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Effect of Different Glucose Monitoring Methods on Bold Glucose Control: A Systematic Review and Meta-Analysis.
Wang, Y, Zou, C, Na, H, Zeng, W, Li, X
Computational and mathematical methods in medicine. 2022;2022:2851572
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Diabetes is one of the most common chronic diseases in China, with a high prevalence rate of 12.8%. Diabetes is divided into type 1 diabetes and type 2 diabetes. Monitoring blood glucose levels is also very important to keep the blood glucose level at a normal level. The aim of this study was to evaluate the effectiveness of continuous glucose monitoring (CGM) and self-monitoring of blood glucose (SMBG) in maintaining glycaemic control among patients with type 1 diabetes. This study is a systematic review and meta-analysis of fifteen studies Results showed that the level of haemoglobin A1C in the CGM group decreased by 2.69 mmol/mol compared with the SMBG group. Furthermore, compared with the SMBG group, the risk of severe hypoglycaemic events in the CGM group was reduced by 48%, which is inconsistent with the results of other meta-analyses. Finally, there was no difference between the two methods in the incidence of diabetic ketoacidosis [is a serious complication of diabetes that can be life-threatening]. Authors conclude that for patients with type 1 diabetes, CGM is a better method for monitoring blood glucose.
Abstract
Objective: To evaluate the effectiveness of different glucose monitoring methods on blood glucose control and the incidence of adverse events among patients with type 1 diabetes mellitus. Methods: Using the method of literature review, the databases PubMed, Cochrane, and Embase were retrieved to obtain relevant research literature, and the selected studies were analyzed and evaluated. This study used Cochrane software RevMan5.4 to statistically analyze all the data. Results: A total of 15 studies were included in this study, including 10 randomized controlled trials and 5 crossover design trials, with a total of 2071 patients. Meta-analysis results showed that continuous blood glucose monitoring (CGM) could significantly reduce the HbA1c level of patients, weighted mean difference (WMD) = -2.69, 95% confidence interval (CI) (-4.25, -1.14), and P < 0.001 compared with self-monitoring of blood glucose (SMBG). Meanwhile, the incidence of severe hypoglycemia in the CGM group was significantly decreased, risk ratio (RR) = 0.52, 95% CI 0.35-0.77, and P = 0.001. However, there was no statistical difference in the probability of diabetic ketoacidosis between CGM and SMBG groups, RR = 1.34, 95% CI 0.57-3.15, and P = 0.5. Conclusion: Continuous blood glucose monitoring is associated with lower blood glucose levels than the traditional blood glucose self-test method.
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Effect of the ketogenic diet on glycemic control, insulin resistance, and lipid metabolism in patients with T2DM: a systematic review and meta-analysis.
Yuan, X, Wang, J, Yang, S, Gao, M, Cao, L, Li, X, Hong, D, Tian, S, Sun, C
Nutrition & diabetes. 2020;10(1):38
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Expert Review
Conflicts of interest:
None
Take Home Message:
A ketogenic diet may be a useful dietary intervention for type 2 diabetics with the potential to:
- Reduce fasting blood glucose
- Reduce HBA1c
- Reduce triglycerides, total cholesterol and LDL
- Increase HDL
- Promote weight loss
- Positive results were observed within in a minimum time frame of 1 week
Based on the findings, the ketogenic diet may prove beneficial as a component of an integrated approach for the management of type 2 diabetes.
Evidence Category:
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X
A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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B: Systematic reviews including RCTs of limited number
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C: Non-randomized trials, observational studies, narrative reviews
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D: Case-reports, evidence-based clinical findings
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E: Opinion piece, other
Summary Review:
Type 2 diabetes has become a worldwide health burden with a global prevalence of 300 million. Being overweight or obese has demonstrated to be a significant risk factor for the development of type 2 diabetes. The ketogenic diet which can be characterised by a diet of <55g of carbohydrates daily has demonstrated to be a beneficial intervention for weight loss and glycemic control suggesting potential utility for type 2 diabetics. This systematic review and meta-analysis compared the effects of a ketogenic diet on markers of glycemic control, lipid metabolism and body weight in type 2 diabetics pre and post intervention. There were a total of 13 studies and 567 subjects included in this meta-analysis. The findings conclude that type 2 diabetics following a ketogenic diet intervention ranging from 1-56 weeks experienced an average reduction of fasting blood glucose of 1.29mmol/l, HBA1c reduced by 1.07%, triglycerides decreased by 0.72 mmol/L , total cholesterol decreased by 0.33 mmol/L, LDL decreased by 0.05 mmol/L, HDL increased by 0.14 mmol/L, the average body weight decreased by 8.66 kg , waist circumference reduced by 9.17 cm and BMI reduced by 3.13 kg/m2.
Clinical practice applications:
This meta-analysis demonstrates that a ketogenic diet may be a useful dietary intervention to improve glycemic control, lipid metabolism and body weight in Caucasian type 2 diabetics. Positive results were seen within as little as 1 week.
Macronutrient ratios of included studies:
* Carbohydrates: <50g/d - 15g/d
● Protein: 20-28% or 1.5g/kg or 72-100g per day
● Fats: 58%-75% or to satiety
Adverse reactions to the ketogenic diet were mentioned in two of the studies. In the first study, fatigue, headache, nausea and vomiting were more common amongst the ketogenic diet group following 2 weeks of the intervention, while constipation and orthostatic hypotension were more commonly observed following 10 weeks. Symptoms of increased hunger, headache, nausea, vomiting, constipation and diarrhea were observed in subjects following a ketogenic diet in a second study. The symptoms were categorised as mild and not related to clinical practice.
Considerations for future research:
This meta-analysis only included 13 studies with primarily Caucasian patients due to limited available clinical trials. Further research is needed in order to determine risk/benefit of the ketogenic diet in type 2 diabetics amongst different populations and ethnic groups, particularly where type 2 diabetes is more prevalent. Follow-up periods ranged from 1-56 weeks. Longer-term studies would be useful to assess potential risks or benefits that would present over a longer time period.
Abstract
BACKGROUND At present, the beneficial effect of the ketogenic diet (KD) on weight loss in obese patients is generally recognized. However, a systematic research on the role of KD in the improvement of glycemic and lipid metabolism of patients with diabetes is still found scarce. METHODS This meta-study employed the meta-analysis model of random effects or of fixed effects to analyze the average difference before and after KD and the corresponding 95% CI, thereby evaluating the effect of KD on T2DM. RESULTS After KD intervention, in terms of glycemic control, the level of fasting blood glucose decreased by 1.29 mmol/L (95% CI: -1.78 to -0.79) on average, and glycated hemoglobin A1c by 1.07 (95% CI: -1.37 to -0.78). As for lipid metabolism, triglyceride was decreased by 0.72 (95% CI: -1.01 to -0.43) on average, total cholesterol by 0.33 (95% CI: -0.66 to -0.01), and low-density lipoprotein by 0.05 (95% CI: -0.25 to -0.15); yet, high-density lipoprotein increased by 0.14 (95% CI: 0.03-0.25). In addition, patients' weight decreased by 8.66 (95% CI: -11.40 to -5.92), waist circumference by 9.17 (95% CI: -10.67 to -7.66), and BMI by 3.13 (95% CI: -3.31 to -2.95). CONCLUSION KD not only has a therapeutic effect on glycemic and lipid control among patients with T2DM but also significantly contributes to their weight loss.
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Probiotics for prevention and treatment of respiratory tract infections in children: A systematic review and meta-analysis of randomized controlled trials.
Wang, Y, Li, X, Ge, T, Xiao, Y, Liao, Y, Cui, Y, Zhang, Y, Ho, W, Yu, G, Zhang, T
Medicine. 2016;95(31):e4509
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Respiratory tract infections (RTIs) are a leading cause of morbidity and mortality among children worldwide. Probiotics are thought to be able to balance the gut microbiota and interact with the immune system, which may promote resistance against pathogens. There are conflicting results from studies investigating the effect of probiotics on RTI infection. The aim of this systematic review and meta-analysis was to provide the latest and convincing evidence of the effect of probiotic consumption on RTIs in children. 32 studies were included in the qualitative analysis, and 23 in the quantitative meta-analysis. All trials were randomised, double-blinded, and placebo-controlled. Probiotic supplementation had a significant effect on the reduction of number of subjects having at least 1 respiratory symptom episode, on the number of days the children were ill and the number of days absent from day care/school. There was no significant statistical difference of illness episode duration. There was statistical heterogeneity among the trials, and subgroup analysis did not highlight the source of this. It was noted, however, that the probiotic strain, the duration of regimens, administration forms, doses, and follow-up times differed across the included studies, as did the age of children. The authors conclude that probiotic consumption may decrease the incidence and illness duration of RTIs, and that further research is needed to establish optimal probiotic strains, dosing, administration form, time of intervention, and long-time follow-up.
Abstract
BACKGROUND Respiratory tract infections (RTIs) represent one of the main health problems in children. Probiotics are viable bacteria that colonize the intestine and affect the host intestinal microbial balance. Accumulating evidence suggests that probiotic consumption may decrease the incidence of or modify RTIs. The authors systematically reviewed data from randomized controlled trials (RCTs) to investigate the effect of probiotic consumption on RTIs in children. METHODS MEDLINE/PubMed, Embase, Cochrane Library, and Web of Science were systematically searched for RCTs regarding the effect of probiotics on RTIs in children. The outcomes included number of children experienced with at least 1 RTI episode, duration of illness episodes, days of illness per subject, and school/day care absenteeism due to infection. A random-effects model was used to calculate pooled relative risks, or mean difference (MD) with the corresponding 95% confidence interval (CI). RESULTS A total of 23 trials involving 6269 children were eligible for inclusion in the systematic review. None of the trials showed a high risk of bias. The quality of the evidence of outcomes was moderate. The age range of subjects was from newborn to 18 years. The results of meta-analysis showed that probiotic consumption significantly decreased the number of subjects having at least 1 RTI episode (17 RCTs, 4513 children, relative risk 0.89, 95% CI 0.82-0.96, P = 0.004). Children supplemented with probiotics had fewer numbers of days of RTIs per person compared with children who had taken a placebo (6 RCTs, 2067 children, MD -0.16, 95% CI -0.29 to 0.02, P = 0.03), and had fewer numbers of days absent from day care/school (8 RCTs, 1499 children, MD -0.94, 95% CI -1.72 to -0.15, P = 0.02). However, there was no statistically significant difference of illness episode duration between probiotic intervention group and placebo group (9 RCTs, 2817 children, MD -0.60, 95% CI -1.49 to 0.30, P = 0.19). CONCLUSION Based on the available data and taking into account the safety profile of RCTs, probiotic consumption appears to be a feasible way to decrease the incidence of RTIs in children.