The Association of Diabetes Mellitus with Clinical Outcomes after Coronary Stenting: A 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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The influence of diabetes mellitus on rotator cuff repair: A systematic review and meta-analysis

Combinatorial Chemistry & High Throughput Screening ◽

10.2174/1386207323666201020114034 ◽

2020 ◽

Vol 23 ◽

Author(s):

Xiaomin Lu ◽

He Sun ◽

YiSheng Xu ◽

Xuewei Cao

Keyword(s):

Diabetes Mellitus ◽

Rotator Cuff ◽

Clinical Outcomes ◽

Clinical Studies ◽

Rotator Cuff Repair ◽

Meta Analysis ◽

Japanese Orthopaedic Association ◽

Cochrane Library ◽

Significant Difference ◽

Cuff Repair

Background: : Clinical outcomes after rotator cuff repair associated with diabetes mellitus(DM) are generally favorable, but no study has attempted to establish the influence of DM on outcomes after rotator cuff repair. Purpose: To conduct a meta-analysis of clinical studies evaluating patient outcomes between people with DM and people without DM after rotator cuff repair. Study Design: Meta-analysis. Methods: A literature search of the Embase, PubMed, and Cochrane Library databases was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Cohort studies and case-control studies about clinical outcomes after rotator cuff repair comparing people with DM and people without DM were included. Statistical analysis was performed with RevMan (v 5.3.3). Results: Nine clinical studies that met the inclusion criteria were identified and included a total of 314 patients treated with DM and 1092 patients without DM. The failure rate was significantly higher in the DM group than in Non-DM group (23.97% compared with 16.60%, OR: 2.39; 95% CI, 1.69–3.37; p < 0.001). The postoperative retear rate and showed a significant difference between the two groups (24.5% and 13.7%; OR: 2.41; 95% CI, 1.57–3.71; p<0.001). The DM group showed a higher rate of postoperative unhealed cuff than the Non-DM group(41.81% and 25.23%; OR: 2.14; 95% CI, 1.69–3.37; p=0.01).Postoperative Range of motion(ROM) at 12 months after surgery show a significant difference in the range of external rotation between two groups (WMD: -6.02; 95% CI, -7.54 to -4.50; p<0.001).The preoperative Japanese Orthopaedic Association (JOA) score, the comparison of pre- and post-operative JOA scores showed a significant difference in the DM and Non-DM group(p<0.001). The postoperative JOA score, the pre- and post-operative muscle strength, the pre- and postoperative visual analog scale (VAS) show significant difference between the the DM and Non-DM group(p<0.001). The postoperative infection rates, the rates of postoperative shoulder stiffness, the preoperative ROM, the postoperative ROM at 6 months, the postoperative ROM at 12 months of forward flexion and abduction, the American Shoulder and Elbow Surgeons score, the University of California, Los Angeles scores, and the preoperative Constant-Murley scores show no significant difference between the two groups. Conclusion: This meta-analysis indicates that DM may be relative to a higher rate of shoulder retear and cuff unhealing. However, patients with DM can achieve great clinical outcomes after cuff repair, compared to patients without DM.

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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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The impact of diabetes mellitus on clinical outcomes following chemotherapy for the patients with pancreatic cancer: a meta-analysis

Acta Diabetologica ◽

10.1007/s00592-019-01337-2 ◽

2019 ◽

Vol 56 (10) ◽

pp. 1103-1111 ◽

Cited By ~ 1

Author(s):

Jichun Ma ◽

Jing Wang ◽

Long Ge ◽

Bo Long ◽

Junqiang Zhang

Keyword(s):

Diabetes Mellitus ◽

Pancreatic Cancer ◽

Clinical Outcomes ◽

Meta Analysis ◽

The Impact

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

Primary Care Diabetes ◽

10.1016/j.pcd.2018.11.007 ◽

2019 ◽

Vol 13 (2) ◽

pp. 158-169 ◽

Cited By ~ 7

Author(s):

Yuvaraj Krishnamoorthy ◽

Manikandanesan Sakthivel ◽

Gokul Sarveswaran ◽

Salin Kandanalil Eliyas

Keyword(s):

Diabetes Mellitus ◽

Systematic Review ◽

Clinical Outcomes ◽

Meta Analysis

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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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