Effectiveness of peer led intervention in improvement of clinical outcomes among diabetes mellitus and hypertension patients—A systematic review and meta-analysis

Patient activation has been recognised as a reliable driver of self-management decision-making. This systematic review and meta-analysis examines existing evidence on whether embedding patient activation within Type 2 diabetes mellitus (T2DM) self-management programs can improve patient outcomes. This review has included 10 randomised controlled trials (RCTs) conducted between 2004 and 2019 retrieved from well-known databases such as MEDLINE, PubMed, CINAHL Plus, Scopus, ProQuest and ScienceDirect. The eligible RCTs were excluded if they scored low according to Cochrane Collaboration’s ‘risk of bias’ criteria. Random-effects meta-analyses showed that there were no significance changes in haemoglobin A1C (HbA1c), body mass index (BMI) and patient activation measure (PAM) between intervention and control groups after the intervention; however, the systematic review findings indicated that an improved patient activation level led to significant improvements in T2DM self-management and clinical outcomes including HbA1c level. Studies with a longer follow-up period conducted in community settings and delivered by peer coaches were more likely to lead to significant improvement in both patient activation levels and T2DM self-management and clinical outcomes. This review concludes that patient activation can be used as a reliable tool for improving T2DM self-management and clinical outcomes.

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Glycated hemoglobin as a surrogate for evaluating the effectiveness of drugs in diabetes mellitus trials: a systematic review and trial-level meta-analysis

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462321001689 ◽

2021 ◽

Vol 38 (1) ◽

Author(s):

Paola Andrea Rivera ◽

Milton J. M. Rodríguez-Zúñiga ◽

José Caballero-Alvarado ◽

Fabián Fiestas

Keyword(s):

Diabetes Mellitus ◽

Myocardial Infarction ◽

Heart Failure ◽

Systematic Review ◽

Clinical Outcomes ◽

Randomized Clinical Trials ◽

Glycated Hemoglobin ◽

Meta Analysis ◽

Strong Association ◽

Kidney Injury

Abstract Objective The objective of this study was to investigate whether glycated hemoglobin (HbA1c) is a valid surrogate for evaluating the effectiveness of antihyperglycemic drugs in diabetes mellitus (DM) trials. Methods We conducted a systematic review of placebo-controlled randomized clinical trials (RCTs) evaluating the effect of a treatment on HbA1c (mean difference between groups) and clinical outcomes (relative risk of mortality, myocardial infarction, stroke, heart failure, and/or kidney injury) in patients with DM. Then, we investigated the association between treatment effects on HbA1c and clinical outcomes using regression analysis at the trial level. Lastly, we interpreted the correlation coefficients (R) using the cut-off points suggested by the Institute for Quality and Efficiency in Healthcare (IQWiG). HbA1c was considered a valid surrogate if it demonstrated a strong association: lower limit of the 95 percent confidence interval (95 percent CI) of R greater than or equal to .85. Results Nineteen RCTs were identified. All studies included adults with type 2 DM. None of the associations evaluated was strong enough to validate HbA1c as a surrogate for any clinical outcome: mortality (R = .34; 95 percent CI −.14 to .69), myocardial infarction (R = .20; −.30 to .61), heart failure (R = .08; −.40 to .53), kidney injury (R = −.04; −.52 to .47), and stroke (R = .81; .54 to .93). Conclusions The evidence from multiple placebo-controlled RCTs does not support the use of HbA1c as a surrogate to measure the effectiveness of antihyperglycemic drugs in DM studies.

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Identification and prevalence of frailty in diabetes mellitus and association with clinical outcomes: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2020-037476 ◽

2020 ◽

Vol 10 (9) ◽

pp. e037476 ◽

Cited By ~ 1

Author(s):

Peter Hanlon ◽

Isabella Fauré ◽

Neave Corcoran ◽

Elaine Butterly ◽

Jim Lewsey ◽

...

Keyword(s):

Diabetes Mellitus ◽

Systematic Review ◽

Clinical Outcomes ◽

Observational Studies ◽

Physiological Stress ◽

Meta Analysis ◽

Older Age ◽

Cross Sectional ◽

Ethical Approval ◽

Newcastle Ottawa Scale

IntroductionDiabetes mellitus is common and growing in prevalence, and an increasing proportion of people with diabetes are living to older age. Frailty is, therefore, becoming an important concept in diabetes. Frailty is associated with older age and describes a state of increased susceptibility to decompensation in response to physiological stress. A range of measures have been used to quantify frailty. This systematic review aims to identify measures used to quantify frailty in people with diabetes (any type); to summarise the prevalence of frailty in diabetes; and to describe the relationship between frailty and adverse clinical outcomes in people with diabetes.Methods and analysisThree electronic databases (Medline, Embase and Web of Science) will be searched from 2000 to November 2019 and supplemented by citation searching of relevant articles and hand searching of reference lists. Two reviewers will independently review titles, abstracts and full texts. Inclusion criteria include: (1) adults with any type of diabetes mellitus; (2) quantify frailty using any validated frailty measure; (3) report the prevalence of frailty and/or the association between frailty and clinical outcomes in people with diabetes; (4) studies that assess generic (eg, mortality, hospital admission and falls) or diabetes-specific outcomes (eg, hypoglycaemic episodes, cardiovascular events, diabetic nephropathy and diabetic retinopathy); (5) cross-sectional and longitudinal observational studies. Study quality will be assessed using the Newcastle–Ottawa Scale for observational studies. Clinical and methodological heterogeneity will be assessed, and a random effects meta-analysis performed if appropriate. Otherwise, a narrative synthesis will be performed.Ethics and disseminationThis manuscript describes the protocol for a systematic review of observational studies and does not require ethical approval.PROSPERO registration numberCRD42020163109.

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Impact of diabetes mellitus on clinical outcomes of pancreatic cancer after surgical resection: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0171370 ◽

2017 ◽

Vol 12 (2) ◽

pp. e0171370 ◽

Cited By ~ 8

Author(s):

Xinghua Lv ◽

Wenhui Qiao ◽

Yufang Leng ◽

Lupeng Wu ◽

Yanming Zhou

Keyword(s):

Diabetes Mellitus ◽

Systematic Review ◽

Pancreatic Cancer ◽

Clinical Outcomes ◽

Surgical Resection ◽

Meta Analysis

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Effect of hypoglycemic agents on survival outcomes of patients with lung cancer and diabetes mellitus: A systematic review and meta-analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e21617 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e21617-e21617

Author(s):

Ping Huang ◽

Wenxiu Xin ◽

Luo Fang ◽

Haiying Ding ◽

Xiaowei Zheng ◽

...

Keyword(s):

Diabetes Mellitus ◽

Lung Cancer ◽

Systematic Review ◽

Cancer Patients ◽

Clinical Outcomes ◽

Meta Analysis ◽

Hypoglycemic Agents ◽

Cochrane Library ◽

Survival Outcomes ◽

Lung Cancer Patients

e21617 Background: Although hypoglycemic agents (metformin, insulin, sulfonylureas [SUs] and thiazolidinediones [TZDs]) may influent prognosis of cancer at several sites, very little is known about their effects on clinical outcomes of lung cancer patients with diabetes mellitus (DM) and results from clinical trials are often inconsistent. Methods: To assess the association between hypoglycemic agents and clinical outcomes of lung cancer, we performed a systematic review of published studies from PubMed, EMBASE, Web of Science and The Cochrane Library up to January, 2016. Meta-analysis was performed to calculate the pooled hazard ratio (HR) and 95% confidence interval (95% CI). Results: The pooled HRs favoring metformin users was 0.77 for overall survival (OS) (n = 12, 95% CI: 0.66-0.89) and 0.59 for disease-free survival (DFS) (n = 6, 95% CI: 0.47-0.72). Only one study assessed the relation between metformin and cancer-specific survival (CSS) in lung cancer patients, reporting no statistically significant results. No significant association between insulin use and OS (n = 2, HR: 0.95, 95% CI: 0.79-1.13) or CSS (n = 2, HR: 1.03, 95% CI: 0.76-1.41) was noted. Only one study evaluated the effect of SUs in patients with lung cancer and reported no statistically clinical benefit (HR: 1.10; 95% CI: 0.87-1.40). Likewise, one study evaluated the effect of TZDs on OS in patients of lung cancer and reported no significant difference between TZDs and non-TZDs groups (HR: 1.04, 95% CI: 0.65-1.66). Conclusions: This meta-analysis demonstrated that metformin could improve survival outcomes of patients with lung cancer and DM. No association between insulin, TZDs or SUs and lung cancer outcomes was found.

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