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BMC Endocrine Disorders Jul 2023Childhood obesity is one of the main concerns of public health. Considering its long-term adverse health effect, various studies investigated the effect of drug therapy... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Childhood obesity is one of the main concerns of public health. Considering its long-term adverse health effect, various studies investigated the effect of drug therapy on anthropometric parameters and provided mixed results. In this systematic review and meta-analysis, we aimed to determine the effect of Orlistat on anthropometrics and biochemical parameters in children and adolescents.
MATERIALS AND METHODS
The databases of PubMed, Scopus, and Web of Science were searched until September 2022. Experimental and semi-experimental studies were included if they evaluated the effect of Orlistat on obesity-related parameters in children and reported the before and after anthropometric values. A revised Cochrane risk-of-bias (Rob2) was used to evaluate the methodological quality. STATA software version 16.0 was used for the meta-analysis of the random-effect model.
RESULTS
Of 810 articles retrieved in the initial search, four experimental and two semi-experimental studies were selected for systematic review. The result of the meta-analysis of experimental studies indicated the significant effect of Orlistat on waist circumference (SMD: -0.27, 95% CI: -0.47, -0.07) and serum insulin level (SMD: -0.89, 95% CI: -1.52, 0.26). However, there were no significant effects of orlistat on body weight, body mass index, lipid profile, and serum glucose level.
CONCLUSION
The present meta-analysis showed the significant effect of Orlistat on the reduction of waist circumference and insulin level in overweight and obese adolescents. However, due to the paucity of studies included in the meta-analysis, more prospective studies with longer duration and more sample sizes will be needed in this age group.
Topics: Child; Adolescent; Humans; Orlistat; Anti-Obesity Agents; Prospective Studies; Pediatric Obesity; Lactones; Insulins
PubMed: 37420181
DOI: 10.1186/s12902-023-01390-7 -
Environmental Science and Pollution... Oct 2021An update on systematic review and meta-analysis was performed to explore effects of phthalate exposure on insulin resistance. A systematic literature search was... (Meta-Analysis)
Meta-Analysis Review
An update on systematic review and meta-analysis was performed to explore effects of phthalate exposure on insulin resistance. A systematic literature search was performed in MEDLINE, Web of Science, and CNKI until March 2021. A conceptual framework was constructed to guide the organization and presentation of results. Besides, beta coefficients with corresponding confidence intervals were extracted from the most adjusted models. Extracted beta coefficients were transformed into correlation, and z Fisher transformation of correlation with the corresponding standard error was included in meta-analysis. Subgroup analyses were performed by age (adult vs. adolescent) and sex (female vs. male) of participants and site of study (America and Europe vs. Asia) to explore potential sources of heterogeneity. Nineteen literatures with 12,533 participants reporting on the association of exposure to specific phthalates and insulin resistance were selected. The majority of included studies revealed positive relationships of insulin resistance with different phthalate metabolites exposure. Meta-analyses were performed on 16 studies. Exposure to MnBP, MBzP, MCPP, MEHP, MEOHP, MEHHP, ∑DEHP, and high-molecular weight phthalate (∑HMWP) was associated with the increase of the homeostasis model assessment of insulin resistance (HOMA-IR) index. The results of sensitivity analyses stratified by age, sex, and site of study remained stable, suggesting the robustness of these meta-analyses. Most of heterogeneity in sensitivity analyses decreased to moderate or low degree. Exposure to MnBP, MBzP, MCPP, MEHP, MEOHP, MEHHP, ∑DEHP, and ∑HMWP was associated with the increased risk of HOMA-IR. Age, sex, and site of study might provide limited source of heterogeneity.
Topics: Adolescent; Adult; Asia; Environmental Exposure; Environmental Pollutants; Female; Humans; Insulin; Insulin Resistance; Male; Phthalic Acids
PubMed: 34498187
DOI: 10.1007/s11356-021-16252-9 -
Acta Paediatrica (Oslo, Norway : 1992) Jun 2023To study the outcomes of very preterm infants with hyperglycaemia treated with Insulin. (Meta-Analysis)
Meta-Analysis Review
AIM
To study the outcomes of very preterm infants with hyperglycaemia treated with Insulin.
METHODS
This is a systematic review of randomised controlled trials (RCTs) and observational studies. PubMed, Medline, EMBASE, Cochrane Library, EMCARE and MedNar databases were searched in May 2022. Data were pooled separately for adjusted and unadjusted odds ratios (ORs) using random-effects model.
MAIN OUTCOME MEASURES
Mortality and morbidities (e.g. Necrotising enterocolitis [NEC], retinopathy of prematurity [ROP]) in very preterm (<32 weeks) or very low birth weight infants (<1500 g) after treatment of hyperglycaemia with insulin.
RESULTS
Sixteen studies with data from 5482 infants were included. Meta-analysis of unadjusted ORs from cohort studies showed that insulin treatment was significantly associated with increased mortality [OR 2.98 CI (1.03 to 8.58)], severe ROP [OR 2.23 CI (1.34 to 3.72)] and NEC [OR 2.19 CI (1.11 to 4)]. However, pooling of adjusted ORs did not show significant associations for any outcomes. The only included RCT found better weight gain in the insulin group, but no effect on mortality or morbidities. Certainty of evidence was 'Low' or 'Very low'.
CONCLUSION
Very low certainty evidence suggests that Insulin therapy may not improve outcomes of very preterm infants with hyperglycaemia.
Topics: Infant; Infant, Newborn; Humans; Infant, Premature; Insulin; Infant, Very Low Birth Weight; Infant, Premature, Diseases; Retinopathy of Prematurity; Hyperglycemia
PubMed: 36895111
DOI: 10.1111/apa.16748 -
Oncotarget Jul 2017A meta-analysis has systematically investigated the antineoplastic efficacy and safety of somatostatin analogs (SSAs) in advanced gastro-entero-pancreatic neuroendocrine... (Meta-Analysis)
Meta-Analysis Review
A meta-analysis has systematically investigated the antineoplastic efficacy and safety of somatostatin analogs (SSAs) in advanced gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs). Randomized controlled trials (RCTs) reporting the hazard ratio (HR) for disease progression (DP) were evaluated. Response rate and risk ratio (RR) for adverse events were also analyzed. A total of 289 patients (143 receiving SSAs vs. 146 placebo) were evaluated from two RCTs. A significant benefit from SSAs in terms of disease control was observed (HR 0.41, 95% CI: 0.29 to 0.58, P < 0.01; I20%), response rate being 58.0% vs. 32.2%, respectively.The occurrence of adverse events significantly differed from the placebo arm only in terms of biliary stones (RR 3.79, 95% CI: 1.28 to 11.17, P = 0.02; I20%). In conclusion, SSAs showed an antiproliferative effect in advanced GEP-NETs, with a good safety profile.
Topics: Antineoplastic Agents; Cell Proliferation; Disease Progression; Gastrointestinal Neoplasms; Humans; Neoplasm Staging; Neuroendocrine Tumors; Pancreatic Neoplasms; Proportional Hazards Models; Somatostatin; Treatment Outcome
PubMed: 28402955
DOI: 10.18632/oncotarget.16686 -
Journal of the ASEAN Federation of... 2023A daily habit of yogic practice or walking, along with an oral hypoglycemic agent (OHA) could be beneficial for better control of type 2 diabetes mellitus (T2DM). We... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
A daily habit of yogic practice or walking, along with an oral hypoglycemic agent (OHA) could be beneficial for better control of type 2 diabetes mellitus (T2DM). We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to find out the efficiency of yoga or walking on glycemic control in T2DM.
METHODOLOGY
The present systematic review and meta-analysis were completed according to the PRISMA guidelines. The risk of bias in included studies was evaluated, by using the revised Cochrane risk-of-bias tool for randomized trials. Meta-analysis was implemented using RevMan software. Forest plots were used to illustrate the study findings and meta-analysis results.
RESULTS
Sixteen studies were included in this systematic review, where 1820 participants were allocated to one of the following interventions: yoga, walking, and without any regular exercise (control group). Participants were between 17-75 years of age. Compared to the control group, the yoga group had a significant reduction in fasting blood glucose (FBG) by 31.98 mg/dL (95% CI = -47.93 to -16.03), postprandial blood glucose (PPBG) by 25.59 mg/dL (95% CI = -44.00 to -7.18], glycosylated hemoglobin (HbAlc) by 0.73% (95% CI = -1.24 to -0.22), fasting insulin by 7.19 μIU/mL (95% CI = -12.10 to -2.28), and homeostatic model assessment for insulin resistance (HOMA-IR) by 3.87 (95% CI = -8.40 to -0.66). Compared to the control group, the walking group had a significant reduction in FBG by 12.37 mg/dL (95% CI = -20.06 to -4.68) and HbA1c by 0.35% (95% CI = -0.70 to -0.01). Compared to the walking group, the yoga group had a significant reduction in FBG by 12.07 mg/dL (95% CI = -24.34 to - 0.20), HbA1c by 0.20% (95% CI = -0.37 to -0.04), fasting insulin by 10.06 μIU/mL (95% CI = -23.84 to 3.71) and HOMA-IR by 5.97 (95% CI = -16.92 to 4.99).
CONCLUSIONS
Yoga or walking with OHA has positive effects on glycemic control. For the management of T2DM, yoga has relatively more significant effects on glycemic control than walking.Review registration number: PROSPERO registration number CRD42022310213.
Topics: Humans; Blood Glucose; Glycated Hemoglobin; Yoga; Glycemic Control; Diabetes Mellitus, Type 2; Insulin; Insulin Resistance; Walking; Insulin, Regular, Human
PubMed: 38045671
DOI: 10.15605/jafes.038.02.20 -
Journal of Trace Elements in Medicine... May 2022Diabetic dyslipidemia is caused by hyperglycemia and excessive mobilization of storage lipids, leading to increasing concentrations of triglycerides and total... (Review)
Review
BACKGROUND
Diabetic dyslipidemia is caused by hyperglycemia and excessive mobilization of storage lipids, leading to increasing concentrations of triglycerides and total cholesterol. Due to the insulin-mimetic or insulin-enhancer features of vanadium, it has been recognized as a regulator of cell metabolism with hypoglycemic and hypolipidemic properties. The purpose of the current animal systematic review was to evaluate the effect of vanadium administration on diabetic dyslipidemia in diabetic animals.
METHODS
This is, to our knowledge, the first systematic review with the aim of investigating the relationship between vanadium and diabetic dyslipidemia among diabetes induced animals. Searches were performed in PubMed, Scopus, and web of science databases for animal studies examining the effect of vanadium on diabetic dyslipidemia in diabetic animals.
RESULTS
Of 124 full-text articles assessed, 48 animal studies were included in the present study with minor risk of bias. The majority of the studies confirmed the beneficial effects of different vanadium compounds in at least one of the parameters of lipid profile, especially regarding triglyceride and total cholesterol.
CONCLUSION
Current findings lend support to assess the long-term effects of different forms and doses of vanadium on lipid profile through well-designed clinical trials.
Topics: Animals; Diabetes Mellitus; Dyslipidemias; Hypoglycemic Agents; Insulin; Vanadium
PubMed: 35303513
DOI: 10.1016/j.jtemb.2022.126955 -
Neuroscience and Biobehavioral Reviews Jul 2021Food anticipatory hormonal responses (cephalic responses) are proactive physiological processes, that allow animals to prepare for food ingestion by modulating their... (Review)
Review
Food anticipatory hormonal responses (cephalic responses) are proactive physiological processes, that allow animals to prepare for food ingestion by modulating their hormonal levels in response to food cues. This process is important for digesting food, metabolizing nutrients and maintaining glucose levels within homeostasis. In this systematic review, we summarize the evidence from animal and human research on cephalic responses. Thirty-six animal and fifty-three human studies were included. The majority (88 %) of studies demonstrated that hormonal levels are changed in response to cues previously associated with food intake, such as feeding time, smell, and sight of food. Most evidence comes from studies on insulin, ghrelin, pancreatic polypeptide, glucagon, and c-peptide. Moreover, impaired cephalic responses were found in disorders related to metabolism and food intake such as diabetes, pancreatic insufficiency, obesity, and eating disorders, which opens discussions about the etiological mechanisms of these disorders as well as on potential therapeutic opportunities.
Topics: Animals; Blood Glucose; Eating; Food; Ghrelin; Humans; Insulin
PubMed: 33812978
DOI: 10.1016/j.neubiorev.2021.03.030 -
International Journal of Obesity (2005) Oct 2023It is unknown whether vegetarian diets (VDs) may improve outcomes in people with overweight and obesity. (Meta-Analysis)
Meta-Analysis Review
Vegetarian diets on anthropometric, metabolic and blood pressure outcomes in people with overweight and obesity: a systematic review and meta-analysis of randomized controlled trials.
BACKGROUND
It is unknown whether vegetarian diets (VDs) may improve outcomes in people with overweight and obesity.
OBJECTIVE
To systematically assess the effects of VDs vs. omnivore diets on anthropometric, metabolic, and blood pressure outcomes in people with overweight and obesity.
METHODS
We searched for randomized controlled trials (RCTs) in EMBASE, PubMed, Web of Science, and Scopus until February 2, 2022. Primary outcomes were anthropometric risk factors (weight, body mass index [BMI], waist circumference [WC], hip circumference [HC], and body fat percentage). Secondary outcomes were metabolic risk factors (fasting serum glucose, HbA1c, insulin levels) and blood pressure (systolic blood pressure [SBP], diastolic blood pressure [DBP]). Random-effects meta-analyses were performed and effects were expressed as mean difference (MD) and their 95% confidence intervals (CI). The quality of evidence was assessed using GRADE methods.
RESULTS
Nine RCTs (n = 1628) were included. VDs decreased weight (MD -3.60 kg, 95%CI -4.75 to -2.46) and glucose (MD -10.64 mg/dL, 95%CI -15.77 to -5.51), but did not decrease WC (MD -3.00 cm, 95%CI -6.20 to 0.20), BMI (MD -0.87 kg/m2, 95%CI -1.80 to 0.06), or HC (MD: -0.86 cm, 95%CI -3.46 to 1.74). VDs did not decrease HbA1c (MD -0.40%, 95%CI -0.89 to 0.10), insulin (MD -3.83 mU/L, 95%CI -8.06 to 0.40), SBP (MD -0.25 mmHg, 95%CI -2.58 to 2.07), or DBP (MD -1.57 mmHg, 95%CI -3.93 to 0.78). Subgroup analyses by type of VD (four RCTs evaluated lacto-ovo-vegetarian diets and five RCTs vegan diets) showed similar results to the main analyses. QoE was very low for most of the outcomes.
CONCLUSIONS
In comparison to an omnivorous diet, VDs may reduce weight and glucose, but not blood pressure or other metabolic or anthropometric outcomes. However, the QoE was mostly very low. Larger RCTs are still needed to evaluate the effects of VD on anthropometric, metabolic factors, and blood pressure in people with overweight and obesity.
Topics: Humans; Overweight; Glycated Hemoglobin; Randomized Controlled Trials as Topic; Obesity; Diet, Vegetarian; Glucose; Insulins
PubMed: 37528197
DOI: 10.1038/s41366-023-01357-7 -
Journal of Endocrinological... Feb 2016A systematic review and meta-analysis of interventional studies was conducted to compare the efficacy and safety of oral insulin versus subcutaneous (SC) insulin in... (Comparative Study)
Comparative Study Meta-Analysis Review
INTRODUCTION
A systematic review and meta-analysis of interventional studies was conducted to compare the efficacy and safety of oral insulin versus subcutaneous (SC) insulin in diabetic patients.
METHODS
Medline, Scopus, ISI Web of Knowledge and Cochrane Central Register of Controlled Trials were searched. Two independent reviewers evaluated studies for eligibility and quality and extracted the data. The primary outcomes were fasting blood glucose (FBG), 1h and 2h postprandial blood glucose, HbA1c, AUC of insulin, C max and T max of insulin, and T max of glucose infusion rate. Secondary outcomes were adverse events.
RESULTS
Eleven studies (n = 373) met the inclusion criteria. Meta-analyses showed that there is no significant difference between oral and SC insulin in controlling HbA1c, FBG, 1 and 2 h postprandial blood glucose and producing C max of insulin (P > 0.05); however oral insulin had faster action as indicated by the shorter T max, compared to SC insulin (P < 0.05). The most included studies were varied in their methodological quality.
CONCLUSION
This systematic review and meta-analysis showed that oral insulin is comparable to SC insulin with regard to glycemic efficacy and safety. However, is necessary to conduct additional studies in which oral insulin administered to large number of patients for long enough periods of time.
Topics: Administration, Oral; Clinical Trials as Topic; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Glycated Hemoglobin; Humans; Hyperglycemia; Hypoglycemia; Hypoglycemic Agents; Injections, Subcutaneous; Insulin
PubMed: 26105973
DOI: 10.1007/s40618-015-0326-3 -
American Journal of Therapeutics 2020A good metabolic control before conception and throughout pregnancy with diabetes decreases the risk of short- and long-term adverse outcomes of the mothers and their...
BACKGROUND
A good metabolic control before conception and throughout pregnancy with diabetes decreases the risk of short- and long-term adverse outcomes of the mothers and their offsprings. Insulin treatment remains the gold standard treatment recommended for any type of diabetes. New technologies including new insulins and insulin analogues, continuous subcutaneous insulin infusion without and with sensors, the low-glucose predictive suspension function, and closed-loop systems that persistently and automatically self-adjust according to patients' continuous glucose monitoring readings have expanded the offer to clinicians for achieving tight glucose control.
AREAS OF UNCERTAINTY
Unsafe effects of insulin and insulin analogues in pregnancy with diabetes could be linked with changes in insulin immunogenicity, teratogenicity, and mitogenicity. Second-generation insulin analogues need to be tested and proven. Effectiveness and safety of new insulin delivery systems in real life of diabetic women in pregnancy need further confirmations.
SOURCES
MEDLINE, EMBASE, Web of Science, Cochrane Library, randomized controlled trials, systematic review and meta-analysis, observational prospective and retrospective studies, case series reports for the most recent insulin analogues, published in English impacted journals, and consensus statements from scientific societies I excluded 60 from 221 papers as not suitable for the purpose of the subject.
RESULTS
Subcutaneous insulin infusion can be safely used during pregnancy and delivery of well-trained women. Sensors are increasingly accurate tools that improve the efficacy and safety of integrated systems' functioning. Continuous glucose monitoring provides metrics ("time in range" time in "hypoglycemia" and in "hyperglycemia," glucose variability, average glucose levels in different time intervals) used as a guide to diabetes management; these new metrics are object of discussion in special populations. Randomized controlled trials have shown that sensor-augmented pump therapy improves pregnancy outcomes in women with type 1 diabetes. Closed-loop insulin delivery provides better glycemic control than sensor-augmented pump therapy during pregnancy, before, and after delivery.
CONCLUSION
Second-generation insulin analogues and newer insulin infusion systems that automatically self-adjust according to patients continuous glucose monitor readings are important tools improving the treatment and quality of life of these women. Multi-institutional and disciplinary teams are working to develop and evaluate a pregnancy-specific artificial pancreas.
Topics: Blood Glucose; Blood Glucose Self-Monitoring; Diabetes Complications; Diabetes Mellitus, Type 1; Drug Delivery Systems; Female; Humans; Hypoglycemia; Hypoglycemic Agents; Insulin; Insulin Infusion Systems; Insulin-Like Growth Factor I; Pregnancy; Quality of Life
PubMed: 31688066
DOI: 10.1097/MJT.0000000000001095