arcsine transformation and a random-effects model comparing Indigenous and non-Indigenous subgroups.
RESULTS
Fifteen studies with 8219 participants met criteria for inclusion. The Indigenous subgroup scored lower on the appraisal tool than the non-Indigenous subgroup (mean score 50% vs. 72%, P = 0.04). In the unadjusted meta-analysis, DR prevalence in the Indigenous subgroup (30.2%; 95% confidence interval [CI], 24.9-35.7) did not differ significantly (P = 0.17) from the non-Indigenous subgroup (23.7%; 95% CI, 16.8-31.4). After adjusting for age and quality, DR prevalence was higher in the Indigenous subgroup (P < 0.01), with prevalence ratio point estimates ranging from 1.72 to 2.58, depending on the meta-regression model. For the secondary outcomes, prevalence estimates were higher in the Indigenous subgroup for diabetic macular edema (DME) (8.7% vs. 2.7%, P = 0.02) and vision-threatening DR (VTDR) (8.6% vs. 3.0%, P = 0.03) but not for proliferative DR (2.5% vs. 0.8%, P = 0.07).
CONCLUSIONS
Indigenous studies scored lower for methodological quality, raising the possibility that systematic differences in research practices may be leading to underestimation of disease burden. After adjusting for age and quality, we found a higher DR prevalence in the Indigenous subgroup. This contrasts with a previous review that reported the opposite finding of lower DR prevalence using unadjusted pooled estimates. Future epidemiological work exploring DR burden in Indigenous communities should aim to address methodological weaknesses identified by this review.
Topics: Humans; Diabetic Retinopathy; Prevalence; Macular Edema; Australia; Risk Factors; Diabetes Mellitus
PubMed: 35931223
DOI: 10.1016/j.ophtha.2022.07.024 -
Journal of Diabetes Feb 2022Diabetes is a cardiometabolic comorbidity that may predispose COVID-19 patients to worse clinical outcomes. This study sought to determine the prevalence of diabetes in... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Diabetes is a cardiometabolic comorbidity that may predispose COVID-19 patients to worse clinical outcomes. This study sought to determine the prevalence of diabetes in hospitalized COVID-19 patients and investigate the association of diabetes severe COVID-19, rate of acute respiratory distress syndrome (ARDS), mortality, and need for mechanical ventilation by performing a systematic review and meta-analysis.
METHODS
Individual studies were selected using a defined search strategy, including results up until July 2021 from PubMed, Embase, and Cochrane Central Register of Controlled Trials. A random-effects meta-analysis was performed to estimate the proportions and level of association of diabetes with clinical outcomes in hospitalized COVID-19 patients. Forest plots were generated to retrieve the odds ratios (OR), and the quality and risk assessment was performed for all studies included in the meta-analysis.
RESULTS
The total number of patients included in this study was 10 648, of whom 3112 had diabetes (29.23%). The overall pooled estimate of prevalence of diabetes in the meta-analysis cohort was 31% (95% CI, 0.25-0.38; z = 16.09, P < .0001). Diabetes significantly increased the odds of severe COVID-19 (OR 3.39; 95% CI, 2.14-5.37; P < .0001), ARDS (OR 2.55; 95% CI, 1.74-3.75; P = <.0001), in-hospital mortality (OR 2.44; 95% CI, 1.93-3.09; P < .0001), and mechanical ventilation (OR 3.03; 95% CI, 2.17-4.22; P < .0001).
CONCLUSIONS
Our meta-analysis demonstrates that diabetes is significantly associated with increased odds of severe COVID-19, increased ARDS rate, mortality, and need for mechanical ventilation in hospitalized patients. We also estimated an overall pooled prevalence of diabetes of 31% in hospitalized COVID-19 patients.
Topics: COVID-19; Diabetes Complications; Hospital Mortality; Humans; Prevalence; Respiration, Artificial; Respiratory Distress Syndrome
PubMed: 34939735
DOI: 10.1111/1753-0407.13243 -
Frontiers in Endocrinology 2023To investigate the effect of embryo stage at the time of transfer on obstetric and perinatal outcomes in programmed frozen-thawed embryo transfer (FET) versus natural... (Meta-Analysis)
Meta-Analysis
The influence of embryo stage on obstetric complications and perinatal outcomes following programmed compared to natural frozen-thawed embryo transfer cycles: a systematic review and meta-analysis.
OBJECTIVE
To investigate the effect of embryo stage at the time of transfer on obstetric and perinatal outcomes in programmed frozen-thawed embryo transfer (FET) versus natural FET cycles.
DESIGN
Systematic review and meta-analysis.
SETTING
Not applicable.
PATIENTS
Women with programmed frozen-thawed embryo transfer (FET) and natural FET.
INTERVENTIONS
The PubMed, MEDLINE, and EMBASE databases and the Cochrane Central Register of Controlled Trials (CCRT) were searched from 1983 to October 2022. Twenty-three observational studies were included.
PRIMARY OUTCOME MEASURE
The primary outcomes were hypertensive disorders of pregnancy (HDPs), gestational hypertension and preeclampsia (PE). The secondary outcomes were gestational diabetes mellitus (GDM), placenta previa, postpartum haemorrhage (PPH), placental abruption, preterm premature rupture of membranes (PPROM), large for gestational age (LGA), small for gestational age (SGA), macrosomia, and preterm delivery (PTD).
RESULTS
The risk of HDP (14 studies, odds ratio (OR) 2.17; 95% confidence interval (CI) 1.95-2.41; P<0.00001; I = 43%), gestational hypertension (11 studies, OR 1.38; 95% CI 1.15-1.66; P=0.0006; I = 19%), PE (12 studies, OR 2.09; 95% CI 1.88-2.32; P<0.00001; I = 0%), GDM (20 studies, OR 1.09; 95% CI 1.02-1.17; P=0.02; I = 8%), LGA (18 studies, OR 1.11; 95% CI 1.07-1.15; P<0.00001; I = 46%), macrosomia (12 studies, OR 1.15; 95% CI 1.07-1.24; P=0.0002; I = 31%), PTD (22 studies, OR 1.21; 95% CI 1.15-1.27; P<0.00001; I = 49%), placenta previa (17 studies, OR 1.2; 95% CI 1.02-1.41; P=0.03; I = 11%), PPROM (9 studies, OR 1.19; 95% CI 1.02-1.39; P=0.02; I = 40%), and PPH (12 studies, OR 2.27; 95% CI 2.02-2.55; P <0.00001; I = 55%) were increased in programmed FET cycles versus natural FET cycles with overall embryo transfer. Blastocyst transfer had a higher risk of HDP (6 studies, OR 2.48; 95% CI 2.12-2.91; P<0.00001; I = 39%), gestational hypertension (5 studies, OR 1.87; 95% CI 1.27-2.75; P=0.002; I = 25%), PE (6 studies, OR 2.23; 95% CI 1.93-2.56; P<0.00001; I = 0%), GDM (10 studies, OR 1.13; 95% CI 1.04-1.23; P=0.005; I = 39%), LGA (6 studies, OR 1.14; 95% CI 1.07-1.21; P<0.0001; I = 9%), macrosomia (4 studies, OR 1.15; 95% CI 1.05-1.26; P<0.002; I = 68%), PTD (9 studies, OR 1.43; 95% CI 1.31-1.57; P<0.00001; I = 22%), PPH (6 studies, OR 1.92; 95% CI 1.46-2.51; P<0.00001; I = 55%), and PPROM (4 studies, OR 1.45; 95% CI 1.14-1.83; P=0.002; I = 46%) in programmed FET cycles than in natural FET cycles. Cleavage-stage embryo transfers revealed no difference in HDPs (1 study, OR 0.81; 95% CI 0.32-2.02; P=0.65; I not applicable), gestational hypertension (2 studies, OR 0.85; 95% CI 0.48-1.51; P=0.59; I = 0%), PE (1 study, OR 1.19; 95% CI 0.58-2.42; P=0.64; Inot applicable), GDM (3 study, OR 0.79; 95% CI 0.52-1.20; P=0.27; I = 21%), LGA (1 study, OR 1.15; 95% CI 0.62-2.11; P=0.66; Inot applicable), macrosomia (1 study, OR 1.22; 95% CI 0.54-2.77; P=0.64; I not applicable), PTD (2 studies, OR 1.05; 95% CI 0.74-1.49; P=0.79; I = 0%), PPH (1 study, OR 1.49; 95% CI 0.85-2.62; P=0.17; Inot applicable), or PPROM (2 studies, OR 0.74; 95% CI 0.46-1.21; P=0.23; I = 0%) between programmed FET cycles and natural FET cycles.
CONCLUSIONS
The risks of HDPs, gestational hypertension, PE, GDM, LGA, macrosomia, SGA, PTD, placenta previa, PPROM, and PPH were increased in programmed FET cycles versus natural FET cycles with overall embryo transfer and blastocyst transfer, but the risks were not clear for cleavage-stage embryo transfer.
Topics: Pregnancy; Infant, Newborn; Humans; Female; Hypertension, Pregnancy-Induced; Fetal Macrosomia; Placenta; Placenta Previa; Pre-Eclampsia; Diabetes, Gestational; Embryo Transfer
PubMed: 37664838
DOI: 10.3389/fendo.2023.1186068 -
Molecules (Basel, Switzerland) Jan 2022(1) Background: Benth. is a traditional medicine used in the treatment of diabetes and chronic renal failure in southern China, Malaysia, and Thailand. Diabetes is a...
(1) Background: Benth. is a traditional medicine used in the treatment of diabetes and chronic renal failure in southern China, Malaysia, and Thailand. Diabetes is a chronic metabolic disease and the number of diabetic patients in the world is increasing. This review aimed to systematically review the effects of in the treatment of diabetes and its complications and the pharmacodynamic material basis. (2) Methods: This systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), using the databases ScienceDirect, PubMed, and Web of Science. (3) Results: Thirty-one articles related to and diabetes were included. The mechanisms of in the treatment of diabetes and its complications mainly included inhibiting α-amylase and α-glucosidase activities, antioxidant and anti-inflammatory activities, regulating lipid metabolism, promoting insulin secretion, ameliorating insulin resistance, increasing glucose uptake, promoting glycolysis, inhibiting gluconeogenesis, promoting glucagon-likepeptide-1 (GLP-1) secretion and antiglycation activity. Phenolic acids, flavonoids and triterpenoids might be the main components for hypoglycemia effects in . (4) Conclusion: could be an antidiabetic agent to treat diabetes and its complications. However, it needs further study on a pharmacodynamic substance basis and the mechanisms of effective constituents.
Topics: Diabetes Complications; Diabetes Mellitus; Humans; Hypoglycemic Agents; Insulin Resistance; Lipid Metabolism; Medicine, East Asian Traditional; Orthosiphon; Plant Extracts; Plants, Medicinal
PubMed: 35056765
DOI: 10.3390/molecules27020444