Comparative effectiveness of telemonitoring versus usual care for type 2 diabetes: A systematic review and meta-analysis

2018 ◽  
Vol 25 (10) ◽  
pp. 587-601 ◽  
Author(s):  
Yunjung Kim ◽  
Jeong-Eun Park ◽  
Byung-Wan Lee ◽  
Chang-Hee Jung ◽  
Dong-Ah Park
Keyword(s):  
Type 2 Diabetes ◽  
Medication Adherence ◽  
Confidence Interval ◽  
Usual Care ◽  
Weighted Mean Difference ◽  
Glycated Haemoglobin ◽  
Mean Difference ◽  
Weighted Mean ◽  
Alarm Message

Aims This study evaluated clinical effectiveness of telemonitoring on the management of patients with type 2 diabetes. Methods We searched Ovid-Medline, Ovid-EMBASE, and the Cochrane Library to identify randomized controlled trials that compared telemonitoring and usual care in patients with type 2 diabetes. Results Thirty-eight studies (6855 patients) were included. Telemonitoring was associated with a significant decrease in glycated haemoglobin levels compared to usual care (weighted mean difference –0.42%, 95% confidence interval –0.56 to –0.27) but there was evidence of heterogeneity ( I2 = 96.9%). Telemonitoring was associated with a significant glycated haemoglobin reduction when biological data were transmitted through a web-based device weekly, when voice feedback was performed daily or immediately and when patients were provided with counselling. Telemonitoring also reduced glycated haemoglobin level in studies that monitored patients’ medication adherence, provided counselling, education and alarm message. The rate of achieving glycated haemoglobin levels of < 7% was 1.8 times higher in the telemonitoring group compared to the usual care group (risk ratio 1.83, 95% confidence interval 1.35 to 2.47, I2 = 0%). There was also significant reduction in systolic blood pressure (weighted mean difference –1.33 mm Hg) and body mass index (weighted mean difference –0.25 kg/m2), but the clinical relevance of these results can be questioned. The data available on patient satisfaction, quality of life, medication adherence, prescription changes, stress and depression were limited. Conclusions Telemonitoring interventions may be a better option than usual care in improving glycated haemoglobin control of patients with type 2 diabetes. Further studies should assess clinical benefit according to specific delivery modes of the intervention and patient-reported outcomes.

Addition of Thiazolidinedione or Exenatide to Oral Agents in Type 2 Diabetes: A Meta-Analysis

2008 ◽  
Vol 42 (11) ◽  
pp. 1541-1551 ◽  
Author(s):  
Nicole R Pinelli ◽  
Raymond Cha ◽  
Morton B Brown ◽  
Linda A Jaber
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Body Weight ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Mean Difference ◽  
Weighted Mean ◽  
Oral Agents

Background: The introduction of several new therapeutic agents for the treatment of type 2 diabetes mellitus has led to significant challenges for providers in deciding which agent to select during the disease course. Objective: To provide a relative comparison of the efficacy and safety of adding thiazolidinediones (TZDs) or exenatide to oral agents for the management of type 2 diabetes mellitus by performing meta-analyses of relevant published studies. Methods: We systematically searched PubMed, MEDLINE, CINHAL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, EMBASE (inception to March 2008 for all databases), and abstracts presented at the 2006 and 2007 American Diabetes Association conferences to identify all relevant publications. Studies were included in the analysis if they (1) were published in English, (2) were prospective, randomized, and controlled with placebo or comparator, (3) were at least 24 weeks' duration, (4) included nonpregnant adults with type 2 diabetes, (5) were full-text, peer-reviewed articles examining the efficacy of either TZDs (rosiglitazone or pioglitazone) or exenatide in combination with other oral drugs, and (6) included hemoglobin A1C (AIC) outcomes in a manner that allowed data analysis. We evaluated mean change in A1C levels, proportion of subjects reaching A1C goals of less than 7%, mean change in fasting plasma glucose (FPG) and body weight, and the occurrence of nonsevere hypoglycemia and gastrointestinal adverse events. Results: A total of 5212 TZD and 3562 exenatide publications were identified. After critical evaluation, 22 publications met all of the inclusion criteria for the meta-analysis. A1C was reduced from baseline for TZDs (weighted mean difference –0.80%; 95% CI –1.10 to –0.50) and exenaiide (weighted mean difference –0.60%; 95% CI –1.04 to –0.16), Compared with controls, TZD- and exenatide-based therapies had odds ratios greater than 1 for reaching A1C targets of less than 7% (TZD OR 2.27; 95% CI 1.22 to 4.24 and exenatide OR 2.90; 95% CI 1.28 to 6.55). FPG concentrations were reduced significantly from baseline in the TZD-based regimens (weighted mean difference –29.58 mg/dL; 95% CI –39.27 to –19.89), but did not achieve significance in the exenatide trials (weighted mean difference –8.77 mg/dL; 95% CI –28.85 to 11.31). Body weight was reduced with exenatide (weighted mean difference –2.74 kg; 95% CI –4.85 to –0.64) and increased in subgroup analyses for TZDs (weighted mean difference 2.19 kg; 95% CI 1.24 to 3.14). There was no significant association between TZD or exenatide therapy and the risk of nonsevere hypoglycemia. The odds ratios for nausea, vomiting, and diarrhea with exenatide relative to controls were 9.02 (95% CI 3.66 to 22.23), 4.56 (95% CI 3.13 to 6.65), and 2.96 (95% CI 2.05 to 4.26), respectively. Conclusions: TZDs and exenatide have modest but beneficial effects on glycemic control and are relatively safe in regard to the adverse events studied. TZDs produce greater improvement in glycemic control, while exenatide Is associated with reduction in body weight.

scholarly journals Impact of pharmacist-led care on glycaemic control of patients with uncontrolled type 2 diabetes: a randomised controlled trial in Nigeria

2021 ◽  
Vol 19 (3) ◽  
pp. 2402
Author(s):  
Emmanuel A. David ◽  
Rebecca O. Soremekun ◽  
Isaac O. Abah ◽  
Roseline I. Aderemi-Williams
Keyword(s):  
Type 2 Diabetes ◽  
Glycaemic Control ◽  
Usual Care ◽  
Usual Care Group ◽  
Intervention Group ◽  
Glycated Haemoglobin ◽  
Care Group ◽  
Laboratory Parameters ◽  
Randomised Controlled

Background: Diabetes mellitus is a chronic, degenerative disease, requiring a multi-dimensional, multi-professional care by healthcare providers and substantial self-care by the patients, to achieve treatment goals. Objective: To evaluate the impact of pharmacist-led care on glycaemic control in patients with uncontrolled Type 2 Diabetes Methods: In a parallel group, single-blind randomised controlled study; type 2 diabetic patients, with greater than 7% glycated haemoglobin (A1C) were randomised into intervention and usual care groups and followed for six months. Glycated haemoglobin analyzer, lipid analyzer and blood pressure monitor/apparatus were used to measure patients’ laboratory parameters at baseline and six months. Intervention group patients received pharmacist-structured care, made up of patient education and phone calls, in addition to usual care. In an intention to treat analysis, Mann-Whitney U test was used to compare median change at six months in the primary (A1C) and secondary outcome measures. Effect size was computed and proportion of patients that reached target laboratory parameters were compared in both arms. Results: All enrolled participants (108) completed the study, 54 in each arm. Mean age was 51 (SD 11.75) and majority were females (68.5%). Participants in the intervention group had significant reduction in A1C of -0.75%, compared with an increase of 0.15% in the usual care group (p<0.001; eta-square= 0.144). The proportion of those that achieved target A1C of <7% at 6 months in the intervention and usual care group was 42.6% vs 20.8% (p=0.02). Furthermore, intervention patients were about 3 times more likely to have better glucose control; A1C<7% (aOR 2.72, 95%CI: 1.14-6.46) compared to usual care group, adjusted for sex, age, and duration of diabetes. Conclusions: Pharmacist-led care significantly improved glycaemic control in patients with uncontrolled T2DM.

scholarly journals Making sense of diabetes medication decisions: a mixed methods cluster randomized trial using a conversation aid intervention

Endocrine ◽  
2021 ◽  
Author(s):  
Marleen Kunneman ◽  
Megan E. Branda ◽  
Jennifer L. Ridgeway ◽  
Kristina Tiedje ◽  
Carl R. May ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Decision Making ◽  
Mixed Methods ◽  
Medication Adherence ◽  
Usual Care ◽  
Cluster Randomized Trial ◽  
Patient Knowledge ◽  
Cluster Randomized

Abstract Purpose To determine the effectiveness of a shared decision-making (SDM) tool versus guideline-informed usual care in translating evidence into primary care, and to explore how use of the tool changed patient perspectives about diabetes medication decision making. Methods In this mixed methods multicenter cluster randomized trial, we included patients with type 2 diabetes mellitus and their primary care clinicians. We compared usual care with or without a within-encounter SDM conversation aid. We assessed participant-reported decisions made and quality of SDM (knowledge, satisfaction, and decisional conflict), clinical outcomes, adherence, and observer-based patient involvement in decision-making (OPTION12-scale). We used semi-structured interviews with patients to understand their perspectives. Results We enrolled 350 patients and 99 clinicians from 20 practices and interviewed 26 patients. Use of the conversation aid increased post-encounter patient knowledge (correct answers, 52% vs. 45%, p = 0.02) and clinician involvement of patients (Mean between-arm difference in OPTION12, 7.3 (95% CI 3, 12); p = 0.003). There were no between-arm differences in treatment choice, patient or clinician satisfaction, encounter length, medication adherence, or glycemic control. Qualitative analyses highlighted differences in how clinicians involved patients in decision making, with intervention patients noting how clinicians guided them through conversations using factors important to them. Conclusions Using an SDM conversation aid improved patient knowledge and involvement in SDM without impacting treatment choice, encounter length, medication adherence or improved diabetes control in patients with type 2 diabetes. Future interventions may need to focus specifically on patients with signs of poor treatment fit. Clinical trial registration ClinicalTrial.gov: NCT01502891.

Multimodal manual therapy vs. pharmacological care for management of tension type headache: A meta-analysis of randomized trials

Cephalalgia ◽  
2015 ◽  
Vol 35 (14) ◽  
pp. 1323-1332 ◽  
Author(s):  
Juan A Mesa-Jiménez ◽  
Cristina Lozano-López ◽  
Santiago Angulo-Díaz-Parreño ◽  
Ángel L Rodríguez-Fernández ◽  
Jose L De-la-Hoz-Aizpurua ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Manual Therapy ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Tension Type Headache ◽  
Mean Difference ◽  
Controlled Trials ◽  
Weighted Mean ◽  
Randomized Controlled ◽  
Type Headache

Background Manual therapies are generally requested by patients with tension type headache. Objective To compare the efficacy of multimodal manual therapy vs. pharmacological care for the management of tension type headache pain by conducting a meta-analysis of randomized controlled trials. Methods PubMed, MEDLINE, EMBASE, AMED, CINAHL, EBSCO, Cochrane Database of Systematic Reviews, Cochrane Collaboration Trials Register, PEDro and SCOPUS were searched from their inception until June 2014. All randomized controlled trials comparing any manual therapy vs. medication care for treating tension type headache adults were included. Data were extracted and methodological quality assessed independently by two reviewers. We pooled headache frequency as the main outcome and also intensity and duration. The weighted mean difference between manual therapy and pharmacological care was used to determine effect sizes. Results Five randomized controlled trials met our inclusion criteria and were included in the meta-analysis. Pooled analyses found that manual therapies were more effective than pharmacological care in reducing frequency (weighted mean difference –0.8036, 95% confidence interval –1.66 to –0.44; three trials), intensity (weighted mean difference –0.5974, 95% confidence interval –0.8875 to –0.3073; five trials) and duration (weighted mean difference –0.5558, 95% confidence interval –0.9124 to –0.1992; three trials) of the headache immediately after treatment. No differences were found at longer follow-up for headache intensity (weighted mean difference –0.3498, 95% confidence interval –1.106 to 0.407; three trials). Conclusion Manual therapies were associated with moderate effectiveness at short term, but similar effectiveness at longer follow-up for reducing headache frequency, intensity and duration in tension type headache than pharmacological medical drug care. However, due to the heterogeneity of the interventions, these results should be considered with caution at this stage.

On-clamp versus off-clamp robotic partial nephrectomy: A systematic review and meta-analysis

2019 ◽  
Vol 86 (2) ◽  
pp. 52-62 ◽  
Author(s):  
Alessandro Antonelli ◽  
Alessandro Veccia ◽  
Simone Francavilla ◽  
Riccardo Bertolo ◽  
Pierluigi Bove ◽  
...  
Keyword(s):  
Systematic Review ◽  
Confidence Interval ◽  
Partial Nephrectomy ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Mean Difference ◽  
Robotic Partial Nephrectomy ◽  
Weighted Mean ◽  
Robot Assisted ◽  
Significant Difference

Background: The debate on the pros and cons of robot-assisted partial nephrectomy performed with (on-clamp) or without (off-clamp) renal artery clamping is ongoing. The aim of this meta-analysis is to summarize the available evidence on the comparative studies assessing the outcomes of these two approaches. Material and methods: A systematic review of the literature on PubMed, ScienceDirect®, and Embase® was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement (PRISMA). Only comparative and case-control studies were submitted to full-text assessment and meta-analysis. RevMan 5.3 software was used. Results: From the initial retrieval of 1937 studies, 15 fulfilling inclusion criteria were selected and provided 2075 patients for analysis (702 off-clamp, 1373 on-clamp). Baseline tumor’s features showed a significant difference in size (weighted mean difference: –0.58 cm; 95% confidence interval: [–1.06, –0.10]; p = 0.02) and R.E.N.A.L. score (weighted mean difference: –0.53; 95% confidence interval: [–0.81, –0.25]; p = 0.0002), but not in the exophytic property, the location, and the PADUA score. Pooled analysis revealed shorter operative time (p = 0.02) and higher estimated blood loss (p = 0.0002) for the off-clamp group. Overall complication and transfusion rates were similar, while higher major complication rate was observed in the on-clamp approach (5.6% vs 1.9%, p = 0.03). No differences in oncological outcomes were found. Finally, functional outcomes (assessed by estimated glomerular filtration rate at early postoperative, 3 month, 6 month, and last available follow-up) were not statistically different. Conclusion: This meta-analysis shows that off-clamp robot-assisted partial nephrectomy is reserved to smaller renal masses. Under such conditions, no differences with the on-clamp approach emerged.

scholarly journals Effect of Urate-Lowering Therapy on Cardiovascular and Kidney Outcomes

2020 ◽  
Vol 15 (11) ◽  
pp. 1576-1586 ◽  
Author(s):  
Qi Chen ◽  
Zi Wang ◽  
Jingwei Zhou ◽  
Zhenjie Chen ◽  
Yan Li ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Risk Ratio ◽  
Kidney Failure ◽  
Cardiovascular Events ◽  
Weighted Mean Difference ◽  
Mean Difference ◽  
Major Adverse Cardiovascular Events ◽  
Weighted Mean ◽  
Lowering Therapy ◽  
All Cause Mortality

Background and objectivesSeveral clinical practice guidelines noted the potential benefits of urate-lowering therapy on cardiovascular disease and CKD progression; however, the effect of this regimen remains uncertain. In this systematic review, we aimed to evaluate the efficacy of urate-lowering therapy on major adverse cardiovascular events, all-cause mortality, kidney failure events, BP, and GFR.Design, setting, participants, & measurementsWe systematically searched MEDLINE, Embase, and the Cochrane databases for trials published through July 2020. We included prospective, randomized, controlled trials assessing the effects of urate-lowering therapy for at least 6 months on cardiovascular or kidney outcomes. Relevant information was extracted into a spreadsheet by two authors independently. Treatment effects were summarized using random effects meta-analysis.ResultsWe identified 28 trials including a total of 6458 participants with 506 major adverse cardiovascular events and 266 kidney failure events. Overall urate-lowering therapy did not show benefits on major adverse cardiovascular events (risk ratio, 0.93; 95% confidence interval, 0.74 to 1.18) and all-cause mortality (risk ratio, 1.04; 95% confidence interval, 0.78 to 1.39) or kidney failure (risk ratio, 0.97; 95% confidence interval, 0.61 to 1.54). Nevertheless, urate-lowering therapy attenuated the decline in the slope of GFR (weighted mean difference, 1.18 ml/min per 1.73 m2 per year; 95% confidence interval, 0.44 to 1.91) and lowered the mean BP (systolic BP: weighted mean difference, −3.45 mm Hg; 95% confidence interval, −6.10 to −0.80; diastolic BP: weighted mean difference, −2.02 mm Hg; 95% confidence interval, −3.25 to −0.78). There was no significant difference (risk ratio, 1.01; 95% confidence interval, 0.94 to 1.08) in the risk of adverse events between the participants receiving urate-lowering therapy and the control group.ConclusionsUrate-lowering therapy did not produce benefits on the clinical outcomes, including major adverse cardiovascular events, all-cause mortality, and kidney failure. Thus, there is insufficient evidence to support urate lowering in patients to improve kidney and cardiovascular outcomes.

scholarly journals The effect of grape products containing polyphenols on oxidative stress: a systematic review and meta-analysis of randomized clinical trials

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Sahar Sarkhosh-Khorasani ◽  
Zohreh Sadat Sangsefidi ◽  
Mahdieh Hosseinzadeh
Keyword(s):  
Oxidative Stress ◽  
Systematic Review ◽  
Confidence Interval ◽  
Randomized Clinical Trials ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Mean Difference ◽  
Weighted Mean ◽  
Stress Markers ◽  
Total Antioxidant

Abstract Background The literature showed that Grape Products Containing Polyphenols (GPCP) had anti-oxidant activity. However, the effects of GPCP on different biomarkers of oxidative stress are still controversial. In this regard, this systematic review and meta-analysis aimed to evaluate the effect of Grape Products Containing Polyphenols (GPCP) intake on oxidative stress markers. Methods PubMed, Scopus, Web of Science, and Google Scholar data bases were searched up to August 20, 2020. A random-effects model, weighted mean difference (WMD), and 95% confidence interval (CI) were applied for data analysis. Meta-analysis was conducted over 17 eligible RCTs with a total of 633 participants. The study registration number is CRD42019116696. Results A significant increase was observed in Total Antioxidant Capacity (TAC) (weighted mean difference (WMD) = 1.524 mmol/L, 95% confidence interval (CI): 0.83, 2.21). Intake of GPCP enhanced Superoxide Dismutase (SOD) (WMD = 0.450 mmol/L, 95% CI: 0.23, 0.66), TAC (WMD = 2.829 mmol/L, 95% CI: 0.13, 5.52), and Oxygen Radical Absorbance Capacity (ORAC) (WMD = 0.524 μmol/L, 95% CI: 0.42, 0.62) among healthy participants. Higher GPCP doses increased SOD (WMD = 0.539 U/mgHb, 95% CI: 0.24, 0.82) and ORAC (WMD = 0.377 μmol/L, 95% CI: 0.08, 0.67), whereas longer intervention periods enhanced ORAC (WMD = 0.543 μmol/L, 95% CI: 0.43, 0.64). Conclusion GPCP intake may partly improve status of oxidative stress, but further well-designed trials are required to confirm these results.

scholarly journals A Smartphone App to Improve Medication Adherence in Patients With Type 2 Diabetes in Asia: Feasibility Randomized Controlled Trial

10.2196/14914 ◽  
2019 ◽  
Vol 7 (9) ◽  
pp. e14914 ◽  
Author(s):  
Zhilian Huang ◽  
Eberta Tan ◽  
Elaine Lum ◽  
Peter Sloot ◽  
Bernhard Otto Boehm ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Medication Adherence ◽  
Usual Care ◽  
Clinical Outcomes ◽  
Intervention Group ◽  
Density Lipoprotein ◽  
Smartphone App ◽  
Control Group ◽  
Improve Medication Adherence

Background The efficacy of smartphone apps for improving medication adherence in type 2 diabetes is not well studied in Asian populations. Objective This study aimed to determine the feasibility, acceptability, and clinical outcomes of using a smartphone app to improve medication adherence in a multiethnic Asian population with type 2 diabetes. Methods We block randomized 51 nonadherent and digitally literate patients with type 2 diabetes between the ages of 21 and 75 years into two treatment arms (control: usual care; intervention: usual care+Medisafe app) and followed them up for 12 weeks. Recruitment occurred at a public tertiary diabetes specialist outpatient center in Singapore. The intervention group received email reminders to complete online surveys monthly, while the control group only received an email reminder(s) at the end of the study. Barriers to medication adherence and self-appraisal of diabetes were assessed using the Adherence Starts with Knowledge-12 (ASK-12) and Appraisal of Diabetes Scale (ADS) questionnaires at baseline and poststudy in both groups. Perception toward medication adherence and app usage, attitude, and satisfaction were assessed in the intervention group during and after the follow-up period. Sociodemographic data were collected at baseline. Clinical data (ie, hemoglobin A1c, body mass index, low-density lipoprotein, high-density lipoprotein, and total cholesterol levels) were extracted from patients’ electronic medical records. Results A total of 51 (intervention group: 25 [49%]; control group: 26 [51%]) participants were randomized, of which 41 (intervention group: 22 [88.0%]; control group: 19 [73.1%]) completed the poststudy survey. The baseline-adjusted poststudy ASK-12 score was significantly lower in the intervention group than in the control group (mean difference: 4.7, P=.01). No changes were observed in the clinical outcomes. The average 12-week medication adherence rate of participants tracked by the app was between 38.3% and 100% in the intervention group. The majority (>80%) of the participants agreed that the app was easy to use and made them more adherent to their medication. Conclusions Our feasibility study showed that among medication-nonadherent patients with type 2 diabetes, a smartphone app intervention was acceptable, improved awareness of medication adherence, and reduced self-reported barriers to medication adherence, but did not improve clinical outcomes in a developed Asian setting.

scholarly journals Effects and safety of separate low-dose hydrocortisone use in patients with septic shock: A meta-analysis

2019 ◽  
Vol 27 (1) ◽  
pp. 39-50
Author(s):  
Jing Wu ◽  
Man Huang ◽  
QianWen Wang ◽  
Yuefeng Ma ◽  
Libing Jiang
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Relative Risk ◽  
Confidence Interval ◽  
Low Dose ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Mean Difference ◽  
Controlled Trials ◽  
Weighted Mean

Objective: The aim of this study was to explore the effects and safety of low-dose hydrocortisone in patients with septic shock. Methods: The PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were searched from database inception until 1 August 2018. Two reviewers performed literature selection, data extraction, and quality evaluation independently. Results: Twelve randomized controlled trials were included in this meta-analysis. The combined results showed that low-dose hydrocortisone use had no survival benefit in patients with septic shock (relative risk = 1.09; 95% confidence interval = 0.88–1.05; P = 0.37). But low-dose hydrocortisone use was useful for shock reverse (relative risk = 1.09; 95% confidence interval = 1.00–1.19; P = 0.04) and in shortening the time of vasopressor support (weighted mean difference = −1.79, 95% confidence interval = −2.05 to −1.52; P < 0.00001). In addition, use of low-dose hydrocortisone was associated with a higher risk of hyperglycemia (relative risk = 1.21; 95% confidence interval = 1.04–1.40; P = 0.01) and hypernatremia (relative risk = 6.34; 95% confidence interval = 1.19–33.81; P = 0.03). There was no significant improvement of intensive care unit mortality (relative risk = 1.11; 95% confidence interval = 0.93–1.33; P = 0.23) or hospital mortality (relative risk = 1.08; 95% confidence interval = 0.94–1.24; P = 0.29), length of intensive care unit (weighted mean difference = −1.84; 95% confidence interval = −5.80 to 2.11; P = 0.36) or length of hospital (weighted mean difference = 0.11; 95% confidence interval = −2.06 to 2.29; P = 0.98), and time of mechanical support (weighted mean difference = −0.69; 95% confidence interval = −1.76 to −0.38; P = 0.20) with the use of low-dose hydrocortisone. There was no significant difference in secondary infection (relative risk = 1.04; 95% confidence interval = 0.91–1.18; P = 0.57), recurrence of shock (relative risk = 1.47; 95% confidence interval = 0.64–3.39; P = 0.36), and gastrointestinal bleeding (relative risk = 1.41; 95% confidence interval = 0.89–2.22; P = 0.14) with the use of low-dose hydrocortisone. Conclusion: Although there was no effect of low-dose hydrocortisone on survival of patients with septic shock, it is associated with a higher rate of shock reversal and shortening duration of vasopressor support; thus, low-dose hydrocortisone may be an alternative drug in septic shock patients who are refractory to fluid resuscitation and vasopressors.

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