Prevalence of depression and anxiety among diabetic patients in Egypt: A cross-sectional study

Depression and anxiety are highly prevalent among diabetics and may reduce their quality of life. However, data is limited on the prevalence of depression and anxiety among Egyptian diabetics. Therefore, we aimed to assess the prevalence of anxiety and depression and their association with different demographics and comorbidities among Egyptian diabetics. This multicentric cross-sectional study included 679 patients with diabetes in Fayoum, Egypt. We assessed the prevalence of depression and anxiety using the Hospital Anxiety and Depression Scale and collected socio-demographic characteristics with other relevant clinical variables. We used descriptive statistics to describe demographic characteristics and frequency of depression and anxiety. We applied logistic regression to measure the association between the different covariates and depression/anxiety. Of 679 diabetic patients, 65.4% were females, and 54.1% were above 50 years old. The median (IQR) age was 52 [43, 60]. Overall, 34.2% had depression, and 38% had anxiety. The results of multiple logistic regression suggested that age (odds ratio [OR] = 2.28, 95% confidence interval [CI] [1.54, 3.41]), neuropathy (OR = 2.25, 95% CI [1.38, 3.70]), sexual dysfunction (OR = 2.24, 95% CI [1.02, 4.96]), the presence of coma or spasm (OR = 2.82, 95% CI [1.44, 5.72]), and anxiety (OR = 3.15, 95% CI [2.21, 4.52]) were associated with increased risk of depression among diabetics. For anxiety, only the presence of depression was strongly associated with an increased risk of anxiety (OR = 2.99, 95% CI [2.12, 4.24]). Over one-third of Egyptian diabetics had depression and anxiety. Depression and anxiety may be associated with poor clinical outcomes in diabetics.

Efficacy and safety of polyethylene glycol loxenatide in type 2 diabetic patients: a systematic review and meta-analysis of randomized controlled trials

Polyethylene glycol loxenatide (PEX168) is a novel glucagon-like peptide-1 receptor agonist with a longer half-life developed by modifying the chemical structure of exenatide. This study aims to assess the efficacy and safety of PEX168 and determine the best dose. We searched PubMed, Scopus, Cochrane Library, and Web of Science databases from inception to April 25, 2023, for randomized controlled trials (RCTs) comparing PEX168 therapy alone or in combination with metformin versus other therapies. We used the risk ratio (RR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes, both with 95% confidence intervals (CI). Six RCTs, including 1248 participants, were included. PEX168 added to metformin was significantly better than metformin alone regarding fasting blood glucose (MD = -1.20, 95% CI (-1.78,  - 0.62), p < 0.0001), HbA1c (MD = -1.01, 95% CI (-1.48,  - 0.53), p < 0.0001), and postprandial glycemia (MD = -1.94, 95% CI (-2.99,  - 0.90), p = 0.0003). Similarly, for glycemic control, PEX168 monotherapy was superior to placebo (P < 0.05). No significant effects were noticed in terms of triglycerides, low-density lipoprotein, or high-density lipoprotein (p > 0.05). Body weight was significantly reduced in obese diabetic patients receiving PEX168 compared to the control group (MD = -5.46, 95% CI (-7.90,  - 3.01), p < 0.0001) but not in non-obese patients (MD = 0.06, 95% CI (-0.47, 0.59), p = 0.83). People who received PEX168 alone or with metformin showed more common gastrointestinal adverse effects, especially nausea and vomiting (p < 0.05). PEX168 100, 200, and 300 ug monotherapy demonstrated comparable safety and diabetes control to metformin, but when combined with metformin, PEX168 100 and 200 ug showed significant effects on diabetes control; however, only the latter showed a significantly higher incidence of nausea and vomiting (p < 0.05). PEX168 could be a viable option for treating diabetic patients whose metformin control is inadequate or who cannot tolerate metformin. PEX168 at 100 ug in combination with metformin was found to be safe and more effective compared to metformin; however, due to the small number of trials included, these findings should be interpreted with caution, and additional trials are required.

The efficacy of oxytocin gel in postmenopausal women with vaginal atrophy: an updated systematic review and meta-analysis

BACKGROUND

Genitourinary syndrome of menopause (GSM) is a common and disturbing issue in the postmenopausal period. Unlike vasomotor symptoms, it has a progressive trend. Our study aims to evaluate the efficacy and safety of oxytocin gel versus placebo gel in postmenopausal women with GSM.

METHODS

A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs) from Web of Science, SCOPUS, PubMed, and Cochrane Central Register of Controlled Trials databases on January 18, 2023. Keywords such as "oxytocin," "intravaginal," "vaginal," "atrophic," and "atrophy" were used. We used Review Manager (RevMan) version 5.4 in our analysis. We used the risk ratio (RR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes; both were presented with the corresponding 95% confidence interval (CI) and were calculated with the Mantel-Haenszel or inverse variance statistical method. Cochrane's Q test and the I2 statistic were used as measures of statistical inconsistency and heterogeneity. The Cochrane Risk of Bias Tool for RCTs was used for the quality assessment of the included studies.

RESULTS

Seven studies with 631 patients were included. Regarding the maturation index, there was a statistically insignificant increase in the oxytocin arm (MD = 12.34, 95% CI (-12.52-37.19), P = 0.33). Clinically assessed vaginal atrophy showed a statistically significant reduction in the oxytocin group (RR = 0.32, 95% CI (0.23 - 0.10), P < 0.00001). For dyspareunia, vaginal pH, and histological evaluation of vaginal atrophy, there was a statistically insignificant difference between the two groups (RR = 1.02, 95% CI (0.82-1.27), P = 0.84), (MD = -0.74, 95% CI (-1.58-0.10), P = 0.08), and (MD = -0.38, 95% CI (-0.82-0.06), P = 0.09), respectively. There was no significant difference in the safety profile between the two groups as measured by endometrial thickness (MD = 0.00, 95% CI (-0.23-0.23), P = 0.99).

CONCLUSIONS

Although oxytocin has been proposed as a viable alternative to estrogen in the treatment of GSM, our findings show the opposite. Larger, high-quality RCTs are needed to confirm or refute our results.

TRIAL REGISTRATION

PROSPERO registration number CRD42022334357.