Comparisons of diabetic retinopathy events associated with glucose‐lowering drugs in patients with type 2 diabetes mellitus: A network meta‐analysis

IntroductionType 2 diabetes mellitus (T2DM) is a substantial health problem worldwide. Pre-diabetic state is associated with increased risk for the development of diabetes. There are various pharmacological therapies with glucose-lowering activity for diabetes prevention. Of those, most are being compared with placebo instead of active agents. The relative effects and safety of different glucose-lowering drugs still remain uncertain. To address this gap, we will conduct a systematic review and network meta-analysis (NMA) to evaluate comparative efficacy and safety of glucose-lowering agents for T2DM prevention in patients with pre-diabetes.Methods and analysisPubMed, the Cochrane library and Embase will be searched from inception to December 2019 for relevant randomised controlled trials (RCTs) that examined anti-diabetic drugs for diabetes prevention in patients with pre-diabetes. Two reviewers working independently will screen titles, abstracts and full papers. Data extraction will also be completed by two independent authors. The primary outcome will be the incidence of T2DM in patients with pre-diabetes at baseline. Secondary outcomes will include the achievement of normoglycaemia, all-cause mortality, cardiovascular mortality and hypoglycaemic event. Pairwise meta-analysis and NMA will be conducted for each outcome using a frequentist random-effects model. Additionally, subgroup analyses will also be performed. The comparison-adjusted funnel plot will be used to assess publication bias. The overall quality of evidence will be rated with the Grading of Recommendations Assessment, Development and Evaluation framework. Data analysis will be conducted using Stata V.14.0.Ethics and disseminationEthics approval is not required. We plan to submit the results of this study to a peer-review journal.PROSPERO registration numberCRD42019119157.

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Magnesium deficiency associated with diabetic retinopathy in type 2 diabetes mellitus: A meta-analysis

International Journal of Public Health Science (IJPHS) ◽

10.11591/ijphs.v10i3.20916 ◽

2021 ◽

Vol 10 (3) ◽

pp. 565

Author(s):

Ronald Pratama Adiwinoto ◽

Robert Dwitama Adiwinoto ◽

Jongky Hendro Prajitno

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Diabetic Retinopathy ◽

Animal Studies ◽

Magnesium Deficiency ◽

Meta Analysis ◽

Serum Magnesium ◽

Increased Risk

Diabetic retinopathy (DR) is the major cause of visual impairment in the working-age population with type 2 diabetes mellitus (T2DM). Magnesium (Mg) is involved in various metabolic processes and in experimental animal studies; Mg has shown essential roles in physiological eye function. Magnesium deficiency is common in T2DM; therefore we analyzed the association between serum Mg status and the presence of DR in T2DM patients. Systematic literature searching in several databases, from 1988 to September 2020, was performed using search terms: “serum magnesium” or “hypomagnesemia” and “diabetic retinopathy” or “retinopathy”. A total of 3,227 patients from 17 studies were included in this meta-analysis. Hypomagnesemia was associated with increased risk of developing DR (OR 4.52 [2.08, 9.81], p=0.0001) in T2DM patients. Serum Mg levels also lower in patients with DR than those without DR (MD –0.30 mg/dL [–0.44, –0.15], p<0.0001). Additionally, serum Mg levels were lower in patients with proliferative DR (PDR) than those with non-proliferative DR (NPDR) (MD-0.21 mg/dL [–0.34, –0.09], p=0.0009). Leave-one-out sensitivity analysis did not change the overall effect. Hypomagnesemia or low serum Mg levels in T2DM patients increased the risk of developing DR.

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