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Family History of Diabetes and the Effectiveness of Lifestyle Intervention on Insulin Secretion and Insulin Resistance in Chinese Individuals with Metabolic Syndrome.
Zhu, H, Chen, X, Zhang, B, Yang, W, Xing, X
Journal of diabetes research. 2021;:8822702
Abstract
AIMS: The current study aims to explore if a family history of diabetes can influence the efficiency of lifestyle intervention on insulin secretion and study the insulin resistance in Chinese men and women with metabolic syndrome in a cohort with a 2-year follow-up. METHODS 151 individuals (90 individuals did not have a family history of diabetes (DMFH (-)) and 61 with a family history of diabetes (DMFH (+)) with metabolic syndrome participated in the lifestyle intervention program at baseline and finished with 1-year follow-up. 124 individuals have two-year follow-up data. A family history of diabetes was ascertained by self-report. Lifestyle interventions were individual sessions on lifestyle changes. RESULTS During the 1-year follow-up, Ln Insulinogenic index (Δbaseline-1year = 0.29 ± 0.65, P = 0.001) and 30-min glucose (Δbaseline-1year = -0.41 ± 1.71, P = 0.024) changed significantly in the DMFH(-) group; in the DMFH(+) group, Ln ISIm (Δbaseline-1year = -0.22 ± 0.60, P = 0.022) and 30-min glucose (Δbaseline-1year = 0.53 ± 1.89, P = 0.032) changed significantly, and there was no significant change of other parameters. The change of 30 min glucose during a 1-year intervention has shown a significant difference between the two groups (P = 0.002). During the 2 years intervention, Ln Insulinogenic index changed significantly in the DMFH(-) group (Δbaseline-1year = 0.33 ± 0.66, P < 0.001 and Δbaseline-2year = 0.43 ± 1.17, P = 0.034). Fasting insulin (Δbaseline-2year = 2.95 ± 8.69, P = 0.034), 2 h insulin (Δbaseline-2year = 23.75 ± 44.89, P = 0.002), Ln HOMA-B (Δbaseline-2year = 0.43 ± 1.02, P = 0.009), Ln HOMA-IR (Δbaseline-2year = 0.53 ± 1.04, P = 0.002), Ln ISIm (Δbaseline-2year = 0.52 ± 0.95, P = 0.004), and Ln Insulinogenic index (Δbaseline-2year = 0.66 ± 1.18, P = 0.047) changed significantly after 2 years of intervention, compared to the baseline in the DMFH(+) group. The change of Ln ISIm (P = 0.023), fasting (P = 0.030), and 2 h insulin (P = 0.007) during the 2-year intervention has shown a significant difference between the two groups. Family history of diabetes was related with a 0.500 unit increase in 2-year ISIm (P = 0.020) modified by lifestyle intervention adjusted for age, baseline BMI, sex, and baseline waist circumference and a 0.476 unit increase in 2-year ISIm (P = 0.027) with extra adjustment for weight change. CONCLUSIONS Patients with a family history of diabetes benefit more from lifestyle intervention in regard to insulin resistance than those without a family history of diabetes adjusting for age, baseline BMI, sex, baseline waist circumference, and weight change.
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Sodium-glucose cotransporter protein-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists for type 2 diabetes: systematic review and network meta-analysis of randomised controlled trials.
Palmer, SC, Tendal, B, Mustafa, RA, Vandvik, PO, Li, S, Hao, Q, Tunnicliffe, D, Ruospo, M, Natale, P, Saglimbene, V, et al
BMJ (Clinical research ed.). 2021;:m4573
Abstract
OBJECTIVE To evaluate sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists in patients with type 2 diabetes at varying cardiovascular and renal risk. DESIGN Network meta-analysis. DATA SOURCES Medline, Embase, and Cochrane CENTRAL up to 11 August 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials comparing SGLT-2 inhibitors or GLP-1 receptor agonists with placebo, standard care, or other glucose lowering treatment in adults with type 2 diabetes with follow up of 24 weeks or longer. Studies were screened independently by two reviewers for eligibility, extracted data, and assessed risk of bias. MAIN OUTCOME MEASURES Frequentist random effects network meta-analysis was carried out and GRADE (grading of recommendations assessment, development, and evaluation) used to assess evidence certainty. Results included estimated absolute effects of treatment per 1000 patients treated for five years for patients at very low risk (no cardiovascular risk factors), low risk (three or more cardiovascular risk factors), moderate risk (cardiovascular disease), high risk (chronic kidney disease), and very high risk (cardiovascular disease and kidney disease). A guideline panel provided oversight of the systematic review. RESULTS 764 trials including 421 346 patients proved eligible. All results refer to the addition of SGLT-2 inhibitors and GLP-1 receptor agonists to existing diabetes treatment. Both classes of drugs lowered all cause mortality, cardiovascular mortality, non-fatal myocardial infarction, and kidney failure (high certainty evidence). Notable differences were found between the two agents: SGLT-2 inhibitors reduced admission to hospital for heart failure more than GLP-1 receptor agonists, and GLP-1 receptor agonists reduced non-fatal stroke more than SGLT-2 inhibitors (which appeared to have no effect). SGLT-2 inhibitors caused genital infection (high certainty), whereas GLP-1 receptor agonists might cause severe gastrointestinal events (low certainty). Low certainty evidence suggested that SGLT-2 inhibitors and GLP-1 receptor agonists might lower body weight. Little or no evidence was found for the effect of SGLT-2 inhibitors or GLP-1 receptor agonists on limb amputation, blindness, eye disease, neuropathic pain, or health related quality of life. The absolute benefits of these drugs vary substantially across patients from low to very high risk of cardiovascular and renal outcomes (eg, SGLT-2 inhibitors resulted in 3 to 40 fewer deaths in 1000 patients over five years; see interactive decision support tool (https://magicevidence.org/match-it/200820dist/#!/) for all outcomes. CONCLUSIONS In patients with type 2 diabetes, SGLT-2 inhibitors and GLP-1 receptor agonists reduced cardiovascular and renal outcomes, with some differences in benefits and harms. Absolute benefits are determined by individual risk profiles of patients, with clear implications for clinical practice, as reflected in the BMJ Rapid Recommendations directly informed by this systematic review. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019153180.
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Clinical analysis of risk factors for severe COVID-19 patients with type 2 diabetes.
Zhang, Q, Wei, Y, Chen, M, Wan, Q, Chen, X
Journal of diabetes and its complications. 2020;(10):107666
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AIMS: To describe characteristics of COVID-19 patients with type 2 diabetes and to analyze risk factors for severity. METHODS Demographics, comorbidities, symptoms, laboratory findings, treatments and outcomes of COVID-19 patients with diabetes were collected and analyzed. RESULTS Seventy-fourCOVID-19 patients with diabetes were included. Twenty-seven patients (36.5%) were severe and 10 patients (13.5%) died. Higher levels of blood glucose, serum amyloid A (SAA), C reactive protein and interleukin 6 were associated with severe patients compared to non-severe ones (P<0.05). Levels of albumin, cholesterol, high density lipoprotein, small and dense low density lipoprotein and CD4+T lymphocyte counts in severe patients were lower than those in non-severe patients (P<0.05). Logistic regression analysis identified decreased CD4+T lymphocyte counts (odds ratio [OR]=0.988, 95%Confidence interval [95%CI] 0.979-0.997) and increased SAA levels (OR=1.029, 95%CI 1.002-1.058) as risk factors for severity of COVID-19 with diabetes (P<0.05). CONCLUSIONS Type 2 diabetic patients were more susceptible to COVID-19 than overall population, which might be associated with hyperglycemia and dyslipidemia. Aggressive treatment should be suggested, especially when these patients had low CD4+T lymphocyte counts and high SAA levels.
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Effects of Sodium-glucose Cotransporter 2 Inhibitor Monotherapy on Weight Changes in Patients With Type 2 Diabetes Mellitus: a Bayesian Network Meta-analysis.
Wang, H, Yang, J, Chen, X, Qiu, F, Li, J
Clinical therapeutics. 2019;(2):322-334.e11
Abstract
PURPOSE The aim of this study was to systematically evaluate the effect of sodium-glucose cotransporter 2 (SGLT2) inhibitor monotherapy on the weight of patients with type 2 diabetes mellitus (T2DM) and to compare different SGLT2 inhibitors with other oral glucose-lowering medications. METHODS PubMed, EMBASE, Cochrane Library, and the ClinicalTrials.gov Web site were searched for relevant randomized controlled trials. Patients with T2DM in the included studies were administered SGLT2 inhibitor monotherapy for at least 12 weeks. The primary outcome was the change in weight from baseline; the secondary outcome was the proportion of patients achieving a weight reduction ≥5%. A pairwise meta-analysis using the DerSimonian-Laird random effects model and a network meta-analysis with Bayesian Markov chain Monte Carlo random effects models were performed. FINDINGS A total of 29 randomized controlled trials (11,999 patients) with a low risk of bias were identified. The results showed that the mean weight loss ranged from -2.26 kg (95% credible interval [CrI], -2.71 to -1.76) with canagliflozin 300 mg to -0.79 kg (95% CrI, -1.54 to -0.05) with ipragliflozin 25 mg compared with metformin. Compared with linagliptin and sitagliptin, the mean weight loss ranged from -3.17 kg (95% CrI, -3.67 to -2.57) with canagliflozin 300 mg to -0.93 kg (95% CrI, -1.92 to 0.05) with ipragliflozin 25 mg. Canagliflozin 300 mg reduced weight to a greater extent than the other SGLT2 inhibitors, with a probability of 99.44%. SGLT2 inhibitors also improved the proportions of patients achieving ≥5% weight loss. The effect of SGLT2 inhibitors on weight reduction was associated with dosage. IMPLICATIONS Available evidence from randomized controlled trials suggests that SGLT2 inhibitor monotherapy exerts more beneficial effects on weight reduction than both metformin and dipeptidyl peptidase 4 inhibitors. The weight reduction effect of 300 mg canagliflozin is greater than that of most other SGLT2 inhibitors. More types of SGLT2 inhibitors in a head-to-head trial, as well as a comparison between SGLT2 inhibitors and glucagon-like peptide 1 receptor agonists, will be involved in our further research. International Prospective Register of Systematic Reviews: CRD42018089761.
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Effects of wine on blood pressure, glucose parameters, and lipid profile in type 2 diabetes mellitus: A meta-analysis of randomized interventional trials (PRISMA Compliant).
Ye, J, Chen, X, Bao, L
Medicine. 2019;(23):e15771
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BACKGROUND Previous studies identified conflicting results about the effects of wine intake on glucose parameters and the risk of cardiovascular diseases in type 2 diabetes mellitus (T2DM). The present study further investigated the association between wine digestion and these outcomes in T2DM patients. MATERIAL AND METHODS A search of PubMed, Embase, and Scopus databases (up to November 2018) was performed for randomized interventional trials which evaluated the effect of wine on blood pressure (BP), glucose parameters and lipid profiles in T2DM people. We used a variety of tests: fixed and random effects models, Q Cochrane test and I index, Egger and Begg tests, forest plots, and sensitivity analysis in our study. RESULTS A total of 9 randomized interventional studies were included in this meta-analysis. Overall, significant association between wine intake with diastolic BP (weighted mean difference [WMD] = 0.10; 95% confidence interval [95% CI]: -0.01 to 0.20, P = .03 I = 13%) and total cholesterol (TC) (WMD = 0.16, 95% CI: 0.02-0.31, P = .03, I = 6%), whereas no noticeable differences in glucose parameters, systolic BP, low-density lipoprotein cholesterol (LDLC), triglyceride (TG) and high-density lipoprotein cholesterol (HDLC) were identified between wine and controls groups (fasting glucose [FG],WMD = -0.00, 95% CI: -0.58 to 0.58; fasting insulin [FI], -0.22, -2.09 to 1.65; HbAc1%, -0.16, -0.40 to 0.07; systolic blood pressure, 0.12, -0.05 to 0.28; LDLC, -0.02, -0.25 to 0.21; TG, -0.34, -1.31 to 0.64; HDLC, 0.22, -0.08 to 0.53]. CONCLUSION This meta-analysis revealed that moderate wine consumption among T2DM patients could reduce the level of diastolic blood pressure and TC, but not glucose parameters and other cardiovascular risk factors.
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Ipragliflozin as an add-on therapy in type 2 diabetes mellitus patients: An evidence-based pharmacoeconomics evaluation.
Wang, H, Yao, G, Chen, X, Ouyang, J, Yang, J
Diabetes research and clinical practice. 2019;:107867
Abstract
AIM: To evaluate the efficacy, safety and cost-effectiveness of ipragliflozin as an add-on therapy in patients with type 2 diabetes mellitus (T2DM). METHODS PubMed, EMBASE, the Cochrane Library, Web of Science and four Chinese databases, as well as the ClinicalTrials.gov website were searched from their inception through Jan 2019. Methodological quality was assessed using the Cochrane risk of bias, and meta-analysis was performed using RevMan5.3. RESULTS A total of 11 randomized controlled trials with 1766 patients were included. Ipragliflozin administered (50 mg) once daily as an add-on therapy to other glucose-lowering medications (metformin, pioglitazone, sulfonylurea, α-glucosidase inhibitor, sitagliptin, insulin) was associated with reductions in hemoglobin A1c (HbA1c) of -0.74% (95% confidence interval (CI) -1.00 to -0.48), fasting plasma glucose (WMD -25.03 mg/dL; 95% CI -32.89 to -17.16), weight, waist circumference, blood pressure, and triglycerides levels. Neither the incidence of treatment-emergent adverse events (TEAEs) (RR 1.08; 95% CI 1.00 to 1.16) nor drug-related TEAEs (RR 1.19; 95% CI 0.93 to 1.54) was significantly increased. However, it was associated with an increased risk of hypoglycemia when added to insulin (RR 1.71; 95% CI 1.13 to 2.61). Compared with the pioglitazone group and the sitagliptin + metformin group, the incremental cost-effectiveness ratio of ipragliflozin add-on therapy group was $4976.89, $2089.76 per percentage of qualified HbA1c, respectively. CONCLUSION Ipragliflozin as an add-on therapy is well tolerated and effective. Ipragliflozin as an add-on therapy do not appear cost-effective compared with metformin alone, but may be competitive against pioglitazone group and the sitagliptin + metformin group.