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Vounzoulaki E, Miksza JK, Zaccardi F, Tan BK, Davies MJ, Khunti K, Gillies CL. Association of ethnicity and socioeconomic status with health outcomes in women with gestational diabetes: Clinical practice research datalink cohort study. Diabetes Metab Syndr 2024; 18:103010. [PMID: 38676970 DOI: 10.1016/j.dsx.2024.103010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 02/05/2024] [Accepted: 04/09/2024] [Indexed: 04/29/2024]
Abstract
AIMS To investigate in women with prior gestational diabetes mellitus (GDM), differences by ethnicity and socioeconomic status in the incidence of recurrent GDM, type 2 diabetes (T2D), hypertension, and depression. METHODS This was a retrospective cohort study including 10,868 women diagnosed with GDM in the Clinical Practice Research Datalink (CPRD GOLD) between January 01, 2000 and November 05, 2018. Linked data were obtained for Hospital Episode Statistics and the Index of Multiple Deprivation. We estimated incidence rates and hazard ratios, by ethnicity and socioeconomic status. RESULTS During a follow-up of 58,479 person years (mean (SD): 5.38 (3.67) years), the crude incidence was 9.67 (95 % confidence interval: 9.30-10.00) per 100 person years for recurrent GDM, 3.86 (3.70-4.02) for depression, 2.15 (2.03-2.27) for T2D and 0.89 (0.81-0.97) for hypertension. South Asian ethnicity was associated with an increased risk of T2D compared to White (adjusted hazard ratio: 1.65; 1.34-2.05) and Black ethnicity was associated with a greater risk of hypertension (2.93; 1.93-4.46). Black and South Asian ethnicity were associated with a reduced risk of depression compared to White: 0.23 (0.13-0.39) and 0.37 (0.29-0.46), respectively. Incidence rates were higher for all conditions with increasing deprivation level. CONCLUSIONS The risk of health complications in women with a prior history of GDM differs by ethnicity and socio-economic status, suggesting the opportunity for targeted assessment in the years following pregnancy. These findings may inform future guidelines on screening for health outcomes in women with GDM.
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Affiliation(s)
- Elpida Vounzoulaki
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK.
| | - Joanne K Miksza
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK
| | - Francesco Zaccardi
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK
| | - Bee K Tan
- Department of Cardiovascular Sciences, University of Leicester, Leicester, LE2 7LX, UK
| | - Melanie J Davies
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), Leicester General Hospital, Leicester, LE5 4PW, UK
| | - Kamlesh Khunti
- National Institute for Health Research (NIHR) Applied Research Collaboration - East Midlands (ARC-EM), Leicester Diabetes Centre, Leicester, LE5 4PW, UK
| | - Clare L Gillies
- Leicester Real World Evidence Unit, Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK
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Worboys HM, Broomfield J, Smith A, Stannard R, Tyrer F, Vounzoulaki E, Czyznikowska B, Grewal-Santini G, Greenwood J, Gray LJ. Incorporation of patient and public involvement in statistical methodology research: development of an animation. Res Involv Engagem 2023; 9:102. [PMID: 37941086 PMCID: PMC10631193 DOI: 10.1186/s40900-023-00513-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/01/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Patient and Public Involvement and Engagement (PPIE) is important to all aspects of health research. However, there are few examples of successful PPIE in statistical methodology research. One of the reasons for this relates to challenges in the identification of individuals interested in statistical methodology research projects, and ambiguities over the importance of PPIE to these projects. METHODS This project was conducted between August 2022 and August 2023. The aim is to report the process of the development of an accessible animation to describe what statistical methodology is and the importance of PPIE in statistical methodology research projects. For this, we combined storyboarding and scriptwriting with feedback from PPIE members and researchers. RESULTS After three stages that incorporated feedback from the relevant stakeholders, we produced a final animation about PPIE in statistical methodology. The resulting animation used minimal text, simple animation techniques and was of short duration (< 3 min) to optimise the communication of the key messages clearly and effectively. CONCLUSIONS The resulting animation provides a starting point for members of the public to learn about PPIE in statistical methodology research and for methodologists who wish to conduct PPIE. We recommend further work to explore ways in which members of the public can be more meaningfully involved in methodology research.
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Affiliation(s)
- Hannah M Worboys
- Department of Population Health Sciences, University of Leicester, Leicester, UK.
| | - Jonathan Broomfield
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Aiden Smith
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Rachael Stannard
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Freya Tyrer
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Elpida Vounzoulaki
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, UK
| | | | | | - Justin Greenwood
- Public Contributor, PPI-SMART (Public and Patient Involvement in Statistical Methods and Research Techniques), University of Leicester, Leicester, UK
| | - Laura J Gray
- Department of Population Health Sciences, University of Leicester, Leicester, UK
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Abell L, Maher F, Begum S, Booth S, Broomfield J, Lee S, Smith E, Stannard R, Teece L, Vounzoulaki E, Worboys H, Gray LJ. Incorporation of patient and public involvement in statistical methodology research: a survey assessing current practices and attitudes of researchers. Res Involv Engagem 2023; 9:100. [PMID: 37891693 PMCID: PMC10612225 DOI: 10.1186/s40900-023-00507-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Patient and public involvement (PPI) ensures that research is designed and conducted in a manner that is most beneficial to the individuals whom it will impact. It has an undisputed place in applied research and is required by many funding bodies. However, PPI in statistical methodology research is more challenging and work is needed to identify where and how patients and the public can meaningfully input in this area. METHODS A descriptive cross-sectional research study was conducted using an online questionnaire, which asked statistical methodologists about themselves and their experience conducting PPI, either to inform a grant application or during a funded statistical methodology project. The survey included both closed-text responses, which were reported using summary statistics, and open-ended questions for which common themes were identified. RESULTS 119 complete responses were recorded. Individuals who completed the survey displayed an even range of ages, career lengths and positions, with the majority working in academia. 40.3% of participants reported undertaking PPI to inform a grant application and the majority reported that the inclusion of PPI was received positively by the funder. Only 21.0% of participants reported undertaking PPI during a methodological project. 31.0% of individuals thought that PPI was "very" or "extremely" relevant to statistical methodology research, with 45.5% responding "somewhat" and 24.4% answering "not at all" or "not very". Arguments for including PPI were that it can provide the motivation for research and shape the research question. Negative opinions included that it is too technical for the public to understand, so they cannot have a meaningful impact. CONCLUSIONS This survey found that the views of statistical methodologists on the inclusion of PPI in their research are varied, with some individuals having particularly strong opinions, both positive and negative. Whilst this is clearly a divisive topic, one commonly identified theme was that many researchers are willing to try and incorporate meaningful PPI into their research but would feel more confident if they had access to resources such as specialised training, guidelines, and case studies.
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Affiliation(s)
- Lucy Abell
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Francesca Maher
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Samina Begum
- Statistical Methodology PPI Group, University of Leicester, Leicester, UK
| | - Sarah Booth
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Jonathan Broomfield
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Sangyu Lee
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Ellesha Smith
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Rachael Stannard
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Lucy Teece
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | | | - Hannah Worboys
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Laura J Gray
- Department of Population Health Sciences, University of Leicester, Leicester, UK.
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Bougioukas KI, Pamporis K, Vounzoulaki E, Karagiannis T, Haidich AB. Types and associated methodologies of overviews of reviews in health care: a methodological study with published examples. J Clin Epidemiol 2023; 153:13-25. [PMID: 36351511 DOI: 10.1016/j.jclinepi.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 10/16/2022] [Accepted: 11/02/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To provide a descriptive insight into the different types of research questions/objectives and associated methodologies of overviews of reviews, supplemented by representative examples from the health care literature. STUDY DESIGN AND SETTING We searched in methodological articles for information on types and methodologies used in overviews and we explored the typology of reviews to identify similar types in literature of overviews. We categorized the types of overviews based on the research question/objective and the methodological approach used. Indicative examples for each category were selected from a sample of 2,121 overviews that were retrieved between 2000 and 2022 from MEDLINE, Scopus, and Cochrane Database of Systematic Reviews. RESULTS Based on type of research question, overviews were classified as overviews of reviews of interventions, associations, prediction, diagnostic accuracy, prevalence/incidence, experiences/views, economic evaluation, and measurement properties. Based on the methodological approach, we identified a variety of methods (systematic, living, rapid, scoping, evidence mapping, framework, and methodological) used in overviews. CONCLUSION The proposed classification and examples provide an essential starting point for future theory-building research on typologies and study designs of overviews of reviews. It is important for methodologists to make vigorous effort to create consensus-based methodological and reporting guidelines to cover these diverse types and key methodological challenges.
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Affiliation(s)
- Konstantinos I Bougioukas
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, Medical School, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - Konstantinos Pamporis
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, Medical School, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - Elpida Vounzoulaki
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK
| | - Thomas Karagiannis
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece; Diabetes Centre, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, Medical School, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece.
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Vounzoulaki E, Khunti K, Miksza JK, Tan BK, Davies MJ, Gillies CL. Screening for type 2 diabetes after a diagnosis of gestational diabetes by ethnicity: A retrospective cohort study. Prim Care Diabetes 2022; 16:445-451. [PMID: 35351389 DOI: 10.1016/j.pcd.2022.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/28/2022] [Accepted: 03/16/2022] [Indexed: 10/18/2022]
Abstract
AIMS To estimate rates and identify determinants of post-partum glucose screening attendance in women with a history of gestational diabetes mellitus (GDM). METHODS Retrospective cohort study using the Clinical Practice Research Datalink linked to Hospital Episode Statistics, to identify women diagnosed with GDM between 01/01/2000 and 05/11/2018. Age adjusted odds ratios (aOR) and 95% confidence intervals (CI) were estimated using multivariable logistic regression models. RESULTS In 10,868 women with GDM, with an average follow-up of 5.38 years (95% CI 5.31,5.45), there was an average of 3.79 (95% CI 3.70,3.89) screening episodes per individual, with a mean time to first screening test of 1.22 (95% CI 1.18, 1.25) years. South Asian women had a significantly greater likelihood of being screened compared to White women within the first 5 years post-partum, aOR: 1.89 95% CI (1.20,2.98). A low proportion of women received at least one test per year of follow-up (23.87%). Older age at GDM diagnosis, polycystic ovary syndrome, prescribed medication for GDM, and living in England, were all associated with a greater likelihood of being screened. CONCLUSION While the majority of women with previous GDM receive at least one glucose screening test within the first 5 years post-partum, fewer than a quarter of them receive on average one test per year of follow-up. Developing strategies to motivate more women to attend screening in primary care is essential.
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Affiliation(s)
- Elpida Vounzoulaki
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK; National Institute for Health Research (NIHR) Applied Research Collaboration, East Midlands (ARC-EM), Leicester Diabetes Centre, Leicester LE5 4PW, UK.
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK; National Institute for Health Research (NIHR) Applied Research Collaboration, East Midlands (ARC-EM), Leicester Diabetes Centre, Leicester LE5 4PW, UK
| | - Joanne K Miksza
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK
| | - Bee K Tan
- Department of Cardiovascular Sciences, University of Leicester, Leicester LE2 7LX, UK
| | - Melanie J Davies
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK; National Institute for Health Research (NIHR) Leicester Biomedical Research Centre (BRC), Leicester General Hospital, Leicester LE5 4PW, UK
| | - Clare L Gillies
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK; National Institute for Health Research (NIHR) Applied Research Collaboration, East Midlands (ARC-EM), Leicester Diabetes Centre, Leicester LE5 4PW, UK
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6
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Cerullo E, Quinn TJ, McCleery J, Vounzoulaki E, Cooper NJ, Sutton AJ. Interrater agreement in dementia diagnosis: A systematic review and meta-analysis. Int J Geriatr Psychiatry 2021; 36:1127-1147. [PMID: 33942363 DOI: 10.1002/gps.5499] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/27/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Dementia remains a clinical diagnosis with a degree of subjective assessment and potential for interrater disagreement. We described interrater agreement of clinical dementia diagnosis for various diagnostic criteria. METHODS We conducted a PROSPERO-registered (CRD42020168245) systematic review and meta-analysis. We searched multiple cross-disciplinary databases from inception until April 2020 for relevant papers, extracted data and described study quality in duplicate. Study quality was assessed using the Guidelines for Reporting Reliability and Agreement Studies. We used random-effects models to obtain summary estimates of interrater agreement using kappa and, where possible, Gwet's AC1/2 coefficients. RESULTS We found 7577 titles and 22 eligible studies. Meta-analysis was possible for all-cause dementia using the Diagnostic and Statistical Manual of Mental Disorders third edition revised (DSM-III-R) criteria (kappa = 0.66, 95% CI = [0.53,0.78]), Alzheimer's disease using the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's disease and Related Disorders Association (NINCDS-ADRDA) criteria (kappa = 0.71, 95% CI = [0.65,0.77] for presence/absence and AC2 = 0.61, 95% CI = [0.53,0.70] when distinguishing probable/possible cases), and vascular dementia using the International Classification of Diseases version 10 (ICD-10) criteria kappa = 0.79 (95% CI = [0.70,0.87]). Data was more limited for other criteria and dementia types. AC1/2 coefficients generally indicated higher agreement. One study was rated as high quality. CONCLUSIONS Diagnostic criteria for clinical dementia may have good but imperfect agreement. This has important implications for clinical practice and research studies, which frequently assume these criteria are perfect tests, such as diagnostic test accuracy studies frequently conducted for biomarkers and neuropsychological tests, and for trials where incident dementia is the outcome.
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Affiliation(s)
- Enzo Cerullo
- Department of Health Sciences, Biostatistics Research Group, University of Leicester, Leicester, UK.,NIHR Complex Reviews Support Unit, University of Leicester & University of Glasgow, Glasgow, UK
| | - Terry J Quinn
- NIHR Complex Reviews Support Unit, University of Leicester & University of Glasgow, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jenny McCleery
- Oxford Health NHS Foundation Trust, Elms Centre, Banbury, UK
| | - Elpida Vounzoulaki
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Nicola J Cooper
- Department of Health Sciences, Biostatistics Research Group, University of Leicester, Leicester, UK.,NIHR Complex Reviews Support Unit, University of Leicester & University of Glasgow, Glasgow, UK
| | - Alex J Sutton
- Department of Health Sciences, Biostatistics Research Group, University of Leicester, Leicester, UK.,NIHR Complex Reviews Support Unit, University of Leicester & University of Glasgow, Glasgow, UK
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Bougioukas KI, Vounzoulaki E, Mantsiou CD, Papanastasiou GD, Savvides ED, Ntzani EE, Haidich AB. Global mapping of overviews of systematic reviews in healthcare published between 2000 and 2020: a bibliometric analysis. J Clin Epidemiol 2021; 137:58-72. [PMID: 33775811 DOI: 10.1016/j.jclinepi.2021.03.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/24/2021] [Accepted: 03/18/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To conduct a bibliometric analysis using a large sample of overviews of systematic reviews (OoSRs) and reveal research trends and areas of interest about these studies. STUDY DESIGN AND SETTING We searched MEDLINE, Scopus and Cochrane Database of Systematic Reviews from 1/1/2000 to 15/10/2020. We used Scopus meta-data and two authors recorded supplementary information independently. We summarized the data using frequencies with percentages. RESULTS A total of 1558 studies were considered eligible for analysis. We found that the publications have been increasing yearly and their nomenclature was not uniform (the most frequent label in the title was "overview of systematic reviews"). The largest number of papers and the most cited ones were published by corresponding authors from the UK. The publications were distributed across 737 scholarly journals and many of them were published in the field of complementary/alternative medicine, psychiatry/psychology, nutrition/dietetics, and pediatrics. The co-authorship analysis revealed collaborations among countries. The most common clinical conditions were depression, diabetes, cancer, dementia, pain, cardiovascular disease, stroke, obesity, and schizophrenia. CONCLUSION OoSRs have recently become a popular approach of evidence synthesis. International collaborations between overview authors from countries with increased research productivity and countries with less research activity should be encouraged.
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Affiliation(s)
- Konstantinos I Bougioukas
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - Elpida Vounzoulaki
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK; National Institute for Health Research Applied Research Collaboration-East Midlands, Leicester Diabetes Centre, Leicester LE5 4PW, UK
| | - Chrysanthi D Mantsiou
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | | | - Eliophotos D Savvides
- 2nd Surgical Department, School of medicine, G. Gennimatas General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evangelia E Ntzani
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, University Campus, Stavros Niarchos Av., Ioannina, Greece; Center for Evidence Synthesis in Health, Department of Health Services, Policy and Practice, School of Public Health, Brown University, 121 South Main Street, Providence, RI 02903, USA; Institute of Biosciences, University Research Center of loannina, University of Ioannina, Ioannina, Greece
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece.
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Tromans S, Yao G, Alexander R, Mukaetova-Ladinska E, Kiani R, Al-Uzri M, Chester V, Carr R, Morgan Z, Vounzoulaki E, Brugha T. The Prevalence of Diabetes in Autistic Persons: A Systematic Review. Clin Pract Epidemiol Ment Health 2020; 16:212-225. [PMID: 33719361 PMCID: PMC7931154 DOI: 10.2174/1745017902016010212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 11/01/2020] [Accepted: 11/23/2020] [Indexed: 02/08/2023]
Abstract
Background: It has been proposed that autistic individuals are at an increased risk of type 1 and type 2 diabetes. Improved understanding of diabetes prevalence in autistic persons will help inform resource allocation for diabetes-related public health measures for this patient group. Objective: To conduct a systematic review of published literature pertaining to type 1 and type 2 diabetes prevalence in autistic individuals, including comparison with their non-autistic peers. Methods: Eligibility criteria included studies investigating the prevalence of diabetes in autistic individuals, as well as having been published in the English language. A systematic search of online databases (MEDLINE, PsycINFO, CINAHL, EMBASE and PubMed) was conducted on 4th April 2020. Additional approaches included the ancestry method, grey literature searches and expert consultation. Studies were qualitatively analysed with reporting quality appraised. Results: 19 eligible studies were identified, 7 of which provided type-specific diabetes prevalence data. Of 15 studies that included a non-autistic control group, 9 reported a higher diabetes prevalence among autistic persons, with a statistically significant difference in 4 studies. Studies demonstrating a higher diabetes prevalence in autistic groups had higher average study population sizes and reporting quality ratings. Conclusion: It is uncertain whether diabetes is significantly more prevalent in autistic persons relative to their non-autistic peers, though larger studies suggest a trend in this direction. Nevertheless, diabetes is a significant public health issue for the autistic community, which may require a tailored approach for identification and management. Prospero database registration number: CRD42019122176.
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Affiliation(s)
- Samuel Tromans
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom.,Leicestershire Partnership NHS Trust, Leicester, United Kingdom
| | - Guiqing Yao
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Regi Alexander
- Department of Psychiatry, University of Hertfordshire, Hatfield, United Kingdom.,Hertfordshire Partnership University NHS Foundation Trust, Hatfield, United Kingdom
| | - Elizabeta Mukaetova-Ladinska
- Leicestershire Partnership NHS Trust, Leicester, United Kingdom.,Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
| | - Reza Kiani
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom.,Leicestershire Partnership NHS Trust, Leicester, United Kingdom
| | - Mohammed Al-Uzri
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom.,Leicestershire Partnership NHS Trust, Leicester, United Kingdom
| | - Verity Chester
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, United Kingdom.,Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Richard Carr
- Leicestershire Partnership NHS Trust, Leicester, United Kingdom
| | - Zoe Morgan
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Elpida Vounzoulaki
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - Traolach Brugha
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom.,Leicestershire Partnership NHS Trust, Leicester, United Kingdom
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9
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Bougioukas KI, Vounzoulaki E, Mantsiou CD, Savvides ED, Karakosta C, Diakonidis T, Tsapas A, Haidich AB. Methods for depicting overlap in overviews of systematic reviews: An introduction to static tabular and graphical displays. J Clin Epidemiol 2020; 132:34-45. [PMID: 33309886 DOI: 10.1016/j.jclinepi.2020.12.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/21/2020] [Accepted: 12/02/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE To introduce potential static tabular and graphical techniques for visually presenting overlap between systematic reviews (SRs) included in overviews of systematic reviews (OoSRs). METHODS The graphical approaches described include Venn and Euler diagrams, as well as matrix-based, node-link, and aggregation-based techniques. We used fundamental concepts of mathematics from set and network theory to develop our novel graphical approaches. The graphical displays were created using R. RESULTS Overview authors have the flexibility to choose from a variety of visualizations, depending on the characteristics of their study. If the OoSRs include few SRs, a Venn or an Euler diagram can be used. In case of OoSRs with more SRs, Upset plots, heatmaps, and node-link graphs are more appropriate for visualizing overlapping SRs. Stacked bar plots constitute an aggregation-based technique of illustrating overlap. Strengths and limitations of each graphical approach are presented. CONCLUSION The degree of overlap should be explored for the entire study and for specific outcomes of interest. The proposed graphical techniques may assist methodologists and authors in identifying overlap, which in turn may improve validity and transparency in OoSRs. More research is needed to understand which technique would be most useful and easiest to understand.
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Affiliation(s)
- Konstantinos I Bougioukas
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - Elpida Vounzoulaki
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK; National Institute for Health Research Applied Research Collaboration-East Midlands, Leicester Diabetes Centre, Leicester LE5 4PW, UK
| | - Chrysanthi D Mantsiou
- Second Medical Department, Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eliophotos D Savvides
- 1st Department of Urology, Medical School, G. Gennimatas General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christina Karakosta
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - Theodoros Diakonidis
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - Apostolos Tsapas
- Second Medical Department, Clinical Research and Evidence-Based Medicine Unit, Aristotle University of Thessaloniki, Thessaloniki, Greece; Second Medical Department, Diabetes Centre, Aristotle University of Thessaloniki, Thessaloniki, Greece; Harris Manchester College, University of Oxford, Oxford, UK
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece.
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10
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Vounzoulaki E, Khunti K, Tan BK, Davies MJ, Gillies CL. Gestational diabetes: screening uptake, current challenges and the future – a focused review. Br J Diabetes 2020. [DOI: 10.15277/bjd.2020.236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The increased risk of developing type 2 diabetes mellitus (T2DM) in women with a history of previous gestational diabetes mellitus (GDM) has been established and is well recognised. Post-partum screening for T2DM is essential to identify those at higher risk and allow for the implementation of preventative interventions. However, attendance rates for post-partum glucose screening in women with previous GDM remain substantially low, with only half of them attending screening. This review aimed to outline the National Institute for Health and Care Excellence (NICE) post-partum screening recommendations and compare them with the guidelines being used worldwide, provide information on post-partum screening uptake and possible determinants of uptake in the UK, and to briefly discuss both patient health implications and the financial burden associated with T2DM progression in the context of the National Health Service (NHS).
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Vounzoulaki E, Khunti K, Abner SC, Tan BK, Davies MJ, Gillies CL. Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis. BMJ 2020; 369:m1361. [PMID: 32404325 PMCID: PMC7218708 DOI: 10.1136/bmj.m1361] [Citation(s) in RCA: 422] [Impact Index Per Article: 105.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To estimate and compare progression rates to type 2 diabetes mellitus (T2DM) in women with gestational diabetes mellitus (GDM) and healthy controls. DESIGN Systematic review and meta-analysis. DATA SOURCES Medline and Embase between January 2000 and December 2019, studies published in English and conducted on humans. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Observational studies investigating progression to T2DM. Inclusion criteria were postpartum follow-up for at least 12 months, incident physician based diagnosis of diabetes, T2DM reported as a separate outcome rather than combined with impaired fasting glucose or impaired glucose tolerance, and studies with both a group of patients with GDM and a control group. RESULTS This meta-analysis of 20 studies assessed a total of 1 332 373 individuals (67 956 women with GDM and 1 264 417 controls). Data were pooled by random effects meta-analysis models, and heterogeneity was assessed by use of the I2 statistic. The pooled relative risk for the incidence of T2DM between participants with GDM and controls was estimated. Reasons for heterogeneity between studies were investigated by prespecified subgroup and meta-regression analyses. Publication bias was assessed by funnel plots and, overall, studies were deemed to have a low risk of bias (P=0.58 and P=0.90). The overall relative risk for T2DM was almost 10 times higher in women with previous GDM than in healthy controls (9.51, 95% confidence interval 7.14 to 12.67, P<0.001). In populations of women with previous GDM, the cumulative incidence of T2DM was 16.46% (95% confidence interval 16.16% to 16.77%) in women of mixed ethnicity, 15.58% (13.30% to 17.86%) in a predominantly non-white population, and 9.91% (9.39% to 10.42%) in a white population. These differences were not statistically significant between subgroups (white v mixed populations, P=0.26; white v non-white populations, P=0.54). Meta-regression analyses showed that the study effect size was not significantly associated with mean study age, body mass index, publication year, and length of follow-up. CONCLUSIONS Women with a history of GDM appear to have a nearly 10-fold higher risk of developing T2DM than those with a normoglycaemic pregnancy. The magnitude of this risk highlights the importance of intervening to prevent the onset of T2DM, particularly in the early years after pregnancy. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019123079.
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Affiliation(s)
- Elpida Vounzoulaki
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
- National Institute for Health Research Applied Research Collaboration-East Midlands, Leicester Diabetes Centre, Leicester LE5 4PW, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
- National Institute for Health Research Applied Research Collaboration-East Midlands, Leicester Diabetes Centre, Leicester LE5 4PW, UK
| | - Sophia C Abner
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
- National Institute for Health Research Applied Research Collaboration-East Midlands, Leicester Diabetes Centre, Leicester LE5 4PW, UK
| | - Bee K Tan
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Clare L Gillies
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
- National Institute for Health Research Applied Research Collaboration-East Midlands, Leicester Diabetes Centre, Leicester LE5 4PW, UK
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Vounzoulaki E, Dipla K, Kintiraki E, Triantafyllou A, Grigoriadou I, Koletsos N, Zafeiridis A, Goulis DG, Douma S. Pregnancy and post-partum muscle and cerebral oxygenation during intermittent exercise in gestational diabetes: A pilot study. Eur J Obstet Gynecol Reprod Biol 2018; 232:54-59. [PMID: 30468984 DOI: 10.1016/j.ejogrb.2018.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/10/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This pilot, prospective, observational, cohort study aimed to examine, for the first time, the in vivo alterations in the oxygenation of the forearm skeletal muscles and the prefrontal lobes during intermittent exercise in women diagnosed with gestational diabetes mellitus (GDM), during and after pregnancy. STUDY DESIGN Nine pregnant women, diagnosed with GDM, performed a 3-min intermittent handgrip exercise protocol (at 35% of Maximal Voluntary Contraction) during pregnancy (mean 27th gestational week) and following labor (mean 71 weeks). During the protocol, muscle and cerebral oxygenation were assessed with near-infrared spectroscopy. Resting vascular parameters [carotid intima-media thickness (cIMT) and hemodynamic parameters (using rheocardiography)], and hematological/biochemical parameters during pregnancy and after delivery have been compared. RESULTS Although changes were observed in certain hematological parameters (p< 0.05), cIMT and hemodynamic parameters were not altered post-partum. In addition, both muscle and cerebral oxygenation parameters during handgrip were not significantly altered post-partum. CONCLUSIONS Despite significant changes in specific hematological parameters in women with GDM, impairments in muscle and cerebral oxygenation during exercise remained at one year after labor. These results indicate that alterations in vascular parameters and muscle/cerebral oxygenation associated with GDM do not entirely reverse post-partum. Future studies are needed to examine which interventions will lead to improvements in microvascular parameters and prevent type 2 diabetes.
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Affiliation(s)
- Elpida Vounzoulaki
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece.
| | - Konstantina Dipla
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Greece
| | - Evangelia Kintiraki
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Areti Triantafyllou
- Third Department of Internal Medicine, Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, Greece
| | - Iris Grigoriadou
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Greece
| | - Nikolaos Koletsos
- Third Department of Internal Medicine, Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, Greece
| | - Andreas Zafeiridis
- Laboratory of Exercise Physiology and Biochemistry, Department of Physical Education and Sports Science at Serres, Aristotle University of Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Stella Douma
- Third Department of Internal Medicine, Aristotle University of Thessaloniki, "Papageorgiou" Hospital, Thessaloniki, Greece
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