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Anderson K, Shehata M, Singh D, Al-Ourani M. Acute Pancreatitis Induced by Polatuzumab-Vedotin-Piiq in Combination With Bendamustine and Rituximab for Diffuse Large B-Cell Lymphoma. Cureus 2020; 12:e10299. [PMID: 33047089 PMCID: PMC7540405 DOI: 10.7759/cureus.10299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
While alcohol and gallstones have been considered the most common causes of pancreatitis, we investigate two uncommon etiologies such as drug-induced and viral-induced. Pancreatitis, an inflammatory process, can lead to many complicated outcomes such as acute respiratory failure, sepsis, and death. Examining drug-induced pancreatitis poses a large challenge for physicians as majority of the data is extrapolated from case reports. This is made even more difficult for patients who are on large chemotherapeutic regimens which include multitude of drugs and various side effects. Besides patient medication regimens, other etiologies of pancreatitis must be ruled out such as viruses. We examine a case of a 48-year-old female undergoing treatment for diffuse large B-cell lymphoma with various chemotherapeutic agents and positive cultures for varicella zoster virus (VZV) presenting with diffuse epigastric abdominal pain.
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Affiliation(s)
- Kara Anderson
- Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Mena Shehata
- Pulmonary and Critical Care, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Davinder Singh
- Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Mohammed Al-Ourani
- Pulmonology and Critical Care, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
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Bevan G, De Poli C, Keng MJ, Raine R. How valid are projections of the future prevalence of diabetes? Rapid reviews of prevalence-based and Markov chain models and comparisons of different models' projections for England. BMJ Open 2020; 10:e033483. [PMID: 32132137 PMCID: PMC7059487 DOI: 10.1136/bmjopen-2019-033483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To examine validity of prevalence-based models giving projections of prevalence of diabetes in adults, in England and the UK, and of Markov chain models giving estimates of economic impacts of interventions to prevent type 2 diabetes (T2D). METHODS Rapid reviews of both types of models. Estimation of the future prevalence of T2D in England by Markov chain models; and from the trend in the prevalence of diabetes, as reported in the Quality and Outcomes Framework (QOF), estimated by ordinary least squares regression analysis. SETTING Adult population in England and UK. MAIN OUTCOME MEASURE Prevalence of T2D in England and UK in 2025. RESULTS The prevalence-based models reviewed use sample estimates of past prevalence rates by age and sex and projected population changes. Three most recent models, including that of Public Health England (PHE), neither take account of increases in obesity, nor report Confidence Intervals (CIs). The Markov chain models reviewed use transition probabilities between states of risk and death, estimated from various sources. None of their accounts give the full matrix of transition probabilities, and only a minority report tests of validation. Their primary focus is on estimating the ratio of costs to benefits of preventive interventions in those with hyperglycaemia, only one reported estimates of those developing T2D in the absence of a preventive intervention in the general population.Projections of the prevalence of T2D in England in 2025 were (in millions) by PHE, 3.95; from the QOF trend, 4.91 and by two Markov chain models, based on our review, 5.64 and 9.07. CONCLUSIONS To inform national policies on preventing T2D, governments need validated models, designed to use available data, which estimate the scale of incidence of T2D and survival in the general population, with and without preventive interventions.
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Affiliation(s)
- Gwyn Bevan
- Department of Management, London School of Economics and Political Science, London, UK
| | - Chiara De Poli
- Department of Management, London School of Economics and Political Science, London, UK
| | - Mi Jun Keng
- Department of Management, London School of Economics and Political Science, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
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Domecq JP, Prutsky G, Elraiyah T, Wang Z, Mauck KF, Brito JP, Undavalli C, Sundaresh V, Prokop LJ, Montori VM, Murad MH. Medications affecting the biochemical conversion to type 2 diabetes: A systematic review and meta-analysis. J Clin Endocrinol Metab 2019; 104:3986-3995. [PMID: 31365088 DOI: 10.1210/jc.2019-01269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 02/13/2023]
Abstract
BACKGROUND The extent to which some pharmacological interventions reduce or increase the risk of biochemical conversion to T2DM in at-risk individuals is unclear. METHODS We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Scopus through August 24, 2017, for randomized controlled trials evaluating the effect of drugs suspected to modify the risk of biochemical conversion to T2DM. RESULTS We included 43 trials with 192,156 subjects (mean age 60 years; 56% men; mean BMI 30.4 kg/m2). Alpha-glucosidase inhibitors, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, metformin, orlistat, phentermine-topiramate and pioglitazone significantly reduced the risk of biochemical conversion to T2DM, whereas statins and nateglinide increased the risk. There was insufficient direct evidence regarding the effects of sulfonylureas, glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors and sodium-glucose cotransporter-2 inhibitors. Most trials were brief and evaluated this outcome during treatment without a withdrawal or washout period. CONCLUSIONS Several drugs modify the risk of biochemical conversation to T2DM, although whether this effect is persistent and clinically relevant is unclear. Future studies need to focus on cardiovascular disease prevention, mortality and patient-important outcomes instead of biochemical conversion to T2DM.
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Affiliation(s)
| | | | - Tarig Elraiyah
- Evidence Based Practice Center, Mayo Clinic, Rochester, MN
- Division of Nephrology, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA
| | - Zhen Wang
- Evidence Based Practice Center, Mayo Clinic, Rochester, MN
| | - Karen F Mauck
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Juan Pablo Brito
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
- Division of Endocrinology, Mayo Clinic, Rochester, MN
| | | | | | - Larry J Prokop
- Evidence Based Practice Center, Mayo Clinic, Rochester, MN
| | - Victor M Montori
- Evidence Based Practice Center, Mayo Clinic, Rochester, MN
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
- Division of Endocrinology, Mayo Clinic, Rochester, MN
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Comparison of the Effectiveness of Lifestyle Modification with Other Treatments on the Incidence of Type 2 Diabetes in People at High Risk: A Network Meta-Analysis. Nutrients 2019; 11:nu11061373. [PMID: 31248094 PMCID: PMC6627198 DOI: 10.3390/nu11061373] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/11/2019] [Accepted: 06/16/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Many clinical trials have been conducted to verify the effects of interventions for prevention of type 2 diabetes (T2D) using different treatments and outcomes. The aim of this study was to compare the effectiveness of lifestyle modifications (LM) with other treatments in persons at high risk of T2D by a network meta-analysis (NMA). METHODS Searches were performed of PUBMED up to January 2018 to identify randomized controlled trials. The odds ratio (OR) with onset of T2D at 1 year in the intervention group (LM, dietary, exercise, or medication) versus a control group (standard treatments or placebo) were the effect sizes. Frequentist and Bayesian NMAs were conducted. RESULTS Forty-seven interventions and 12 treatments (20,113 participants) were used for the analyses. The OR in the LM was approximately 0.46 (95% CI: 0.33 to 0.61) times lower compared to the standard intervention by the Bayesian approach. The effects of LM compared to other treatments by indirect comparisons were not significant. CONCLUSIONS This meta-analysis further strengthened the evidence that LM reduces the onset of T2D compared to standard and placebo interventions and appears to be at least as effective as nine other treatments in preventing T2D.
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Sheng Z, Cao JY, Pang YC, Xu HC, Chen JW, Yuan JH, Wang R, Zhang CS, Wang LX, Dong J. Effects of Lifestyle Modification and Anti-diabetic Medicine on Prediabetes Progress: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2019; 10:455. [PMID: 31354627 PMCID: PMC6639788 DOI: 10.3389/fendo.2019.00455] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 06/24/2019] [Indexed: 01/03/2023] Open
Abstract
Background: Pre-diabetes is a risk factor for full-blown diabetes; it presents opportunities to prevent the actual diseases. It is therefore essential to identify effective preventive strategies, and to clarify the direction of future research. Methods: PubMed, Embase and Cochrane Central Register of Controlled Trials were searched using key terms (Supplementary Table 1). We applied network meta-analysis to multiple comparisons among various diabetic preventive strategies, including lifestyle and pharmacological interventions; traditional meta-analysis for the synthesis of basal metabolic changes after interventions; and trial sequential analysis for determinations as to whether analysis conclusions meet expectations. Results: We included 32 randomized controlled trials comprising 43,669 patients and 14 interventions in the meta-analysis. Both lifestyle modifications and anti-diabetic medications improved physical conditions, including weight loss, blood glucose, and blood pressure. Network meta-analysis suggested that the progression of diabetes could be delayed to varying degrees by lifestyle and pharmacological interventions, except for angiotensin-converting enzyme inhibitors, statins, sulfonylureas and vitamin D. The risk ratios (RR) [95% credible interval (CrI)] compared with control were: GLP-1RAs 0.28 (0.15, 0.50), Orlistat 0.33 (0.18, 0.55), TZM 0.33 (0.16, 0.63), TZD 0.39 (0.27, 0.53), LST 0.54 (0.32, 0.88), lifestyle 0.58 (0.49, 0.67), LSM 0.62 (0.45, 0.80), GI 0.66 (0.46, 0.88), SU 0.67 (0.40, 1.00), Vitamin D 0.91 (0.59, 1.40), ACEI 0.93 (0.62, 1.40), statins 1.20 (0.84, 1.60). Conclusions: In adults with pre-diabetes, firm evidence supports the notion that lifestyle modifications and metformin reduces the incidence of diabetes with an average of 20% relative risk reduction, while statins increase the relative risk 20%. We found that lifestyle modifications, promising long-term strategies involving three factors (nutrition, exercise, and weight loss) contribute to health by reducing BMI, body weight, waist and hip circumference, systolic and diastolic pressure, fasting, and 2-h postprandial blood glucose, total cholesterol and by increasing HDL. We made this determination using TSA, avoiding further waste of experimental resources.
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Affiliation(s)
- Zhi Sheng
- Clinical Medicine Department, Medical College, Qingdao University, Shandong, China
| | - Jia-Yu Cao
- Clinical Medicine Department, Medical College, Qingdao University, Shandong, China
| | - Ying-Chang Pang
- Clinical Medicine Department, Medical College, Qingdao University, Shandong, China
| | - Hang-Cheng Xu
- Clinical Medicine Department, Medical College, Qingdao University, Shandong, China
| | - Jing-Wen Chen
- Clinical Medicine Department, Medical College, Qingdao University, Shandong, China
| | - Jun-Hua Yuan
- Special Medicine Department, Medical College, Qingdao University, Shandong, China
| | - Rui Wang
- Special Medicine Department, Medical College, Qingdao University, Shandong, China
| | - Cai-Shun Zhang
- Special Medicine Department, Medical College, Qingdao University, Shandong, China
| | - Liu-Xin Wang
- Special Medicine Department, Medical College, Qingdao University, Shandong, China
| | - Jing Dong
- Special Medicine Department, Medical College, Qingdao University, Shandong, China
- Physiology Department, Medical College, Qingdao University, Shandong, China
- *Correspondence: Jing Dong
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Haw JS, Galaviz KI, Straus AN, Kowalski AJ, Magee MJ, Weber MB, Wei J, Narayan KMV, Ali MK. Long-term Sustainability of Diabetes Prevention Approaches: A Systematic Review and Meta-analysis of Randomized Clinical Trials. JAMA Intern Med 2017; 177:1808-1817. [PMID: 29114778 PMCID: PMC5820728 DOI: 10.1001/jamainternmed.2017.6040] [Citation(s) in RCA: 207] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 08/31/2017] [Indexed: 01/01/2023]
Abstract
Importance Diabetes prevention is imperative to slow worldwide growth of diabetes-related morbidity and mortality. Yet the long-term efficacy of prevention strategies remains unknown. Objective To estimate aggregate long-term effects of different diabetes prevention strategies on diabetes incidence. Data Sources Systematic searches of MEDLINE, EMBASE, Cochrane Library, and Web of Science databases. The initial search was conducted on January 14, 2014, and was updated on February 20, 2015. Search terms included prediabetes, primary prevention, and risk reduction. Study Selection Eligible randomized clinical trials evaluated lifestyle modification (LSM) and medication interventions (>6 months) for diabetes prevention in adults (age ≥18 years) at risk for diabetes, reporting between-group differences in diabetes incidence, published between January 1, 1990, and January 1, 2015. Studies testing alternative therapies and bariatric surgery, as well as those involving participants with gestational diabetes, type 1 or 2 diabetes, and metabolic syndrome, were excluded. Data Extraction and Synthesis Reviewers extracted the number of diabetes cases at the end of active intervention in treatment and control groups. Random-effects meta-analyses were used to obtain pooled relative risks (RRs), and reported incidence rates were used to compute pooled risk differences (RDs). Main Outcomes and Measures The main outcome was aggregate RRs of diabetes in treatment vs control participants. Treatment subtypes (ie, LSM components, medication classes) were stratified. To estimate sustainability, post-washout and follow-up RRs for medications and LSM interventions, respectively, were examined. Results Forty-three studies were included and pooled in meta-analysis (49 029 participants; mean [SD] age, 57.3 [8.7] years; 48.0% [n = 23 549] men): 19 tested medications; 19 evaluated LSM, and 5 tested combined medications and LSM. At the end of the active intervention (range, 0.5-6.3 years), LSM was associated with an RR reduction of 39% (RR, 0.61; 95% CI, 0.54-0.68), and medications were associated with an RR reduction of 36% (RR, 0.64; 95% CI, 0.54-0.76). The observed RD for LSM and medication studies was 4.0 (95% CI, 1.8-6.3) cases per 100 person-years or a number-needed-to-treat of 25. At the end of the washout or follow-up periods, LSM studies (mean follow-up, 7.2 years; range, 5.7-9.4 years) achieved an RR reduction of 28% (RR, 0.72; 95% CI, 0.60-0.86); medication studies (mean follow-up, 17 weeks; range, 2-52 weeks) showed no sustained RR reduction (RR, 0.95; 95% CI, 0.79-1.14). Conclusions and Relevance In adults at risk for diabetes, LSM and medications (weight loss and insulin-sensitizing agents) successfully reduced diabetes incidence. Medication effects were short lived. The LSM interventions were sustained for several years; however, their effects declined with time, suggesting that interventions to preserve effects are needed.
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Affiliation(s)
- J. Sonya Haw
- Division of Endocrinology, Metabolism and Lipids, School of Medicine, Emory University, Atlanta, Georgia
| | - Karla I. Galaviz
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Alysse J. Kowalski
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Matthew J. Magee
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta
| | - Mary Beth Weber
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jingkai Wei
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - K. M. Venkat Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mohammed K. Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Department of Family and Preventive Medicine, Emory University, Atlanta, Georgia
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Hemmingsen B, Sonne DP, Metzendorf M, Richter B. Insulin secretagogues for prevention or delay of type 2 diabetes mellitus and its associated complications in persons at increased risk for the development of type 2 diabetes mellitus. Cochrane Database Syst Rev 2016; 10:CD012151. [PMID: 27749986 PMCID: PMC6461156 DOI: 10.1002/14651858.cd012151.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The projected rise in the incidence of type 2 diabetes mellitus (T2DM) could develop into a substantial health problem worldwide. Whether insulin secretagogues (sulphonylureas and meglitinide analogues) are able to prevent or delay T2DM and its associated complications in people at risk for the development of T2DM is unknown. OBJECTIVES To assess the effects of insulin secretagogues on the prevention or delay of T2DM and its associated complications in people with impaired glucose tolerance, impaired fasting blood glucose, moderately elevated glycosylated haemoglobin A1c (HbA1c) or any combination of these. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, Embase, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform, and the reference lists of systematic reviews, articles and health technology assessment reports. We asked investigators of the included trials for information about additional trials. The date of the last search of all databases was April 2016. SELECTION CRITERIA We included randomised controlled trials (RCTs) with a duration of 12 weeks or more comparing insulin secretagogues with any pharmacological glucose-lowering intervention, behaviour-changing intervention, placebo or no intervention in people with impaired fasting glucose, impaired glucose tolerance, moderately elevated HbA1c or combinations of these. DATA COLLECTION AND ANALYSIS Two review authors read all abstracts and full-text articles/records, assessed quality and extracted outcome data independently. One review author extracted data which were checked by a second review author. We resolved discrepancies by consensus or the involvement of a third review author. For meta-analyses we used a random-effects model with investigation of risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, using 95% confidence intervals (CIs) for effect estimates. We carried out trial sequential analyses (TSAs) for all outcomes that could be meta-analysed. We assessed the overall quality of the evidence by using the GRADE instrument. MAIN RESULTS We included six RCTs with 10,018 participants; 4791 participants with data on allocation to intervention groups were randomised to a second- or third-generation sulphonylurea or a meglitinide analogue as monotherapy and 29 participants were randomised to a second-generation sulphonylurea plus metformin. Three trials investigated a second-generation sulphonylurea, two trials investigated a third-generation sulphonylurea and one trial a meglitinide analogue. A total of 4873 participants with data on allocation to control groups were randomised to a comparator group; 4820 participants were randomised to placebo, 23 to diet and exercise, and 30 participants to metformin monotherapy. One RCT of nateglinide contributed 95% of all participants. The duration of the intervention varied from six months to five years. We judged none of the included trials as at low risk of bias for all 'Risk of bias' domains.All-cause and cardiovascular mortality following sulphonylurea (glimepiride) treatment were rarely observed (very low-quality evidence). The RR for incidence of T2DM comparing glimepiride monotherapy with placebo was 0.75; 95% CI 0.54 to 1.04; P = 0.08; 2 trials; 307 participants; very low-quality evidence. One of the trials reporting on the incidence of T2DM did not define the diagnostic criteria used. The other trial diagnosed T2DM as two consecutive fasting blood glucose values ≥ 6.1 mmol/L. TSA showed that only 4.5% of the diversity-adjusted required information size was accrued so far. No trial reported data on serious adverse events, non-fatal myocardial infarction (MI), non-fatal stroke, congestive heart failure (HF), health-related quality of life or socioeconomic effects.One trial with a follow-up of five years compared a meglitinide analogue (nateglinide) with placebo. A total of 310/4645 (6.7%) participants allocated to nateglinide died compared with 312/4661 (6.7%) participants allocated to placebo (hazard ratio (HR) 1.00; 95% CI 0.85 to 1.17; P = 0.98; moderate-quality evidence). The two main criteria for diagnosing T2DM were a fasting plasma glucose level ≥ 7.0 mmol/L or a 2-hour post challenge glucose ≥ 11.1 mmol/L. T2DM developed in 1674/4645 (36.0%) participants in the nateglinide group and in 1580/4661 (33.9%) in the placebo group (HR 1.07; 95% CI 1.00 to 1.15; P = 0.05; moderate-quality evidence). One or more serious adverse event was reported in 2066/4602 (44.9%) participants allocated to nateglinide compared with 2089/4599 (45.6%) participants allocated to placebo. A total of 126/4645 (2.7%) participants allocated to nateglinide died because of cardiovascular disease compared with 118/4661 (2.5%) participants allocated to placebo (HR 1.07; 95% CI 0.83 to 1.38; P = 0.60; moderate-quality evidence). Comparing participants receiving nateglinide with those receiving placebo for the outcomes MI, non-fatal stroke and HF gave the following event rates: MI 116/4645 (2.5%) versus 122/4661 (2.6%), stroke 100/4645 (2.2%) versus 110/4661 (2.4%) and numbers hospitalised for HF 85/4645 (1.8%) versus 100/4661 (2.1%) - (HR 0.85; 95% CI 0.64 to 1.14; P = 0.27). The quality of the evidence was moderate for all these outcomes. Health-related quality of life or socioeconomic effects were not reported. AUTHORS' CONCLUSIONS There is insufficient evidence to demonstrate whether insulin secretagogues compared mainly with placebo reduce the risk of developing T2DM and its associated complications in people at increased risk for the development of T2DM. Most trials did not investigate patient-important outcomes.
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Affiliation(s)
- Bianca Hemmingsen
- Herlev University HospitalDepartment of Internal MedicineHerlev Ringvej 75HerlevDenmarkDK‐2730
| | - David Peick Sonne
- Gentofte Hospital, University of CopenhagenCenter for Diabetes Research, Department of MedicineKildegaardsvej 28HellerupDenmarkDK‐2900
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupMoorenstr. 5DüsseldorfGermany40225
| | - Bernd Richter
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupMoorenstr. 5DüsseldorfGermany40225
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Stevens JW, Khunti K, Harvey R, Johnson M, Preston L, Woods HB, Davies M, Goyder E. Preventing the progression to type 2 diabetes mellitus in adults at high risk: a systematic review and network meta-analysis of lifestyle, pharmacological and surgical interventions. Diabetes Res Clin Pract 2015; 107:320-31. [PMID: 25638454 DOI: 10.1016/j.diabres.2015.01.027] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/31/2014] [Accepted: 01/02/2015] [Indexed: 11/29/2022]
Abstract
AIMS Individuals with impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) have an increased risk of progression to Type 2 diabetes mellitus. The objective of this review was to quantify the effectiveness of lifestyle, pharmacological and surgical interventions in reducing the progression to Type 2 diabetes mellitus in people with IFG or IGT. METHODS A systematic review was carried out. A network meta-analysis (NMA) of log-hazard ratios was performed. Results are presented as hazard ratios and the probabilities of treatment rankings. RESULTS 30 studies were included in the NMA. There was a reduced hazard of progression to Type 2 diabetes mellitus associated with all interventions versus standard lifestyle advice; glipizide, diet plus pioglitazone, diet plus exercise plus metformin plus rosiglitazone, diet plus exercise plus orlistat, diet plus exercise plus pedometer, rosiglitazone, orlistat and diet plus exercise plus voglibose produced the greatest effects. CONCLUSIONS Lifestyle and some pharmacological interventions are beneficial in reducing the risk of progression to Type 2 diabetes mellitus. Lifestyle interventions require significant behaviour changes that may be achieved through incentives such as the use of pedometers. Adverse events and cost of pharmacological interventions should be taken into account when considering potential risks and benefits.
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Merlotti C, Morabito A, Pontiroli AE. Prevention of type 2 diabetes; a systematic review and meta-analysis of different intervention strategies. Diabetes Obes Metab 2014; 16:719-27. [PMID: 24476122 DOI: 10.1111/dom.12270] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 09/30/2013] [Accepted: 01/19/2014] [Indexed: 02/06/2023]
Abstract
AIM Different intervention strategies can prevent type 2 diabetes (T2DM). Aim of the present systematic review and meta-analysis was to evaluate the effectiveness of different strategies. METHODS Studies were grouped into 15 different strategies: 1: diet plus physical activity; 2: physical activity; 3-6: anti-diabetic drugs [glitazones, metformin, beta-cell stimulating drugs (sulphanylureas, glinides), alfa-glucosidase inhibitors]; 7-8: cardiovascular drugs (ACE inhibitors, ARB, calcium antagonists); 9-14 [diets, lipid-affecting drugs (orlistat, bezafibrate), vitamins, micronutrients, estrogens, alcohol, coffee]; 15: bariatric surgery. Only controlled studies were included in the analysis, whether randomized, non-randomized, observational studies, whether primarily designed to assess incident cases of diabetes, or performed with other purposes, such as control of hypertension, of ischemic heart disease or prevention of cardiovascular events. Appropriate methodology [preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement] was used. Seventy-one studies (490 813 subjects), published as full papers, were analysed to identify predictors of new cases of T2DM, and were included in a meta-analysis (random-effects model) to study the effect of different strategies. Intervention effect (new cases of diabetes) was expressed as odds ratio (OR), with 95% confidence intervals (C.I.s). Publication bias was formally assessed. RESULTS Body mass index was in the overweight range for 13 groups, obese or morbidly obese in lipid-affecting drugs and in bariatric surgery. Non-surgical strategies, except for beta-cell stimulating drugs, estrogens and vitamins, were able to prevent T2DM, with different effectiveness, from 0.37 (C.I. 0.26-0.52) to 0.85 (C.I. 0.77-0.93); the most effective strategy was bariatric surgery in morbidly obese subjects [0.16 (C.I. 0.11,0.24)]. At meta-regression analysis, age of subjects and amount of weight lost were associated with effectiveness of intervention. CONCLUSIONS These data indicate that several strategies prevent T2DM, making it possible to make a choice for the individual subject.
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Affiliation(s)
- C Merlotti
- Cattedra di Medicina Interna and Cattedra di Statistica Medica e Biometria, Università degli Studi di Milano, Dipartimento di Scienze della Salute, and Dipartimento di Scienze Cliniche e di Comunità, Milano, Italy
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Phung OJ, Baker WL, Tongbram V, Bhardwaj A, Coleman CI. Oral antidiabetic drugs and regression from prediabetes to normoglycemia: a meta-analysis. Ann Pharmacother 2012; 46:469-76. [PMID: 22474136 DOI: 10.1345/aph.1q554] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Impaired glucose tolerance, impaired fasting glucose, and elevated hemoglobin A(1c) are intermediate stages, considered prediabetes, a precursor to overt type 2 diabetes mellitus. Prediabetes is associated with increased risk for cardiovascular disease, independent of diabetes development. Data have shown that various oral antidiabetic drugs can help people regress from prediabetes to normoglycemia. OBJECTIVE To evaluate the efficacy of oral antidiabetic drugs in promoting regression from prediabetes to normoglycemia. METHODS MEDLINE (1950-November 2011), EMBASE (1990-November 2011), and Cochrane Central Register of Controlled Trials (indexed September 2011) were systematically searched. A manual search of references from reports of clinical trials and review articles was performed to identify additional relevant studies. Randomized controlled trials 12 weeks or more in duration evaluating any of the oral antidiabetic drugs and studying regression from prediabetes to normoglycemia were included. A random-effects model was used to calculate pooled odds ratios with 95% confidence intervals. RESULTS Thirteen studies (N = 11,600 participants) were included in the meta-analysis. Use of oral antidiabetic drugs in prediabetic patients was shown to double the odds of achieving normoglycemia compared to controls (OR 2.03, 95% CI 1.54 to 2.67). When individual classes of oral antidiabetic drugs were evaluated, use of thiazolidinediones (OR 2.33, 95% CI 1.93 to 2.81) and α-glucosidase inhibitors (OR 2.02, 95% CI 1.26 to 3.24) was associated with significantly increased odds. However, biguanides (OR 2.04) and sulfonylureas (OR 1.84) failed to reach statistical significance (p = 0.06 and p = 0.39, respectively). CONCLUSIONS In patients with prediabetes, oral antidiabetic drugs were associated with increased odds of regression to normoglycemia versus placebo/control. Only thiazolidinediones and α-glucosidase inhibitors provided a statistically significant increase in odds of regressing to normoglycemia.
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Affiliation(s)
- Olivia J Phung
- College of Pharmacy, Western University of Health Sciences, Pomona, CA, USA.
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The selective androgen receptor modulator GTx-024 (enobosarm) improves lean body mass and physical function in healthy elderly men and postmenopausal women: results of a double-blind, placebo-controlled phase II trial. J Cachexia Sarcopenia Muscle 2011; 2:153-161. [PMID: 22031847 PMCID: PMC3177038 DOI: 10.1007/s13539-011-0034-6] [Citation(s) in RCA: 248] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 07/11/2011] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND: Cachexia, also known as muscle wasting, is a complex metabolic condition characterized by loss of skeletal muscle and a decline in physical function. Muscle wasting is associated with cancer, sarcopenia, chronic obstructive pulmonary disease, end-stage renal disease, and other chronic conditions and results in significant morbidity and mortality. GTx-024 (enobosarm) is a nonsteroidal selective androgen receptor modulator (SARM) that has tissue-selective anabolic effects in muscle and bone, while sparing other androgenic tissue related to hair growth in women and prostate effects in men. GTx-024 has demonstrated promising pharmacologic effects in preclinical studies and favorable safety and pharmacokinetic profiles in phase I investigation. METHODS: A 12-week double-blind, placebo-controlled phase II clinical trial was conducted to evaluate GTx-024 in 120 healthy elderly men (>60 years of age) and postmenopausal women. The primary endpoint was total lean body mass assessed by dual energy X-ray absorptiometry, and secondary endpoints included physical function, body weight, insulin resistance, and safety. RESULTS: GTx-024 treatment resulted in dose-dependent increases in total lean body mass that were statistically significant (P < 0.001, 3 mg vs. placebo) and clinically meaningful. There were also significant improvements in physical function (P = 0.013, 3 mg vs. placebo) and insulin resistance (P = 0.013, 3 mg vs. placebo). The incidence of adverse events was similar between treatment groups. CONCLUSION: GTx-024 showed a dose-dependent improvement in total lean body mass and physical function and was well tolerated. GTx-024 may be useful in the prevention and/or treatment of muscle wasting associated with cancer and other chronic diseases.
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Abstract
AIM To determine the comparative efficacy of oral anti-diabetic drugs in preventing the development of Type 2 diabetes. METHODS A systematic literature search of MEDLINE, EMBASE and Cochrane CENTRAL was conducted for randomized controlled trials evaluating oral anti-diabetic drugs in patients at high risk for developing Type 2 diabetes. Mixed-treatment comparison meta-analysis methods were used to evaluate the relative risks and risk differences of developing Type 2 diabetes, along with associated 95% credible intervals. RESULTS Overall, 20 trials (n = 23 230 participants) were included. Upon mixed-treatment comparison meta-analysis, thiazolidinediones, alpha-glucosidase inhibitors and biguanides significantly reduced the relative risk of developing diabetes by 64, 40 and 27%, respectively, compared with control. Sulphonylureas and glinides showed no significant effect. Moreover, thiazolidinediones significantly reduced the relative risk of diabetes by 50% compared with biguanides and trended towards a 40% risk reduction vs. alpha-glucosidase inhibitors [relative risk 0.60 (95% credible intervals 0.34-1.02)]. None of the results were appreciably altered upon subgroup or sensitivity analyses. When evaluating risk differences compared with control, thiazolidinediones (-9%, number needed to treat = 11), alpha-glucosidase inhibitors (-7%, number needed to treat = 14) and biguanides (-7%, number needed to treat = 14) continued to show significant benefit. CONCLUSIONS Of the oral anti-diabetic drugs evaluated to prevent Type 2 diabetes, thiazolidinediones were associated with the greatest risk reduction compared with control and associated with greater risk reduction than biguanides. Alpha-glucosidase inhibitors and biguanides performed similarly, and better than control, while sulphonylureas and glinides provided no significant benefit.
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Affiliation(s)
- O J Phung
- Western University of Health Sciences College of Pharmacy, Pomona, CA, USA
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Affiliation(s)
- Saul Genuth
- Division of Clinical and Molecular Endocrinology, Department of Medicine, Case Western Reserve University, Cleveland, Ohio 44106-4951, USA.
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15
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Gillies CL, Lambert PC, Abrams KR, Sutton AJ, Cooper NJ, Hsu RT, Davies MJ, Khunti K. Different strategies for screening and prevention of type 2 diabetes in adults: cost effectiveness analysis. BMJ 2008; 336:1180-5. [PMID: 18426840 PMCID: PMC2394709 DOI: 10.1136/bmj.39545.585289.25] [Citation(s) in RCA: 201] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To compare four potential screening strategies, and subsequent interventions, for the prevention and treatment of type 2 diabetes: (a) screening for type 2 diabetes to enable early detection and treatment, (b) screening for type 2 diabetes and impaired glucose tolerance, intervening with lifestyle interventions in those with a diagnosis of impaired glucose tolerance to delay or prevent diabetes, (c) as for (b) but with pharmacological interventions, and (d) no screening. DESIGN Cost effectiveness analysis based on development and evaluation of probabilistic, comprehensive economic decision analytic model, from screening to death. SETTING A hypothetical population, aged 45 at time of screening, with above average risk of diabetes. DATA SOURCES Published clinical trials and epidemiological studies retrieved from electronic bibliographic databases; supplementary data obtained from the Department of Health statistics for England and Wales, the screening those at risk (STAR) study, and the Leicester division of the ADDITION study. METHODS A hybrid decision tree/Markov model was developed to simulate the long term effects of each screening strategy, in terms of both clinical and cost effectiveness outcomes. The base case model assumed a 50 year time horizon with discounting of both costs and benefits at 3.5%. Sensitivity analyses were carried out to investigate assumptions of the model and to identify which model inputs had most impact on the results. RESULTS Estimated costs for each quality adjusted life year (QALY) gained (discounted at 3.5% a year for both costs and benefits) were pound14,150 (euro17 560; $27,860) for screening for type 2 diabetes, pound6242 for screening for diabetes and impaired glucose tolerance followed by lifestyle interventions, and pound7023 for screening for diabetes and impaired glucose tolerance followed by pharmacological interventions, all compared with no screening. At a willingness-to-pay threshold of pound20,000 the probability of the intervention being cost effective was 49%, 93%, and 85% for each of the active screening strategies respectively. CONCLUSIONS Screening for type 2 diabetes and impaired glucose tolerance, with appropriate intervention for those with impaired glucose tolerance, in an above average risk population aged 45, seems to be cost effective. The cost effectiveness of a policy of screening for diabetes alone, which offered no intervention to those with impaired glucose tolerance, is still uncertain.
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Affiliation(s)
- Clare L Gillies
- Centre for Biostatistics and Genetic Epidemiology, Department of Health Sciences, University of Leicester, Leicester LE1 7RH.
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Abstract
The increasing prevalence of diabetes worldwide is cause for concern both in terms of associated morbidity and increasing health costs. This review aims to focus on new and emerging treatments for type 1 and type 2 diabetes. There has been recent focus on diabetes prevention both for type 1 and type 2 diabetes. Prevention programme including lifestyle measures and oral hypoglycaemic agents have shown up to 61% reduction in the development of type 2 diabetes in patients with impaired glucose tolerance or impaired fasting glucose. Little progress has been made to date on type 1 diabetes prevention although current work is focusing on T-cell immunomodulation therapy and beta cell regeneration. Management of type 2 diabetes has been improved by the recent introduction of the peroxisome proliferator-activated receptor-gamma agonists and more recently by the incretins including glucagons like peptide analogues and dipeptidyl peptidase-4 inhibitors. This article focuses on the benefits and restrictions of these new agents. The new insulin analogues glargine and detemir have made significant improvements in the management of type 1 diabetes both in terms of improvement in glycaemic control and in reducing hypoglycaemia rates. Inhaled insulin also shows promise for needle-free treatment of diabetes and these insulins are currently undergoing phase 3 trials. Insulin infusion pumps are becoming more sophisticated and increasingly popular in the management of type 1 diabetes. Many studies have shown benefits for improved glycaemic control and reduced rates of hypoglycaemia with pump treatment compared with multiple daily injections. Pancreas and islet cell transplantation are the subject of ongoing research, but currently require immunosuppressive treatment regimes. The main limitation is lack of availability of donor pancreases. There is much hope that new treatments outlined in this review will result in improved outcomes in the treatment of diabetes.
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Affiliation(s)
- N D Cohen
- International Diabetes Institute, Melbourne, Victoria, Australia.
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