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Broad synthesis / Overview of systematic reviews

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Conducting and Interpreting Results of Network Meta-Analyses in Type 2 Diabetes Mellitus: A Review of Network Meta-Analyses That Include Sodium Glucose Co-transporter 2 Inhibitors.

Giornale Diabetes research and clinical practice
Year 2019
Links Pubmed DOI

Questo articolo contiene 35 Systematic reviews Systematic reviews (35 references)

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AIMS: Network meta-analyses (NMAs) are valuable ways to generate comparative effectiveness data for therapies available to treat type 2 diabetes mellitus (T2DM). This review assesses NMAs that evaluate sodium glucose co-transporter 2 (SGLT2) inhibitors for treatment of T2DM and discusses potential issues in conducting and interpreting NMAs. METHODS: A systematic literature search was conducted on September 13, 2018 using the search terms "network meta-analysis," "SGLT2," variations of these terms and individual SGLT2 inhibitor names. Extracted data included NMA objectives, methods, target populations, treatments, study endpoints, length of follow-up, and funding. Differences between NMAs were investigated. RESULTS: Thirty-five full-length publications met criteria for inclusion. In most NMAs, the target population was defined by therapeutic regimen (e.g., combination with metformin). Follow-up intervals permitted in NMAs varied considerably (range, 4-208 weeks). Twenty-nine NMAs included dapagliflozin, 28 evaluated canagliflozin, and 27 evaluated empagliflozin. Nine NMAs used frequentist methods; 16 used Bayesian methods. Six NMAs were funded by pharmaceutical manufacturers. Heterogeneity across NMAs was seen in scope, time frame, and other aspects of analytic design. CONCLUSIONS: Although this review indicates that methodological guidelines for reporting NMAs were generally followed, it also emphasizes the need for T2DM-specific guidance requiring clear reporting of NMA scope and objectives to aid appropriate interpretation and use of NMA results.

Broad synthesis / Overview of systematic reviews

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DPP-4 inhibitors for the treatment of type 2 diabetes: a methodology overview of systematic reviews

Giornale Acta diabetologica
Year 2019
Links Pubmed DOI

Questo articolo contiene 58 Systematic reviews Systematic reviews (58 references)

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Aims: To evaluate the methodological quality of systematic reviews (SRs), and summarize evidence of important outcomes from dipeptidyl peptidase-4 inhibitors (DPP4-I) in treating type 2 diabetes mellitus (T2DM). Methods: We included SRs of DPP4-I for the treatment of T2DM until January, 2018 by searching the Cochrane Library, PubMed, EMBASE and three Chinese databases. We evaluated the methodological qualities with the AMSTAR (Assessing the Methodological Quality of Systematic Reviews) tool and the GRADE (The Grading of Recommendations Assessment, Development and Evaluation) approach. Results: Sixty-three SRs (a total of 2,603,140 participants) receiving DPP4-I for the treatment of T2DM were included. The results of AMSTAR showed that the lowest quality was “a list of studies (included and excluded) item” with only one (1.6%) study provided, followed by the “providing a priori design” item with only four (6.3%) studies conforming to this item, the next were “the status of publication (gray literature) used as an inclusion criterion item”, with only 18 (28.9%) studies conforming to these items. Only seven (11.1%) studies scored more than nine points in AMSTAR, indicating high methodological quality. For GRADE, of the 128 outcomes, high quality evidence was provided in only 28 (21.9%), moderate in 70 (54.7%), low in 27 (21.1%), and very low in three (2.3%). Conclusions: The methodological quality of SRs of DPP4-I for type 2 diabetes mellitus is not high and there are common areas for improvement. Furthermore, the quality of evidence level is moderate and more high quality evidence is needed. © 2018, Springer-Verlag Italia S.r.l., part of Springer Nature.

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Cardiovascular Outcomes with Sodium-glucose Co-transporter 2 Inhibitors: A Review of the Clinical Evidence

Autori [No authors listed]
Book CADTH Rapid Response Reports
Year 2015
Links Pubmed

Questo articolo contiene 7 Primary studies Primary studies (7 references) 2 Systematic reviews Systematic reviews (2 references)

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Sodium-glucose co-transport 2 (SGLT-2) inhibitors are a new class of drugs used to treat type-2 diabetes (T2DM). They exert antihyperglycemic action by blocking the renal reabsorption of glucose, leading to increased urinary glucose excretion. In healthy individuals, the kidney filters up to 180g of glucose every day, which is almost entirely reabsorbed into the blood in the proximal convoluted tubule through the mediation of SGLT-1 and SGLT-2, with the latter reabsorbing the majority (80% to 90%). Based on their mechanism of action and observations from clinical trials, the SGLT-2 inhibitors have demonstrated the potential to reduce the risk of cardiovascular events in addition to reducing blood glucose levels. By inhibiting renal reabsorption of glucose, they lower blood glucose to clinically significant levels, increase the potential for weight loss through calorie reduction, and increase water content of urine by osmotic diuresis to potentially reduce blood pressure. Many clinical trials have shown significant reductions from baseline in both systolic and diastolic blood pressure following the administration of SGLT-2 inhibitors. However, while persistently elevated blood pressure (BP) is a recognized risk factor for cardiovascular events, high BP alone does not necessarily imply a cardiovascular event, such as myocardial infarction, stroke, heart failure, and unstable angina. A recent study has reported that empagliflozin has favorable effects on markers of arterial stiffness and vascular resistance, while another RCT concluded that compared with placebo, T2DM patients at high risk for cardiovascular events who received empagliflozin as add-on therapy to standard care had a lower rate of the primary composite cardiovascular outcome and of death from any cause. However, there is currently no conclusive outcome data on the ability of SGLT-2 inhibitors as a class to reduce the risk of cardiovascular events in patients with T2DM. The aim of this report is to review the evidence on cardiovascular outcomes with SGLT-2 inhibitors compared with placebo as well as with incretin-based therapies to help inform policy decisions.

Broad synthesis / Overview of systematic reviews

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Potential increased risk of cancer from commonly used medications: An umbrella review of meta-analyses

Giornale Annals of oncology : official journal of the European Society for Medical Oncology / ESMO
Year 2014
Links Pubmed DOI PubMed Central

Questo articolo contiene 74 Systematic reviews Systematic reviews (74 references)

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Several commonly used medications have been associated with increased cancer risk in the literature. Here, we evaluated the strength and consistency of these claims in published meta-analyses. We carried out an umbrella review of 74 meta-analysis articles addressing the association of commonly used medications (antidiabetics, antihyperlipidemics, antihypertensives, antirheumatics, drugs for osteoporosis, and others) with cancer risk where at least one meta-analysis in the medication class included some data from randomized trials. Overall, 51 articles found no statistically significant differences, 13 found some decreased cancer risk, and 11 found some increased risk (one reported both increased and decreased risks). The 11 meta-analyses that found some increased risks reported 16 increased risk estimates, of which 5 pertained to overall cancer and 11 to site-specific cancer. Six of the 16 estimates were derived from randomized trials and 10 from observational data. Estimates of increased risk were strongly inversely correlated with the amount of evidence (number of cancer cases) (Spearman's correlation coefficient = -0.77, P < 0.001). In 4 of the 16 topics, another meta-analysis existed that was larger (n = 2) or included better controlled data (n = 2) and in all 4 cases there was no statistically significantly increased risk of malignancy. No medication or class had substantial and consistent evidence for increased risk of malignancy. However, for most medications we cannot exclude small risks or risks in population subsets. Such risks are unlikely to be possible to document robustly unless very large, collaborative studies with standardized analyses and no selective reporting are carried out.

Broad synthesis / Overview of systematic reviews

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Revisione sistematica di recensioni di componenti di intervento connessi con maggiore efficacia negli interventi dietetici e attività fisica.

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Giornale BMC public health
Year 2011
Links Pubmed DOI PubMed Central

Questo articolo contiene 24 Systematic reviews Systematic reviews (24 references)

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BACKGROUND: Per sviluppare programmi più efficienti per la promozione alimentare e / o cambio di attività fisica (per evitare diabete di tipo 2) è di fondamentale importanza garantire che i componenti e le caratteristiche di intervento più strettamente associati con efficacia sono inclusi. Lo scopo di questa revisione sistematica di recensioni è stato quello di identificare i componenti di intervento che sono associati con un aumento cambiamento nella dieta e / o attività fisica nei soggetti a rischio di diabete di tipo 2. METODI: MEDLINE, EMBASE, CINAHL, PsycINFO, e la Cochrane Library sono state ricercate revisioni sistematiche di interventi mirati dieta e / o attività fisica in adulti a rischio di sviluppare diabete di tipo 2 1998-2008. Due revisori hanno selezionato indipendentemente recensioni e valutato la qualità metodologica. Analisi individuali di recensioni relative a componenti efficacia di intervento sono stati estratti, classificati per la qualità prove e sintesi. RISULTATI: Dei 3856 articoli identificati, 30 hanno soddisfatto i criteri di inclusione e 129 componenti di intervento analisi relative all'efficacia. Tra queste analisi causali (sulla base di randomizzazione dei partecipanti a condizioni diverse di intervento) e analisi associativi (ad esempio meta-regressione). Nel complesso, gli interventi prodotto perdita di peso clinicamente significativo (3-5 kg ​​a 12 mesi; 2-3 kg a 36 mesi) e una maggiore attività fisica (30-60 minuti / settimana di attività moderata a 12-18 mesi). Sulla base delle analisi causali, l'efficacia dell'intervento è stata aumentata trattando il sostegno sociale, di mira sia la dieta e l'attività fisica, e l'utilizzo di well-defined/established tecniche di cambiamento del comportamento. Maggiore efficacia è stata anche associata ad una maggiore frequenza di contatti e l'utilizzo di uno specifico cluster di "autoregolamentazione" tecniche di cambiamento comportamentale (ad esempio la fissazione di obiettivi, auto-monitoraggio). Non sono chiari i rapporti sono stati trovati tra l'efficacia e l'impostazione di intervento, modalità di consegna, la popolazione di studio o di provider di recapito. Prove su efficacia a lungo termine suggerito la necessità di una maggiore considerazione delle strategie di manutenzione comportamento. CONCLUSIONI: Questa recensione completa di recensioni identifica i componenti specifici che sono associati con una maggiore efficacia negli interventi per promuovere il cambiamento nella dieta e / o attività fisica. Per massimizzare l'efficacia dei programmi per la prevenzione del diabete, gli operatori e le organizzazioni committenti dovrebbero prendere in considerazione anche questi componenti.

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Conferenza sul tema "Approcci multidisciplinari ai problemi nutrizionali". Simposio su "Diabete e salute". Interventi nutrizionali per la prevenzione del diabete di tipo 2.

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Autori Steyn NP , Lambert EV , Tabana H
Giornale The Proceedings of the Nutrition Society
Year 2009
Links Pubmed DOI

Questo articolo contiene 40 Primary studies Primary studies (40 references) 1 Systematic review Systematic reviews (1 reference)

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Il diabete mellito si sta aggravando a livello globale e si prevede che 200 milioni di persone in tutto il mondo si ha il diabete entro il 2010 e 300 milioni nel 2025. Tuttavia, vi è prova convincente da molti studi che per i soggetti con alterata glicemia a digiuno o ridotta tolleranza al glucosio la presentazione del diabete di tipo 2 può essere ritardata modifica stile di vita. L'obiettivo della revisione è quello di presentare una sintesi di interventi di modificazione dello stile di vita che hanno incluso una componente alimentare nel loro programma generale prevenzione del diabete. Medline, la letteratura e le riviste di salute alleati del diabete sono state ricercate letteratura peer-reviewed usando '* dieta' i termini e 'diabete' e 'l'intervento'. Criteria di inclusione erano: studi peer-reviewed dal 1975 al 2008; un campione di almeno cinquanta soggetti; un mangiare sano e / o componente di attività fisica, prevenzione del diabete come un obiettivo primario. Generalmente, i partecipanti erano in una categoria ad alto rischio per lo sviluppo di diabete. Gli esiti sono stati valutati in due punti nel tempo (pre-e post-intervento) in termini di conoscenza, cambiamento del comportamento ed il miglioramento clinico, che comprendeva il peso, pressione arteriosa, BMI, il grasso corporeo, la circonferenza della vita, vita: il rapporto fianchi e fisiologico e / o misure biochimiche. I risultati indicano che gli interventi di maggior successo combinano individuale counseling dietetico con una componente di attività. Altri fattori che predicono il successo sono perdita di peso ottenuta, la durata e l'intensità della rispondenza dell'intervento e dietetici.