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Annals of Medicine and Surgery (2012) Jun 2024Dyslipidemia is an established cardiovascular risk factor in persons with type 2 diabetes (T2D), yet the extent to which these conditions co-occur in Africa is unknown....
BACKGROUND
Dyslipidemia is an established cardiovascular risk factor in persons with type 2 diabetes (T2D), yet the extent to which these conditions co-occur in Africa is unknown. This systematic review and meta-analysis aimed to determine the prevalence of dyslipidemia among persons with T2D in Africa.
METHODS
Medline, Embase, Global Health, Scopus, and Web of Science were searched on 5 December 2023. This review adhered to the PRISMA guidelines and was prospectively registered on PROSPERO. The prevalence data for dyslipidemia was pooled through a random-effects meta-analysis. The authors assessed heterogeneity and publication bias using statistics and Egger's test, respectively.
RESULTS
Our search identified 8035 records, of which 60 articles involving 20 034 individuals with T2D were included in this review. The pooled prevalence of dyslipidemia recorded 38.6% (95% CI: 34.1-43.4) for high TC (≥ 5.2 mmol/l), 52.7% (95% CI: 44.2-61.1) for high low-density lipoprotein cholesterol (LDL-C) (≥ 2.6 mmol/l), 43.5% (95% CI: 37.1-50.0) for low high-density lipoprotein cholesterol (HDL-C) (< 1.0 mmol/l in men and less than 1.3 mmol/l in women), and 37.4% (95% CI: 32.2-42.9) for high triglycerides (TG) (≥ 1.7 mmol/l). Subgroup analysis based on gender indicated a notably higher prevalence of dyslipidemia among females compared to males.
CONCLUSION
Dyslipidemia is prevalent among persons with T2D in Africa. This highlights the need for early screening, diagnosis, and management of dyslipidemia to mitigate the risk of cardiovascular complications in this population.
PubMed: 38846843
DOI: 10.1097/MS9.0000000000002122 -
Annals of Medicine and Surgery (2012) Jun 2024Diabetic nephropathy is one of the consequences of diabetes mellitus that causes a continuous decline in the eGFR. After the COVID-19 pandemic, studies have shown that...
BACKGROUND
Diabetic nephropathy is one of the consequences of diabetes mellitus that causes a continuous decline in the eGFR. After the COVID-19 pandemic, studies have shown that patients with diabetic nephropathy who had contracted COVID-19 have higher rates of morbidity and disease progression. The aim of this study was to systematically review the literature to determine and understand the effects and complications of SARS-CoV-2 on patients with diabetic nephropathy.
MATERIALS AND METHODS
The authors' research protocol encompassed the study selection process, search strategy, inclusion/exclusion criteria, and a data extraction plan. A systematic review was conducted by a team of five reviewers, with an additional reviewer assigned to address any discrepancies. To ensure comprehensive coverage, the authors employed multiple search engines including PubMed, ResearchGate, ScienceDirect, SDL, Ovid, and Google Scholar.
RESULTS
A total of 14 articles meeting the inclusion criteria revealed that COVID-19 directly affects the kidneys by utilizing ACE2 receptors for cell entry, which is significant because ACE2 receptors are widely expressed in the kidney.
CONCLUSION
COVID-19 affects kidney health, especially in individuals with diabetic nephropathy. The mechanisms include direct viral infection and immune-mediated injury. Early recognition and management are vital for improving the outcomes.
PubMed: 38846830
DOI: 10.1097/MS9.0000000000002053 -
Heliyon Jun 2024Gestational diabetes mellitus (GDM) is the most common medical complication of pregnancy, and it can lead to complications for the mother and the infant/fetus. This was...
BACKGROUND
Gestational diabetes mellitus (GDM) is the most common medical complication of pregnancy, and it can lead to complications for the mother and the infant/fetus. This was especially evident during the COVID-19 pandemic. Therefore, the present systematic review aimed to describe the changes in screening, diagnosis, management, and outcomes of gestational diabetes during the COVID-19 pandemic.
METHODS
The systematic review was conducted from December 2019 until January 1, 2022. To find articles related to the purpose of the study, PubMed, Scopus, Web of Science, and WHO were searched using relevant and validated keywords using MeSH/Emtree.
RESULTS
In total, 675 entries were ascertained from the database inquiry, and 17 scholarly works were deemed suitable for inclusion in the final review. The salient conclusions derived from this review were as follows: (a) During the COVID-19 pandemic, there was a significant decrease in the use of OGTTs and a rise in the use of HbA1c assays for both GDM screening and diagnosing. (b) A predominant number of physicians incorporated some variation of telemedicine to remotely supervise and conduct follow-up evaluations of patients with GDM. Various strategies are presented for the provision of prenatal care to women afflicted with GDM, such as concentrating on high-risk demographics, the initiation of lifestyle modifications at early stages, and the implementation of remote patient monitoring techniques. The 'single test procedure' is identified as the most suitable for the preliminary screening of GDM. The OGTT should be assigned clinical precedence in patients at high risk during the ongoing COVID-19 pandemic. Additionally, Medical Nutrition Therapy (MNT) was established as the primary management strategy, and the most influential determinant of the transition from dietary adjustments to pharmacotherapy was the Fasting Blood Glucose (FBG) levels during the second trimester.
CONCLUSION
Suggested strategies for GDM screening and management during the pandemic integrated into routine antenatal care, emphasized the importance of remote diabetes education and technology utilization during health emergencies.
PubMed: 38845870
DOI: 10.1016/j.heliyon.2024.e31943 -
Renal Failure Dec 2024To determine the efficacy and safety of Astragalus combined with renin-angiotensin-aldosterone system (RAAS) blockers in treating stage III diabetic nephropathy (DN) by... (Meta-Analysis)
Meta-Analysis
Efficacy of astragalus combined with renin-angiotensin-aldosterone system blockers in the treatment of stage III diabetic nephropathy: a systematic review and meta-analysis.
OBJECTIVE
To determine the efficacy and safety of Astragalus combined with renin-angiotensin-aldosterone system (RAAS) blockers in treating stage III diabetic nephropathy (DN) by meta-analysis.
METHODS
PubMed, Embase, Cochrane Library, Wiley, and Web of Science databases were searched for articles published between August 2007 and August 2022. Clinical studies on Astragalus combined with RAAS blockers for the treatment of stage III DN were included. Meta-analysis was performed by RevMan 5.1 and Stata 14.3 software.
RESULTS
A total of 32 papers were included in this meta-analysis, containing 2462 patients from randomized controlled trials, with 1244 receiving the combination treatment and 1218 solely receiving RAAS blockers. Astragalus combined with RAAS blockers yielded a significantly higher total effective rate (TER) (mean difference [MD] 3.63, 95% confidence interval [CI] 2.59-5.09) and significantly reduced urinary protein excretion rate (UPER), serum creatinine (Scr), blood urine nitrogen (BUN) and glycosylated hemoglobin (HbAlc) levels. In subgroup analysis, combining astragalus and angiotensin receptor blocker significantly lowered fasting plasma glucose (FPG) and 24 h urinary protein (24hUTP) levels, compared with the combined astragalus and angiotensin-converting enzyme inhibitor treatment. Meanwhile, the latter significantly decreased the urinary microprotein (β-MG). Importantly, the sensitivity analysis confirmed the study's stability, and publication bias was not detected for UPER, BUN, HbAlc, FPG, or β-MG. However, the TER, SCr, and 24hUTP results suggested possible publication bias.
CONCLUSIONS
The astragalus-RAAS blocker combination treatment is safe and improves outcomes; however, rigorous randomized, large-scale, multi-center, double-blind trials are needed to evaluate its efficacy and safety in stage III DN.
Topics: Humans; Diabetic Nephropathies; Angiotensin-Converting Enzyme Inhibitors; Renin-Angiotensin System; Drug Therapy, Combination; Angiotensin Receptor Antagonists; Astragalus Plant; Randomized Controlled Trials as Topic; Drugs, Chinese Herbal; Treatment Outcome; Creatinine; Glycated Hemoglobin; Proteinuria
PubMed: 38836372
DOI: 10.1080/0886022X.2024.2359033 -
Frontiers in Endocrinology 2024The optimal resuscitative fluid for patients with diabetic ketoacidosis (DKA) remains controversial. Therefore, our objective was to assess the effect of balanced... (Meta-Analysis)
Meta-Analysis Comparative Study
PURPOSE
The optimal resuscitative fluid for patients with diabetic ketoacidosis (DKA) remains controversial. Therefore, our objective was to assess the effect of balanced crystalloids in contrast to normal saline on clinical outcomes among patients with DKA.
METHODS
We searched electronic databases for randomized controlled trials comparing balanced crystalloids versus normal saline in patients with DKA, the search period was from inception through October 20, 2023. The outcomes were the time to resolution of DKA, major adverse kidney events, post-resuscitation chloride, and incidence of hypokalemia.
RESULTS
Our meta-analysis encompassed 11 trials, incorporating a total of 753 patients with DKA. There was no significant difference between balanced crystalloids and normal saline group for the time to resolution of DKA (MD -1.49, 95%CI -4.29 to 1.31, P=0.30, I = 65%), major adverse kidney events (RR 0.88, 95%CI 0.58 to 1.34, P=0.56, I = 0%), and incidence of hypokalemia (RR 0.80, 95%CI 0.43 to 1.46, P=0.46, I = 56%). However, there was a significant reduction in the post-resuscitation chloride (MD -3.16, 95%CI -5.82 to -0.49, P=0.02, I = 73%) among patients received balanced crystalloids.
CONCLUSION
Among patients with DKA, the use of balanced crystalloids as compared to normal saline has no effect on the time to resolution of DKA, major adverse kidney events, and incidence of hypokalemia. However, the use of balanced crystalloids could reduce the post-resuscitation chloride.
SYSTEMATIC REVIEW REGISTRATION
https://osf.io, identifier c8f3d.
Topics: Humans; Diabetic Ketoacidosis; Crystalloid Solutions; Randomized Controlled Trials as Topic; Fluid Therapy; Saline Solution; Hypokalemia
PubMed: 38836222
DOI: 10.3389/fendo.2024.1367916 -
PloS One 2024Cognitive impairment (CI) is common among patients with chronic kidney disease (CKD), and is associated with a poor prognosis. We assessed the prevalence and associated... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Cognitive impairment (CI) is common among patients with chronic kidney disease (CKD), and is associated with a poor prognosis. We assessed the prevalence and associated factors of CI in patients with CKD.
METHODS
A systematic review and meta-analysis were conducted by searching PubMed, Embase, and the Web of Science through December 1, 2023. Random effects models were performed with subgroup analyses to further explore the heterogeneity.
RESULTS
50 studies involving 25,289 CKD patients were included. The overall prevalence of CI was 40% (95% confidence interval 33-46). The pooled prevalence of CI was relatively higher in CKD patients from Africa (58%), Asia (44%) and America (37%). Attention and executive dysfunction appeared to be the most common manifestations. The prevalence of CI was higher among patients with hemodialysis (53%) and peritoneal dialysis (39%) than those without dialysis (32%) and post-kidney transplanted (26%). In addition, advanced age, the presence of diabetes and hypertension might increase the risk of CI in CKD patients.
CONCLUSIONS
People with CKD have a high prevalence of CI, especially in patients with hemodialysis. An early and comprehensive screening for CI in CKD patients is needed to improve clinical outcomes.
TRIAL REGISTRATION
Registration number: PROSPERO (CRD42023412864).
Topics: Humans; Renal Insufficiency, Chronic; Cognitive Dysfunction; Prevalence; Renal Dialysis; Risk Factors
PubMed: 38829896
DOI: 10.1371/journal.pone.0304762 -
Diabetes Research and Clinical Practice Jun 2024This review aims to identify and report epidemiological associations between modifiable lifestyle risk factors for overweight or obesity in children and adolescents with... (Review)
Review
This review aims to identify and report epidemiological associations between modifiable lifestyle risk factors for overweight or obesity in children and adolescents with type 1 diabetes (T1D). A systematic literature search of medical databases from 1990 to 2023 was undertaken. Inclusion criteria were observational studies reporting on associations between dietary factors, disordered eating, physical activity, sedentary and sleep behaviours and measures of adiposity in children and adolescents (<18 years) with T1D. Thirty-seven studies met inclusion criteria. Studies were mostly cross-sectional (89 %), and 13 studies included adolescents up to 19 years which were included in this analysis. In adolescents with T1D, higher adiposity was positively associated with disordered eating behaviours (DEB) and a higher than recommended total fat and lower carbohydrate intake. A small amount of evidence suggested a positive association with skipping meals, and negative associations with diet quality and sleep stage. There were no published associations between overweight and physical activity, sedentary behaviours and eating disorders. Overall, the findings infer relationships between DEB, fat and carbohydrate intake and adiposity outcomes in people with T1D. Prospective studies are needed to determine causal relationships and to investigate sleep stages. High quality studies objectively measuring physical activity and include body composition outcomes are needed.
Topics: Humans; Adolescent; Diabetes Mellitus, Type 1; Child; Risk Factors; Life Style; Exercise; Pediatric Obesity; Overweight; Feeding Behavior; Sedentary Behavior; Female
PubMed: 38821415
DOI: 10.1016/j.diabres.2024.111724 -
PloS One 2024The increased prevalence of visual impairment among diabetes patients has become a major global public health problem. Although numerous primary studies have been... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
The increased prevalence of visual impairment among diabetes patients has become a major global public health problem. Although numerous primary studies have been conducted to determine the prevalence of visual impairment and its associated factors among diabetes patients in Ethiopia, these studies presented inconsistent findings. Therefore, this review aimed to determine the pooled prevalence of visual impairment and identify associated factors among diabetes patients.
METHODS
An extensive search of literature was done on PubMed, Google Scholar, and Web of Sciences databases. A manual search of the reference lists of included studies was performed. A weighted inverse-variance random-effects model was used to calculate the pooled prevalence of visual impairment.
RESULTS
A total of 34 eligible primary studies with a sample size of 11,884 participants were included in the final meta-analysis. The pooled prevalence of visual impairment was 21.73% (95% CI: 18.15, 25.30; I2 = 96.47%; P<0.001). Diabetes mellitus with a duration of diagnosis ≥10 years [AOR = 3.18, 95% CI: 1.85, 5.49], presence of co-morbid hypertension [AOR = 3.26, 95% CI: 1.93, 5.50], poor glycemic control [AOR = 4.30, 95% CI: 3.04, 6.06], age ≥56 years [AOR = 4.13, 95% CI: 2.27, 7.52], family history of diabetes mellitus [AOR = 4.18 (95% CI: 2.61, 6.69], obesity [AOR = 4.77, 95% CI: 3.00, 7.59], poor physical activity [AOR = 2.46, 95% CI: 1.75, 3.46], presence of visual symptoms [AOR = 4.28, 95% CI: 2.73, 6.69] and no history of eye exam [AOR = 2.30, 95% CI: 1.47, 3.57] were significantly associated with visual impairment.
CONCLUSIONS
The pooled prevalence of visual impairment was high in Ethiopia. Diabetes mellitus with a duration of diagnosis ≥10 years, presence of co-morbid hypertension, poor glycemic control, age ≥56 years, and family history of diabetes mellitus, obesity, poor physical activity, presence of visual symptoms, and no history of eye exam were independent predictors. Therefore, diabetic patients with these identified risks should be screened, and managed early to reduce the occurrence of visual impairment related to diabetes. Moreover, public health policy with educational programs and regular promotion of sight screening for all diabetes patients are needed.
Topics: Humans; Diabetes Complications; Diabetes Mellitus; Ethiopia; Hypertension; Prevalence; Risk Factors; Vision Disorders; Middle Aged
PubMed: 38820429
DOI: 10.1371/journal.pone.0303388 -
Nutrition & Diabetes May 2024Vitamin D deficiency has been linked with several adverse maternal and fetal outcomes.
BACKGROUND
Vitamin D deficiency has been linked with several adverse maternal and fetal outcomes.
OBJECTIVE
To summarize systematic reviews and meta-analyses evaluating the effects of vitamin D deficiency and of vitamin D supplementation in pregnancy on maternal and offspring health-related outcomes.
METHODS
Prior to conducting this umbrella review, we registered the protocol in PROSPERO (CRD42022368003). We conducted searches in PubMed, Embase, and Cochrane Library for systematic reviews and meta-analyses on vitamin D in pregnancy, from database inception to October 2, 2023. All outcomes related to vitamin D in pregnancy obtained from the systematic reviews and meta-analyses were extracted.
DATA EXTRACTION
Two reviewers independently chose studies and collected information on health outcomes. The quality of the included articles' methodology was assessed using AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews-2).
RESULTS
We identified 16 eligible systematic reviews and meta-analyses, which included 250,569 women. Our results demonstrated that vitamin D deficiency in pregnancy is associated with increased risk of preterm birth, small-for gestational age/low birth weight infants, recurrent miscarriage, bacterial vaginosis and gestational diabetes mellitus. Vitamin D supplementation in pregnancy increases birth weight, and reduces the risk of maternal pre-eclampsia, miscarriage, and vitamin D deficiency, fetal or neonatal mortality, as well as attention-deficit hyperactivity disorder, and autism spectrum disorder in childhood. In women with gestational diabetes mellitus, vitamin D supplementation in pregnancy can reduce the risk of maternal hyperbilirubinemia, polyhydramnios, macrosomia, fetal distress, and neonatal hospitalization.
CONCLUSION
Due to the association with adverse maternal and offspring health outcomes, we recommend the vitamin D status in pregnancy should be monitored, particularly in women at high risk of vitamin D deficiency. It is suggested that pregnant women take a dose of >400 IU/day of vitamin D supplementation during pregnancy to prevent certain adverse outcomes.
Topics: Humans; Pregnancy; Female; Vitamin D Deficiency; Vitamin D; Pregnancy Complications; Dietary Supplements; Pregnancy Outcome; Systematic Reviews as Topic; Meta-Analysis as Topic; Infant, Newborn; Premature Birth
PubMed: 38816412
DOI: 10.1038/s41387-024-00296-0 -
Diabetology & Metabolic Syndrome May 2024Several studies have focused on the impact of frailty on the health outcomes of individuals with diabetes mellitus (DM). This meta-analysis aims to systematically...
BACKGROUND
Several studies have focused on the impact of frailty on the health outcomes of individuals with diabetes mellitus (DM). This meta-analysis aims to systematically synthesize the existing evidence on frailty and its association with mortality, hospitalizations, cardiovascular diseases, and diabetic complications in DM.
METHODS
A comprehensive search in PubMed, Embase, and SCOPUS was carried out to identify relevant studies assessing the impact of frailty on mortality, hospitalizations, complications, and cardiovascular events in individuals with DM. The quality of the included studies was evaluated using the New Castle Ottawa Scale.
RESULTS
From the 22 studies included, our meta-analysis revealed significant associations between frailty and adverse outcomes in individuals with DM. The pooled hazard ratios for mortality and frailty showed a substantial effect size of 1.84 (95% CI 1.46-2.31). Similarly, the odds ratio for hospitalization and frailty demonstrated a significant risk with an effect size of 1.63 (95% CI 1.50-1.78). In addition, frailty was associated with an increased risk of developing diabetic nephropathy (HR, 3.17; 95% CI 1.16-8.68) and diabetic retinopathy (HR, 1.94; 95% CI 0.80-4.71).
CONCLUSION
Our results show a consistent link between frailty and increased mortality, heightened hospitalization rates, and higher risks of cardiovascular disease, diabetic nephropathy, and diabetic retinopathy for patients with DM. PROSPERO Registration Number: CRD42023485166.
PubMed: 38802895
DOI: 10.1186/s13098-024-01352-6