Prevalence of lipohypertrophy in insulin‐treated diabetes patients: A systematic review and meta‐analysis

Aims/Introduction

Insulin‐treated diabetes patients are at high risk for lipohypertrophy (LH), but this clinical problem has been overlooked by some medical professionals. In addition, studies differed from each other significantly in regard to the prevalence of LH. The present systematic review aimed to determine pooled prevalence levels of LH among insulin‐injecting diabetes patients.

Materials and Methods

Four electronic databases (PubMed, EMBASE, The Cochrane Library and Scopus) were searched for eligible studies from their inception until April 2017, and reference lists were searched manually to identify additional studies. Studies containing data on LH in patients with diabetes mellitus were included. Meta‐analysis was carried out with a random effects model.

Results

A total of 26 studies with a total of 12,493 participants met the inclusion criteria. Meta‐analysis showed that the pooled prevalence of LH was 38% (95% confidence interval [CI] 29–46%, I² = 99.1%). The main influence on LH was the type of diabetes mellitus. The pooled prevalence of LH among patients with type 2 diabetes mellitus was higher than patients with type 1 diabetes mellitus (49%, 95% CI 23–74% vs 34%, 95% CI 19–49%). The pooled prevalence of LH of studies involving a mixed type of diabetes mellitus was 37% (95% CI 25–48%, I² = 98.3%).

Conclusion

The prevalence of LH was high in insulin‐treated diabetes patients. It showed that diabetes nurses should screen for LH regularly in their patients, and teach them how to prevent LH in their daily management of diabetes mellitus.     

吸烟对男性2型糖尿病患者血糖控制的影响

对757例男性2型糖尿病患者进行糖尿病病史、吸烟状况、体力活动、饮食控制和与糖代谢有关的实验室检查，发现每日吸烟数量与空腹血糖(FBG)、餐后2h血糖(2hPBG)、HbAic正相关。     

Hip circumference,height and risk of type 2 diabetes: systematic review and meta‐analysis

Although several epidemiological studies have investigated the relationship between type 2 diabetes mellitus (T2DM) and hip circumference or height, the results are inconsistent. The present systematic review and meta‐analysis of published observational studies was conducted to assess the effects of hip circumference and height on diabetes risk. Online databases were searched through January 2012, and the reference lists of pertinent articles reporting observational studies in humans were examined. Pooled relative risks (RR) and 95% confidence intervals (CI) were calculated with a random‐effects model. Eighteen studies (nine cross‐sectional and nine cohort) were included, with 250,497 participants and 7,765 cases of T2DM. Hip circumference was inversely associated with an increased risk of T2DM in men (summary RR [95% CI] 0.60 [0.45, 0.80]) and women (0.54 [0.42, 0.70]). These results were consistent between cross‐sectional and cohort studies. An inverse association between height and T2DM was observed in women only (summary RR [95% CI] 0.83 [0.73, 0.95]). Our meta‐analysis strongly supports an inverse relationship between hip circumference and risk of T2DM in men and women. The inverse association between height and risk was significant only in women.     

Effects of mindfulness-based intervention on glycemic control and psychological outcomes in people with diabetes: A systematic review and meta-analysis

Aims/IntroductionPsychological therapies have showed benefits for both glycemic control and psychological outcomes in people with diabetes. However, the effects of mindfulness‐based intervention (MBI) on glycemic control and psychological outcomes are inconsistent across studies, and the evidence for MBI has not been summarized. We aimed to identify the effects of MBI on glycemic control and psychological outcomes in people with diabetes by carrying out a systematic review and meta‐analysis.Materials and MethodsSix databases (Pubmed, Embase, CINAHL, Cochrane, Web of science and PsycINFO) were searched from inception to October 2019. Randomized controlled trials of MBI for people with type 1 and type 2 diabetes were included. Two authors independently extracted relevant data and assessed the risk of bias, with a third reviewer as arbitrator. Subgroup analyses and sensitivity analyses were also carried out.ResultsEight studies with 841 participants met the eligibility criteria. Meta‐analysis showed that MBI can slightly improve glycosylated hemoglobin (HbA1c; −0.25%, 95% confidence interval [CI] −0.43 to −0.07) and diabetes‐related distress (−5.81, 95% CI −10.10 to −1.52) contribute to a moderate effect size in reducing depression (standardized mean difference −0.56, 95% CI −0.82 to −0.30) and stress (standardized mean difference −0.53, CI −0.75 to −0.31). Subgroup analyses showed greater HbA1c reductions in subgroups with baseline HbA1c levels <8% and follow‐up duration >6 months. Mixed effects were observed for anxiety.ConclusionsMBI appears to have benefits on HbA1c, depression, stress and diabetes‐related distress in people with diabetes. More rigorous studies with longer follow‐up duration are warranted to establish the full potential of MBI.     

Prevalence of diabetes in liver cirrhosis: A systematic review and meta‐analysis

An association between diabetes mellitus (DM) and liver cirrhosis is well‐known, but estimates of the prevalence of DM in patients with liver cirrhosis vary widely. A systematic review was undertaken to determine the prevalence of DM in adult patients with liver cirrhosis. The Medline, EMBASE, and Cochrane Library databases were searched for peer‐reviewed studies published in English (1979‐2017) that investigated the prevalence of diabetes in adult patients with cirrhosis. Pooled estimates of prevalence of DM were determined for all eligible patients and according to aetiology and severity of liver disease. Fifty‐eight studies satisfied criteria for inclusion, with 9705 patients included in the pooled prevalence analysis. The overall prevalence of DM was 31%. The prevalence of DM was highest in patients with nonalcoholic fatty liver disease (56%), cryptogenic (51%), hepatitis C (32%), or alcoholic (27%) cirrhosis. For assessing prevalence of DM as a function of severity of liver disease, evaluable data were available only for hepatitis C and hepatitis B cirrhosis. DM may be more prevalent in cirrhosis than previously thought. This has implications for prognosis and treatment in these patients.     

Factors associated with good glycemic control among patients with type 2 diabetes mellitus

Aims/Introduction

The aim of the present study was to determine the status of glycemic control and identify factors associated with good glycemic control among diabetic patients treated at primary health clinics.

Materials and Methods

A systematic random sample of 557 patients was selected from seven clinics in the Hulu Langat District. Data were collected from patients'' medication records, glycemic control tests and structured questionnaires. Logistic regression analysis was carried out to predict factors associated with good glycemic control.

Results

Variables associated with good glycemic control included age (odds ratio 1.033; 95% confidence interval 1.008–1.059) and duration of diabetes mellitus (odds ratio 0.948; 95% confidence interval 0.909–0.989). Compared with the patients who were receiving a combination of insulin and oral antidiabetics, those receiving monotherapy (odds ratio 4.797; 95% confidence interval 1.992–11.552) and a combination of oral antidiabetics (odds ratio 2.334; 95% confidence interval 1.018–5.353) were more likely to have good glycemic control. In the present study, the proportion of patients with good glycemic control was lower than that in other published studies. Older patients with a shorter duration of diabetes who were receiving monotherapy showed better glycemic control.

Conclusions

Although self‐management behavior did not appear to influence glycemic control, diabetic patients should be consistently advised to restrict sugar intake, exercise, stop smoking and adhere to medication instructions. Greater effort by healthcare providers in the primary health clinics is warranted to help a greater number of patients achieve good glycemic control.     

A systematic review and meta‐analysis of the efficacy of lixisenatide in the treatment of patients with type 2 diabetes

The aim of this study is to assess the efficacy and safety of lixisenatide for treating type 2 diabetes. A systematic search in electronic databases (up to October 2012) was conducted and the manufacturer was contacted regarding unpublished data. Randomized controlled trials (RCTs) were included if they provided information on at least one of the following outcomes: mortality, health‐related quality of life, hypoglycaemic events, adverse events, change in HbA1c, body weight, blood pressure, gastric emptying, fasting plasma glucose or 2 h postprandial glucose (PPG). Twenty‐six publications and 10 unpublished study reports, relating to 14 RCTs (6156 patients) were included. Eleven studies related to placebo comparisons; active comparators were in three studies. Compared to placebo, lixisenatide significantly reduced HbA1c (?0.52%; 95% CI: ?0.64 to ?0.39), bodyweight (?0.65 kg; 95% CI: ?0.94 to ?0.37) and 2‐h PPG level (?4.58 mmol/l; 95% CI: ?5.88 to ?3.28). There were significantly more symptomatic hypoglycaemic events among lixisenatide compared to placebo‐treated patients (log OR: 0.54; 95% CI: 0.32–0.75), but significantly fewer compared to other incretin mimetics. In comparison to exenatide and liraglutide, lixisenatide was more effective in reducing 2 h‐PPG with a better adverse events profile, but it showed a lower reduction in HbA1c and body weight. Lixisenatide improves HbA1c levels and moderately reduces body weight compared to placebo and showed less frequent symptomatic hypoglycaemic and gastrointestinal events and an improvement in PPG control compared to other GLP‐1 agonists. Firm conclusions regarding the performance of lixisenatide compared to other incretin mimetics, however, can not yet be drawn, due to limited data.     

Improvement of glycemic control after periodontal treatment by resolving gingival inflammation in type 2 diabetic patients with periodontal disease

Aims/Introduction: Chronic inflammation aggravates glycemic control in patients with type 2 diabetes mellitus. An increase or decrease in the release and activities of various inflammatory mediators, such as tumor necrosis factor (TNF)‐α, interleukin (IL)‐6, and C‐reactive protein (CRP), are presumed to be responsible for inducing insulin resistance. The purpose of the present study was to examine the effects of non‐surgical periodontal treatment incorporating topical antibiotics on glycemic control and serum inflammatory mediators in patients with type 2 diabetes mellitus with periodontitis. Materials and Methods: Periodontal inflammation and periodontal tissue destruction were evaluated by bleeding on probing (BOP) and the probing pocket depth (PPD), respectively. A total of 41 patients with type 2 diabetes and periodontitis received periodontal treatment with the topical application of antibiotics four times within a 2‐month period. A periodontal examination, including PPD and BOP, and venous blood sampling were carried out at baseline and at 2 and 6 months after periodontal treatment. Glycated hemoglobin (HbA_1c), and serum levels of high‐sensitivity (hs)‐CRP, TNF‐α and IL‐6 were analyzed. Results: A generalized linear model showed significant associations between the change in the HbA_1c values at 6 months after periodontal treatment, and the change in the BOP, baseline TNF‐α levels and the baseline mean PPD. Conclusions: As BOP is a marker of total gingival inflammation, these results suggest that non‐surgical periodontal therapy with topical antibiotics in patients with mild periodontitis might improve glycemic control by resolving periodontal inflammation. Such treatments might be insufficient for the amelioration of insulin resistance in type 2 diabetic patients with severe periodontitis. This trial was registered with the University Hospital Medical Information Network (no. UMIN000006693). (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2012.00209.x, 2012)     

Obstructive sleep apnea,prediabetes and progression of type 2 diabetes: A systematic review and meta‐analysis

Aims/IntroductionObstructive sleep apnea (OSA) is related to prediabetes and diabetes. Whether patients with OSA have a higher risk of prediabetes/diabetes remains unclear. We aimed to carry out a meta‐analysis of published studies to evaluate the relationships between OSA and prediabetes and diabetes, and the impact of the severity of OSA on diabetes.Materials and MethodsThe PubMed, EMBASE and Cochrane databases were searched from January 2011 to July 2021. The associations between OSA and impaired fasting glucose, impaired glucose tolerance, impaired glucose regulation and diabetes mellitus were analyzed. We estimated the pooled odds ratios using fixed or random effects models. We included 25 studies comprising a total of 154,948 patients with OSA and risk factors for prediabetes/diabetes (20 and 16, respectively) in the analysis.ResultsOSA was associated with a higher risk of impaired fasting glucose, impaired glucose tolerance, impaired glucose regulation and diabetes mellitus in the cohort studies and cross‐sectional studies. The pooled odds ratios were 2.34 (95% confidence interval [CI] 1.16–4.72), 1.58 (95% CI 1.15–2.15), 1.65 (95% CI 1.12–2.42), 2.15 (95% CI 1.68–2.75) and 3.62 (95% CI 2.75–4.75), respectively. Subgroup analyses were based on the proportions of men and women. The results showed that OSA was a risk factor, and there was no significant difference between the two groups. The risk of diabetes increased with the severity of OSA.ConclusionsThe risk of developing prediabetes and diabetes was higher in patients with OSA.     

Effect of green tea on glycemic control in patients with type 2 diabetes mellitus: A systematic review and meta-analysis

Background and aimsSeveral studies have investigated the potential beneficial effects of green tea in patients with type 2 diabetes mellitus (T2DM). Therefore, we aimed to perform a systematic review and meta-analysis of the randomized controlled trials (RCTs) that assessed the effect of supplementary intake of green tea on fasting plasma glucose (FPG), fasting insulin, hemoglobin A1c (HbA1c) and HOMA-IR in patients with T2DM.MethodsA systematic search was performed in Web of Science, PubMed and Scopus without any language and time restriction up to June 2019, to retrieve the related RCTs. Meta-analysis was carried out using both the random and fixed effects model where appropriate. I2 index was used to evaluate the heterogeneity.ResultsInitial search yielded 780 publications. Fourteen articles were eligible. Our meta-analysis indicated that the supplementary intake of green tea had no significant effect on FPG, fasting insulin, HbA1c and HOMA-IR in patients with T2DM.ConclusionResults of the present systematic review and meta-analysis indicated that the supplementary intake of green tea had no significant effect on FPG, fasting insulin, HbA1c and HOMA-IR in patients with T2DM.