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Cognitive behavioral therapy for lifestyle changes in patients with obesity and type 2 diabetes: a systematic review and meta-analysis.
Kurnik Mesarič, K, Pajek, J, Logar Zakrajšek, B, Bogataj, Š, Kodrič, J
Scientific reports. 2023;13(1):12793
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Obesity and type 2 diabetes mellitus (T2DM) are two of the most common chronic diseases and lifestyle modification, including diet, exercise and weight management, are recognised as important for prevention. Cognitive behavioural therapy (CBT) has been shown to contribute to lifestyle modification. The aim of this meta-analysis was to evaluate the effect of CBT, compared to no intervention/standard care only, in patients with obesity and/or T2DM, with a focus on health outcomes and implementation of changes long-term. Nine randomised controlled trials (RCT) with 902 participants were included in this meta-analysis. The health outcomes included weight loss and maintenance and glycosylated haemoglobin (HbA1c, a measure of blood glucose control) whilst the lifestyle changes included diet, physical activity, smoking, and compliance with treatments. There was a statistically significant benefit of CBT for weight loss and weight maintenance (based on 3 RCTs each) with a medium effect size, but no significant effect on HbA1c (based on 3 RCTs). In all 3 RCTs that evaluated depression, a significant benefit was observed. As the behavioural outcomes were too heterogenous to be pooled for a meta-analysis, they were reviewed in a descriptive manner only. Benefits were reported in terms of better dietary choices/reduced energy intake, increased physical activity, better adherence to medication and glucose monitoring as well as a reduction in smoking. The authors suggest that CBT appears to be moderately effective in promoting lifestyle modifications and weight loss.
Abstract
The aim of this systematic review and meta-analysis was to examine the contribution of cognitive behavioral therapy (CBT) to the implementation of lifestyle changes, considering health-related and behavioral outcomes. A systematic literature review was performed using multiple databases (PsycInfo, PubMed and MEDLINE). The inclusion criteria comprised randomised controlled trials of CBT for lifestyle changes in patients with obesity and/or type 2 diabetes. The quality of study reporting was assessed with the revised Cochrane Collaboration's risk of bias tool. A meta-analysis was conducted on studies with appropriate outcomes. Nine randomised controlled trials, with a total sample size of 902 participants, met the inclusion criteria. The meta-analysis has shown a medium, significant effect size of CBT interventions for weight loss and weight maintenance, and a low, non-significant effect size of CBT interventions for reducing glycated hemoglobin (HbA1c) levels. A separate, combined, meta-analysis for all nine calculated effect sizes has yielded a medium and significant overall effect size for the model. Our review of the studies about the effectiveness of CBT in implementing lifestyle changes has, in comparison to usual control groups, proven the efficacy of CBT interventions in implementing lifestyle changes, especially for weight loss and weight maintenance.
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The effects of probiotics supplementation on glycaemic control among adults with type 2 diabetes mellitus: a systematic review and meta-analysis of randomised clinical trials.
Li, G, Feng, H, Mao, XL, Deng, YJ, Wang, XB, Zhang, Q, Guo, Y, Xiao, SM
Journal of translational medicine. 2023;21(1):442
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Type 2 diabetes mellitus (T2DM), an endocrine and metabolic disease, is influenced by host physiology and environmental factors. Recent studies have shown that the gut microbiota plays a key role in the maintenance of host homeostasis and pathogenesis of T2DM. The aim of this study was to evaluate the effects of a probiotic intervention on glycaemic control in T2DM patients and to evaluate the variations in these effects due to participant characteristics and intervention characteristics. This study was a systematic review and meta-analysis of thirty randomised-controlled studies including a total of 1,827 individuals. Results showed that probiotic supplementation had favourable effects on glycaemic control in T2DM patients. Bifdobacterium and food-type probiotics had greater glucose-lowering effects than other probiotic genera and types of vehicles used to deliver the probiotics. Authors concluded that the administration of probiotics may be a promising adjuvant therapy for glycaemic control in T2DM patients.
Abstract
OBJECTIVE This systematic review and meta-analysis study aimed to evaluate the effectiveness of probiotics supplementation on glycaemic control in patients with type 2 diabetes mellitus (T2DM) based on the data from the randomised clinical trials (RCTs). METHODS PubMed, Web of Sciences, Embase, and Cochrane Library were searched from the inception to October 2022, and RCTs about probiotics and T2DM were collected. The standardised mean difference (SMD) with 95% confidence interval (CI) was used to estimate the effects of probiotics supplementation on glycaemic control related parameters, e.g. fasting blood glucose (FBG), insulin, haemoglobin A1c (HbA1c), and homeostasis model of assessment of insulin resistance (HOMA-IR). RESULTS Thirty RCTs including 1,827 T2MD patients were identified. Compared with the placebo group, the probiotics supplementation group had a significant decrease in the parameters of glycaemic control, including FBG (SMD = - 0.331, 95% CI - 0.424 to - 0.238, Peffect < 0.001), insulin (SMD = - 0.185, 95% CI - 0.313 to - 0.056, Peffect = 0.005), HbA1c (SMD = - 0.421, 95% CI - 0.584 to - 0.258, Peffect < 0.001), and HOMA-IR (SMD = - 0.224, 95% CI - 0.342 to - 0.105, Peffect < 0.001). Further subgroup analyses showed that the effect was larger in the subgroups of Caucasians, high baseline body mass index (BMI ≥ 30.0 kg/m2), Bifidobacterium and food-type probiotics (Psubgroup < 0.050). CONCLUSION This study supported that probiotics supplementation had favourable effects on glycaemic control in T2DM patients. It may be a promising adjuvant therapy for patients with T2DM.
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Effects of Probiotics on Glycemic Control and Metabolic Parameters in Gestational Diabetes Mellitus: Systematic Review and Meta-Analysis.
Yefet, E, Bar, L, Izhaki, I, Iskander, R, Massalha, M, Younis, JS, Nachum, Z
Nutrients. 2023;15(7)
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The prevalence of gestational diabetes is increasing worldwide. Gestational diabetes mellitus (GDM) increases obesity and future development of type 2 diabetes in mother and child. Previous research has looked at the beneficial effects of probiotics in reducing metabolic diseases, however, these specific benefits on women with GDM are not fully understood yet. This systematic review and meta-analysis of fourteen randomised controlled trials assessed the beneficial effects of probiotics on glycemic control and metabolic parameters in women with GDM. This study separately assessed probiotic bacterial strains such as Lactobacillus acidophilus, Bifidobacterium bifidum, and Lactobacillus casei to understand their beneficial effects on metabolic parameters. This meta-analysis and systematic review suggest that probiotic supplementation could help improve glycemic control, insulin resistance and lipid levels in women diagnosed with GDM. All probiotic strains showed improvements in metabolic parameters when assessed separately. Further robust studies are required to assess the effect of probiotic supplementation on post- and pre-prandial glycemic control in women with GDM. Healthcare professionals can employ the results of this study to understand the therapeutic benefits of probiotics for improving GDM.
Abstract
OBJECTIVES To assess the effects of probiotic supplements on glycemic control and metabolic parameters in women with gestational diabetes mellitus (GDM) by performing a systematic review and meta-analysis of randomized controlled trials. The primary outcome was glycemic control, i.e., serum glucose and insulin levels. Secondary outcomes were maternal weight gain, neonatal birth weight, and lipid parameters. Weighted mean difference (WMD) was used. Cochrane's Q test of heterogeneity and I2 were used to assess heterogeneity. RESULTS Of the 843 papers retrieved, 14 (n = 854 women) met the inclusion criteria and were analyzed. When compared with placebo, women receiving probiotic supplements had significantly lower mean fasting serum glucose, fasting serum insulin, homeostatic model assessment for insulin resistance (HOMA-IR), triglycerides, total cholesterol, and VLDL levels. Decreased neonatal birth weight was witnessed in supplements containing Lactobacillus acidophilus. CONCLUSION Probiotic supplements may improve glycemic control and lipid profile and reduce neonatal birth weight in women with GDM.
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Prevalence and outcomes of malnutrition among hospitalized COVID-19 patients: A systematic review and meta-analysis.
Abate, SM, Chekole, YA, Estifanos, MB, Abate, KH, Kabthymer, RH
Clinical nutrition ESPEN. 2021;43:174-183
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Malnutrition during Coronavirus Disease 2019 (COVID-19) is a ‘two-edged sword’ particularly in low-income countries where chronic malnutrition is very high. The disease is still very high, and it is relapsing to the worst in some countries. The aim of this study was to investigate the prevalence and outcome of malnutrition among patients with COVID-19. This study is a systemic review and meta-analysis of 14 studies with 4187 participants. Results indicate that the prevalence of malnutrition was very high among hospitalized patients with COVID-19, and that mortality among hospitalized patients with COVID-19 was more than 10 times more likely as compared to those who were well-nourished. Authors conclude that a mitigating strategy by different stakeholders is needed to prevent and manage malnutrition and its outcomes.
Abstract
BACKGROUND Malnutrition is inevitable in patients with Coronavirus Disease 2019 (COVID-19) due to its effect on the gastrointestinal system, immune system, and high metabolic activity. However, the prevalence of malnutrition and its outcomes is uncertain. This study aimed to investigate the prevalence and outcome of malnutrition among patients with COVID-19. METHOD A comprehensive search was conducted in PubMed/Medline; Science direct and LILACS from December 29, 2019 to September, 2020 without language restriction. All observational studies reporting the prevalence of malnutrition were included while case reports and reviews were excluded. The data were extracted with two independent authors with a customized format and the disagreements were resolved by the other authors. The methodological quality of included studies was evaluated using a standardized critical appraisal tool. RESULTS A total of 511 articles were identified from different databases and 27 articles were selected for evaluation after the successive screening. Fourteen articles with 4187 participants were included. The pooled prevalence of malnutrition among hospitalized patients with COVID-19 was 49.11% (95% CI: 31.67 to 66.54). The odd of mortality among patients COVID-19 with malnutrition was 10 times more likely as compared to those who were well-nourished. CONCLUSION The prevalence of malnutrition and mortality associated with malnutrition among COVID-19 hospitalized patients was very high which entails a mitigating strategy by different stakeholders to prevent and manage malnutrition and its outcomes. REGISTRATION This systematic review was registered in Prospero's international prospective register of systematic reviews (CRD42020215396).
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Dietary Protein Consumption and the Risk of Type 2 Diabetes: ADose-Response Meta-Analysis of Prospective Studies.
Fan, M, Li, Y, Wang, C, Mao, Z, Zhou, W, Zhang, L, Yang, X, Cui, S, Li, L
Nutrients. 2019;11(11)
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Diabetes mellitus is considered a serious public health issue worldwide with the vast majority of patients having type 2 diabetes (T2D). Dietary factors are major behavioural factors that can influence the risk for T2D. The aim of this study was to quantify the relationship between protein consumption and high-protein food intake with T2D risk and to identify optimal food types for a low T2D risk. This study is a meta-analysis which included 60 articles consisting of 72 studies for quantitative synthesis. Results indicate that total and animal protein intake increase the risk of T2D incidence, whereas plant protein intake lowers this risk. Furthermore, the consumption of red meat, processed meat, milk, and eggs are positively linked with an increased risk of T2D incidence; only yoghurt consumption lowered the incidence of T2D. Authors conclude that selecting specific optimal protein intakes can lead to a significant decrease in the risk for T2D.
Abstract
The relationship between dietary protein consumption and the risk of type 2 diabetes (T2D) has been inconsistent. The aim of this meta-analysis was to explore the relations between dietary protein consumption and the risk of T2D. We conducted systematic retrieval of prospective studies in PubMed, Embase, and Web of Science. Summary relative risks were compiled with a fixed effects model or a random effects model, and a restricted cubic spline regression model and generalized least squares analysis were used to evaluate the diet-T2D incidence relationship. T2D risk increased with increasing consumption of total protein and animal protein, red meat, processed meat, milk, and eggs, respectively, while plant protein and yogurt had an inverse relationship. A non-linear association with the risk for T2D was found for the consumption of plant protein, processed meat, milk, yogurt, and soy. This meta-analysis suggests that substitution of plant protein and yogurt for animal protein, especially red meat and processed meat, can reduce the risk for T2D.
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Vitamin D and diabetic foot ulcer: a systematic review and meta-analysis.
Dai, J, Jiang, C, Chen, H, Chai, Y
Nutrition & diabetes. 2019;9(1):8
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The diabetic foot ulcer is a severe complication in patients with diabetes mellitus. The aim of the study was to assess the relationship between serum vitamin D levels with diabetic foot ulcer. The study is a review and metanalysis of seven cohort studies of which one was published in Russian. 115 patients were recruited for the study. The meta-analysis results indicate that patients with diabetic foot ulcer had significantly lower vitamin D levels compared to diabetic patients without foot ulcer. Authors conclude that severe vitamin D deficiency was associated with an increased risk of diabetic foot ulcer.
Abstract
We aimed to evaluate the association between vitamin D deficiency and diabetic foot ulcer (DFU) in patients with diabetes. Pubmed, EMBASE, BIOSIS, the Cochrane Library, and Web of Knowledge, last updated in July 2018, were searched. We assessed eligible studies for the association between vitamin D deficiency and DFU in diabetic patients. The mean difference (MD) or the odds ratio (OR) was calculated for continuous or dichotomous data respectively. Data were analyzed by using the Cochrane Collaboration's RevMan 5.0 software. Seven studies that involved 1115 patients were included in this study. There were significantly reduced vitamin D levels in DFU (MD -13.47 nmol/L, 95%CI -16.84 to -10.10; P = 0.34, I2 = 12%). Severe vitamin D deficiency was significantly associated with an increased risk of DFU (OR 3.22, 95%CI 2.42-4.28; P = 0.64, I2 = 0%). This is the first meta-analysis demonstrating the association between serum vitamin D levels and DFU. Severe vitamin D deficiency is significantly associated with an increased risk of DFU.
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Effectiveness and safety of carbohydrate counting in the management of adult patients with type 1 diabetes mellitus: a systematic review and meta-analysis.
Vaz, EC, Porfírio, GJM, Nunes, HRC, Nunes-Nogueira, VDS
Archives of endocrinology and metabolism. 2018;62(3):337-345
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Glycaemic control of patients with diabetes mellitus is important because it impacts the development of diabetic complications. Carbohydrate counting is a meal planning tool that allows for great variation and flexibility in food choices among individuals with diabetes mellitus. The aim of the study was to evaluate the effectiveness and safety of carbohydrate counting in the treatment of adult patients with type 1 diabetes mellitus using a systematic literature review. The study included randomised controlled trials with at least 3 months of follow-up, and evaluation of outcomes in which patients were randomly divided into two groups. The meta-analysis showed that the final haemoglobin A1c (HbA1c) - a test that shows the average blood glucose levels for the last two to three months - was significantly lower in the carbohydrate counting group than in the control group. Authors conclude that the meta-analysis showed evidence favouring the use of carbohydrate counting in the management of adult patients with type 1 diabetes mellitus. However, this benefit was limited to the final HbA1c.
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness and safety of carbohydrate counting (CHOC) in the treatment of adult patients with type 1 diabetes mellitus (DM1). MATERIALS AND METHODS We performed a systematic review of randomized studies that compared CHOC with general dietary advice in adult patients with DM1. The primary outcomes were changes in glycated hemoglobin (HbA1c), quality of life, and episodes of severe hypoglycemia. We searched the following electronic databases: Embase, PubMed, Lilacs, and the Cochrane Central Register of Controlled Trials. The quality of evidence was analyzed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS A total of 3,190 articles were identified, and two reviewers independently screened the titles and abstracts. From the 15 potentially eligible studies, five were included, and 10 were excluded because of the lack of randomization or different control/intervention groups. Meta-analysis showed that the final HbA1c was significantly lower in the CHOC group than in the control group (mean difference, random, 95% CI: -0.49 (-0.85, -0.13), p = 0.006). The meta-analysis of severe hypoglycemia and quality of life did not show any significant differences between the groups. According to the GRADE, the quality of evidence for severe hypoglycemia, quality of life, and change in HbA1c was low, very low, and moderate, respectively. CONCLUSION The meta-analysis showed evidence favoring the use of CHOC in the management of DM1. However, this benefit was limited to final HbA1c, which was significantly lower in the CHOC than in the control group.
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Effect of Probiotics on Glucose and Lipid Metabolism in Type 2 Diabetes Mellitus: A Meta-Analysis of 12 Randomized Controlled Trials.
Yao, K, Zeng, L, He, Q, Wang, W, Lei, J, Zou, X
Medical science monitor : international medical journal of experimental and clinical research. 2017;23:3044-3053
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The pathogenesis of type 2 diabetes involves both genetic and environmental factors, among which gut microorganisms play an important role. The human gut hosts trillions of microorganisms including thousands of bacterial species, affecting large number of biological functions and metabolism in humans. The aim of the study was to summarize the effect of probiotics on type 2 diabetes. The study is a meta-analysis based on 12 randomized controlled trials (684 patients) which investigated the effect of probiotics as a dietary supplementation on glucose and lipid metabolism and inflammatory markers in patients with type 2 diabetes. Results show that probiotics supplementation significantly reduced glucose level and alleviated insulin resistance. This meta-analysis demonstrated that probiotics supplementation may potentially improve clinical prognosis of type 2 diabetes.
Abstract
BACKGROUND It has been unclear whether supplemental probiotics therapy improves clinical outcomes in type 2 diabetic patients. This meta-analysis aimed to summarize the effect of probiotics on glucose and lipid metabolism and C-reactive protein (CRP) from 12 randomized controlled trials (RCTs). MATERIAL AND METHODS An up-to-date search was performed for all relevant RCTs up to April 2016 from PubMed, Embase, and Cochrane Library. Standardized mean difference (SMD) and weighted mean difference (WMD) were calculated for a fixed-effect and random-effect meta-analysis to assess the impact of supplemental probiotics on fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), lipid profile, and CRP level. RESULTS A total of 12 studies (684 patients) were entered into the final analysis. The effect of probiotics was significant on reducing HbA1c level (standardized mean difference [SMD], -0.38; confidence interval [CI], -0.62 to -0.14, P=0.002; I²=0%, P=0.72 for heterogeneity), fasting insulin level (SMD, -0.38; CI -0.59 to -0.18, P=0.0003; I²=0%, P=0.81 for heterogeneity), and HOMA-IR (SMD, -0.99; CI -1.52 to -0.47, P=0.0002; I²=86%, P<0.00001 for heterogeneity). Pooled results on effects of probiotics on FPG, CRP, or lipid profile were either non-significant or highly heterogeneous. CONCLUSIONS This meta-analysis demonstrated that probiotics supplementation was associated with significant improvement in HbA1c and fasting insulin in type 2 diabetes patients. More randomized placebo-controlled trials with large sample sizes are warranted to confirm our conclusions.
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Effect of Probiotics on Metabolic Outcomes in Pregnant Women with Gestational Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Taylor, BL, Woodfall, GE, Sheedy, KE, O'Riley, ML, Rainbow, KA, Bramwell, EL, Kellow, NJ
Nutrients. 2017;9(5)
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The gut microbiota is an important ecosystem consisting of both residential and pathogenic bacteria. The microbiota produce bioactive compounds shown to benefit host metabolism. A variety of factors influence the gut microbiome, including host genetics, illness, antibiotic use, dietary patterns, weight loss and pregnancy. Throughout pregnancy the gut microbiota undergoes significant changes. The aim of this study is to determine the effect of 6-8-week probiotic supplementation versus placebo on glucose homeostasis, lipid levels and gestational weight gain in pregnant women diagnosed with gestational diabetes mellitus. This study is a systemic review based on four randomised controlled trials involving 288 participants. All studies included healthy pregnant women, age range between 18 – 40 years, who were diagnosed with gestational diabetes mellitus at 24 – 30 weeks gestation by oral glucose tolerance test. The study found that a 6 – 8-week probiotic intervention did not improve fasting blood glucose or LDL-cholesterol levels. However, probiotic supplementation in women with gestational diabetes mellitus was associated with significant reductions in insulin resistance. Authors conclude that while probiotic supplementation resulted in a significant reduction in insulin resistance in pregnant women with gestational diabetes mellitus, there was no significant effect on fasting blood glucose or LDL-cholesterol.
Abstract
The metabolic effects of probiotic administration in women with gestational diabetes mellitus (GDM) is unknown. The objective of this review was to investigate the effect of probiotics on fasting plasma glucose (FPG), insulin resistance (HOMA-IR) and LDL-cholesterol levels in pregnant women diagnosed with GDM. Seven electronic databases were searched for RCTs published in English between 2001 and 2017 investigating the metabolic effects of a 6-8 week dietary probiotic intervention in pregnant women following diagnosis with GDM. Eligible studies were assessed for risk of bias and subjected to qualitative and quantitative synthesis using a random effects model meta-analyses. Four high quality RCTs involving 288 participants were included in the review. Probiotic supplementation was not effective in decreasing FBG (Mean Difference = -0.13; 95% CI -0.32, 0.06, p = 0.18) or LDL-cholesterol (-0.16; 95% CI -0.45, 0.13, p = 0.67) in women with GDM. However, a significant reduction in HOMA-IR was observed following probiotic supplementation (-0.69; 95% CI -1.24, -0.14, p = 0.01). There were no significant differences in gestational weight gain, delivery method or neonatal outcomes between experimental and control groups, and no adverse effects of the probiotics were reported. Probiotic supplementation for 6-8 weeks resulted in a significant reduction in insulin resistance in pregnant women diagnosed with GDM. The use of probiotic supplementation is promising as a potential therapy to assist in the metabolic management of GDM. Further high quality studies of longer duration are required to determine the safety, optimal dose and ideal bacterial composition of probiotics before their routine use can be recommended in this patient group.