scholarly journals HbA1c Change and Diabetic Retinopathy During GLP-1 Receptor Agonist Cardiovascular Outcome Trials: A Meta-analysis and Meta-regression

2020 ◽  
Author(s):  
M. Angelyn Bethel ◽  
Rafael Diaz ◽  
Noelia Castellana ◽  
Indranil Bhattacharya ◽  
Hertzel C. Gerstein ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Meta Analysis ◽  
Cardiovascular Outcome ◽  
Data Sources ◽  
Sensitivity Analyses ◽  
Cardiovascular Outcome Trials ◽  
Meta Regression ◽  
Long Term Impact

<a><b>Background: </b></a>Long-term glycemic control reduces retinopathy risk, but transient worsening can occur with glucose control intensification. GLP-1 receptor agonists (RA) lower glucose, but long-term impact on retinopathy is unknown. GLP-1RA cardiovascular outcome trials (CVOTs) provide long-term follow-up, allowing examination of retinopathy outcomes. <p><b>Purpose: </b>To examine the associations between retinopathy, HbA1c, systolic blood pressure (SBP) and weight in GLP-1RA CVOTs. </p> <p><b>Data Sources: </b>Systematic review identified 6 placebo-controlled GLP-1RA CVOTs reporting prespecified retinopathy outcomes. </p> <p><b>Study Selection: </b>Published trial reports were used as primary data sources. </p> <p><b>Data Extraction: </b>HbA1c, SBP, and weight data throughout follow-up by treatment group were extracted. </p> <p><b>Data Synthesis: </b>Random effects model meta-analysis showed no association between GLP-1RA treatment and retinopathy (odds ratio [OR] 1.10; 95% CI 0.93, 1.30), with high heterogeneity between studies (I2=52.2%; Q-statistic p=0.063). Univariate meta-regression showed an association between retinopathy and average HbA1c reduction during the overall follow-up (slope=0.77, p=0.007), but no relationship for SBP or weight. Sensitivity analyses for HbA1c showed a relationship at 3 months (p=0.006) and 1 year (p=0.002). A 0.1% (1.09 mmol/mol) increase in HbA1c reduction was associated with 6%, 14%, or 8% increased ln (OR) for retinopathy at the 3-month, 1-year, and overall follow-up, respectively.<b> </b></p> <p><b>Limitations: </b>CVOTs were not powered to assess retinopathy outcomes and differed in retinopathy-related criteria and methodology. The median follow-up of 3.4 years is short compared to the onset of retinopathy.<b> </b></p> <p><b>Conclusions: </b>HbA1c reduction was significantly associated with increased retinopathy risk in meta-regression for GLP-1RA CVOTs. The magnitude of HbA1c reduction was correlated with retinopathy risk in people with diabetes and additional cardiovascular risk factors, but the long-term impact of improved glycemic control on retinopathy is unmeasured in these studies. Retinopathy status should be assessed when intensifying glucose-lowering therapy. </p>

scholarly journals HbA1c Change and Diabetic Retinopathy During GLP-1 Receptor Agonist Cardiovascular Outcome Trials: A Meta-analysis and Meta-regression

2020 ◽  
Author(s):  
M. Angelyn Bethel ◽  
Rafael Diaz ◽  
Noelia Castellana ◽  
Indranil Bhattacharya ◽  
Hertzel C. Gerstein ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Meta Analysis ◽  
Cardiovascular Outcome ◽  
Data Sources ◽  
Sensitivity Analyses ◽  
Cardiovascular Outcome Trials ◽  
Meta Regression ◽  
Long Term Impact

<a><b>Background: </b></a>Long-term glycemic control reduces retinopathy risk, but transient worsening can occur with glucose control intensification. GLP-1 receptor agonists (RA) lower glucose, but long-term impact on retinopathy is unknown. GLP-1RA cardiovascular outcome trials (CVOTs) provide long-term follow-up, allowing examination of retinopathy outcomes. <p><b>Purpose: </b>To examine the associations between retinopathy, HbA1c, systolic blood pressure (SBP) and weight in GLP-1RA CVOTs. </p> <p><b>Data Sources: </b>Systematic review identified 6 placebo-controlled GLP-1RA CVOTs reporting prespecified retinopathy outcomes. </p> <p><b>Study Selection: </b>Published trial reports were used as primary data sources. </p> <p><b>Data Extraction: </b>HbA1c, SBP, and weight data throughout follow-up by treatment group were extracted. </p> <p><b>Data Synthesis: </b>Random effects model meta-analysis showed no association between GLP-1RA treatment and retinopathy (odds ratio [OR] 1.10; 95% CI 0.93, 1.30), with high heterogeneity between studies (I2=52.2%; Q-statistic p=0.063). Univariate meta-regression showed an association between retinopathy and average HbA1c reduction during the overall follow-up (slope=0.77, p=0.007), but no relationship for SBP or weight. Sensitivity analyses for HbA1c showed a relationship at 3 months (p=0.006) and 1 year (p=0.002). A 0.1% (1.09 mmol/mol) increase in HbA1c reduction was associated with 6%, 14%, or 8% increased ln (OR) for retinopathy at the 3-month, 1-year, and overall follow-up, respectively.<b> </b></p> <p><b>Limitations: </b>CVOTs were not powered to assess retinopathy outcomes and differed in retinopathy-related criteria and methodology. The median follow-up of 3.4 years is short compared to the onset of retinopathy.<b> </b></p> <p><b>Conclusions: </b>HbA1c reduction was significantly associated with increased retinopathy risk in meta-regression for GLP-1RA CVOTs. The magnitude of HbA1c reduction was correlated with retinopathy risk in people with diabetes and additional cardiovascular risk factors, but the long-term impact of improved glycemic control on retinopathy is unmeasured in these studies. Retinopathy status should be assessed when intensifying glucose-lowering therapy. </p>

Long-Term Effects of Bariatric Surgery on Type II Diabetes, Hypertension and Hyperlipidemia: A Meta-Analysis and Meta-Regression Study with 5-Year Follow-Up

2014 ◽  
Vol 25 (3) ◽  
pp. 397-405 ◽  
Author(s):  
Cristian Ricci ◽  
Maddalena Gaeta ◽  
Emanuele Rausa ◽  
Emanuele Asti ◽  
Francesco Bandera ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Type Ii Diabetes ◽  
Meta Analysis ◽  
Type Ii ◽  
Long Term Effects ◽  
Meta Regression

scholarly journals Proton pump inhibitors do not increase the risk of dementia: a systematic review and meta-analysis of prospective studies

2020 ◽  
Vol 33 (10) ◽  
Author(s):  
Madhav Desai ◽  
Venkat Nutalapati ◽  
Sachin Srinivasan ◽  
Jihan Fathallah ◽  
Chandra Dasari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Proton Pump ◽  
Prospective Studies ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Extensive Literature ◽  
Meta Regression

SUMMARY Published studies have reported variable results on the association between duration of proton pump inhibitor (PPI) use and the risk of dementia. An extensive literature search was performed in PubMed, Embase, Google Scholar, and Cochrane for studies examining the risk of cognitive decline and dementia among PPI users versus non-PPI users in prospective studies. Retrospective database linkage studies, case reports, case series, editorials, uncontrolled cohort studies, cross-sectional studies, and review articles were excluded. Primary outcome was pooled hazard rate (HR) of any dementia among PPI users compared with non-PPI users. Secondary outcomes were pooled HR of Alzheimer’s dementia (AD) and risk with long-term PPI follow-up (more than 5 years) studies. Meta-analysis outcomes, heterogeneity (I2), and meta-regression (for the effect of covariates) were derived by statistical software R and Open meta-analyst. A total of six studies (one RCT and five prospective) with 308249 subjects, average age of 75.8 ± 5.2 years, and follow-up of 5 (range 1.5–11) years were included in the analysis. Pooled HR of any dementia was 1.16 (n = 6, 95% confidence interval (CI) = 0.86–1.47). Results remained unchanged when only studies with long-term PPI use (more than 5 years) were analyzed (n = 4, pooled HR 1.10, 95% CI 0.66–1.53). Finally, the pooled HR for AD was 1.06 (n = 3, 95% CI 0.70–1.41). There was substantial heterogeneity among inclusion studies (I2 = 93%). Meta-regression did not demonstrate a significant role of age at study start (P = 0.1) or duration of PPI use (P = 0.62) to incident dementia. The results of this systematic review and meta-analysis do not show a significant relationship between PPI use and dementia in prospective studies with at least a 5-year follow-up.

scholarly journals Incidence of Long-term Post-acute Sequelae of SARS-CoV-2 Infection Related to Pain and Other Symptoms: A Living Systematic Review and Meta-analysis

2021 ◽  
Author(s):  
Hiroshi Hoshijima ◽  
Takahiro Mihara ◽  
Hiroyuki Seki ◽  
Shunsuke Hyuga ◽  
Norifumi Kuratani ◽  
...  
Keyword(s):  
Data Extraction ◽  
Meta Analysis ◽  
Persistent Symptoms ◽  
Initial Stage ◽  
Study Selection ◽  
Inverse Variance ◽  
Meta Regression ◽  
Substantial Heterogeneity

Importance: Persistent symptoms are reported in patients who survive the initial stage of COVID-19, often referred to as ″long COVID″ or ″post-acute sequelae of SARS-CoV-2 infection″ (PASC); however, evidence on incidence is still lacking, and symptoms relevant to pain are yet to be assessed. Objective: To determine long-term symptoms in COVID-19 survivors after infection. Data Sources: A literature search was performed using the electronic databases PubMed, EMBASE, Scopus, and CHINAL and preprint servers MedRχiv and BioRχiv through January 15, 2021. Study Selection: Eligible studies were those reporting patients with a confirmed diagnosis of SARS-CoV-2 and who showed any symptoms persisting beyond the acute phase. Data Extraction and Synthesis: Incidence rate of symptoms were pooled using inverse variance methods with a DerSimonian-Laird random-effects model. Main Outcomes and Measures: The primary outcome was pain-related symptoms such as headache or myalgia. Secondary outcomes were symptoms relevant to pain (depression or muscle weakness) and symptoms frequently reported (anosmia and dyspnea). Heterogeneity among studies and publication bias for each symptom were estimated. The source of heterogeneity was explored using meta-regression, with follow-up period, age and sex as covariates. Results: In total, 35 studies including 18,711 patients were eligible. Eight pain-related symptoms and 26 other symptoms were identified. The highest pooled incidence among pain-related symptoms was chest pain (17%, 95% CI, 12%-25%), followed by headache (16%, 95% CI, 9%-27%), arthralgia (13%, 95% CI, 7%-24%), neuralgia (12%, 95% CI, 3%-38%) and abdominal pain (11%, 95% CI, 7%-16%). The highest pooled incidence among other symptoms was fatigue (45%, 95% CI, 32%-59%), followed by insomnia (26%, 95% CI, 9%-57%), dyspnea (25%, 95% CI, 15%-38%), weakness (25%, 95% CI, 8%-56%) and anosmia (19%, 95% CI, 13%-27%). Substantial heterogeneity was identified (I2, 50-100%). Meta-regression analyses partially accounted for the source of heterogeneity, and yet, 53% of the symptoms remained unexplained. Conclusions and Relevance: The current meta-analysis may provide a complete picture of incidence in PASC. It remains unclear, however, whether post-COVID symptoms progress or regress over time or to what extent PASC are associated with age or sex.

scholarly journals Clinical outcomes in pediatric intestinal failure: a meta-analysis and meta-regression

2019 ◽  
Vol 110 (2) ◽  
pp. 430-436 ◽  
Author(s):  
Aureliane Chantal Stania Pierret ◽  
James Thomas Wilkinson ◽  
Matthias Zilbauer ◽  
Jake Peter Mann
Keyword(s):  
Small Bowel ◽  
Mortality Rate ◽  
Meta Analysis ◽  
Intestinal Failure ◽  
Long Term Outcomes ◽  
Neurodevelopmental Outcomes ◽  
Small Bowel Length ◽  
Meta Regression

ABSTRACT Background Intestinal failure (IF) is associated with significant morbidity and mortality, yet specific parameters that determine medium- and long-term outcomes remain ill defined. Objective The aim of this study was to determine the long-term outcomes in childhood IF and identify patient characteristics associated with clinical endpoints. Design MEDLINE and EMBASE were searched for cohorts of >10 pediatric-onset IF patients with >12 mo follow-up. Random-effects meta-analysis and meta-regression weighted by follow-up duration were used to calculate clinical outcome rates and patient factors associated with outcomes. Primary outcome was mortality rate; secondary outcomes included neurodevelopmental status, transplantation, IF-associated liver disease (IFALD), enteral autonomy, and sepsis. Results In total, 175 cohorts (9318 patients and 34,549 y follow-up) were included in the meta-analysis. Overall mortality was 5.2% per y (95% CI: 4.3, 6.0) and was associated with sepsis and IFALD on meta-regression. Mortality rate improved with time from 5.9% per y pre-2000 to 4.5% per y post-2005. Sepsis rate was also predictive of IFALD and liver failure. Enteral autonomy was associated with small bowel length but not presence of ileo-cecal valve. There was a relative lack of data on neurodevelopmental outcomes. Conclusions Sepsis is the primary modifiable factor associated with mortality and liver failure, whereas enteral autonomy correlates with small-bowel length. No clear parameters have been identified that accurately predict neurodevelopmental outcomes, and hence further research is needed. Together, our findings are helpful for parental counseling and resource planning, and support targeting reduction in sepsis.

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