scholarly journals Effects of Vitamin C Supplementation on Glycemic Control and Cardiovascular Risk Factors in People With Type 2 Diabetes: A GRADE-Assessed Systematic Review and Meta-analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Shaun A Mason ◽  
Michelle A Keske ◽  
Glenn D Wadley
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Vitamin C ◽  
Controlled Trials ◽  
Short Term ◽  
Randomized Controlled ◽  
Vitamin C Supplementation

<a><b>BACKGROUND </b></a>Evidence suggests vitamin C supplementation could be a potential therapy in type 2 diabetes. However, its effectiveness and evidence quality require further evaluation. <p><b>PURPOSE</b> To investigate the efficacy of oral vitamin C supplementation in improving glycemic control, cardiovascular risk factors, and oxidative stress in people with type 2 diabetes.</p> <p><b>DATA SOURCES</b> Databases (PubMed, Embase, Scopus, Cochrane Library) and clinical trial registries were searched for randomized controlled trials up to 09/08/2020. </p> <p><b>STUDY SELECTION</b> Trials in adults with type 2 diabetes were included. Trials were excluded if supplements were not exclusive to vitamin C, and if <2 weeks in duration. </p> <p><b>DATA EXTRACTION</b> Primary outcomes were HbA1c, glucose, cholesterol, triglycerides, and blood pressure (BP). Data were extracted for changes in outcomes between vitamin C and control groups. Evidence certainty was assessed using GRADE methods. </p> <p><b>DATA SYNTHESIS</b> Twenty-eight studies (n=1574) were included in the review. Outcomes changed to a statistically and clinically significant extent with Vitamin C were systolic BP (mean difference [MD] −6.27, 95% CI [−9.60, −2.96] mmHg; p=0.0002) with moderate evidence certainty; and HbA1c (MD −0.54 [−0.90, −0.17] %; p=0.004) and diastolic BP (MD −3.77 [−6.13, −1.42] mmHg; p=0.002) with very low evidence certainty. </p> <p><b>LIMITATIONS</b> Studies were predominantly short-term (<6 months) with a small number of participants (n<100).</p> <a><b>CONCLUSION</b> While evidence from short-term studies suggests vitamin C supplementation may improve glycemic control and blood pressure in people with type 2 diabetes, vitamin C supplementation cannot currently be recommended as a therapy until larger, long-term and high quality trials confirm these findings. </a>

scholarly journals Effects of Vitamin C Supplementation on Glycemic Control and Cardiovascular Risk Factors in People With Type 2 Diabetes: A GRADE-Assessed Systematic Review and Meta-analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Shaun A Mason ◽  
Michelle A Keske ◽  
Glenn D Wadley
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Vitamin C ◽  
Controlled Trials ◽  
Short Term ◽  
Randomized Controlled ◽  
Vitamin C Supplementation

<a><b>BACKGROUND </b></a>Evidence suggests vitamin C supplementation could be a potential therapy in type 2 diabetes. However, its effectiveness and evidence quality require further evaluation. <p><b>PURPOSE</b> To investigate the efficacy of oral vitamin C supplementation in improving glycemic control, cardiovascular risk factors, and oxidative stress in people with type 2 diabetes.</p> <p><b>DATA SOURCES</b> Databases (PubMed, Embase, Scopus, Cochrane Library) and clinical trial registries were searched for randomized controlled trials up to 09/08/2020. </p> <p><b>STUDY SELECTION</b> Trials in adults with type 2 diabetes were included. Trials were excluded if supplements were not exclusive to vitamin C, and if <2 weeks in duration. </p> <p><b>DATA EXTRACTION</b> Primary outcomes were HbA1c, glucose, cholesterol, triglycerides, and blood pressure (BP). Data were extracted for changes in outcomes between vitamin C and control groups. Evidence certainty was assessed using GRADE methods. </p> <p><b>DATA SYNTHESIS</b> Twenty-eight studies (n=1574) were included in the review. Outcomes changed to a statistically and clinically significant extent with Vitamin C were systolic BP (mean difference [MD] −6.27, 95% CI [−9.60, −2.96] mmHg; p=0.0002) with moderate evidence certainty; and HbA1c (MD −0.54 [−0.90, −0.17] %; p=0.004) and diastolic BP (MD −3.77 [−6.13, −1.42] mmHg; p=0.002) with very low evidence certainty. </p> <p><b>LIMITATIONS</b> Studies were predominantly short-term (<6 months) with a small number of participants (n<100).</p> <a><b>CONCLUSION</b> While evidence from short-term studies suggests vitamin C supplementation may improve glycemic control and blood pressure in people with type 2 diabetes, vitamin C supplementation cannot currently be recommended as a therapy until larger, long-term and high quality trials confirm these findings. </a>

scholarly journals Cardiovascular safety and efficacy of metformin-SGLT2i versus metformin-sulfonylureas in type 2 diabetes: systematic review and meta-analysis of randomized controlled trials

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Desye Gebrie ◽  
Desalegn Getnet ◽  
Tsegahun Manyazewal
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Combination Therapy ◽  
Adverse Events ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Safety And Efficacy ◽  
Randomized Controlled ◽  
Sodium Glucose Cotransporter

AbstractDiabetes is a serious threat to global health and among the top 10 causes of death, with nearly half a billion people living with it worldwide. Treating patients with diabetes tend to become more challenging due to the progressive nature of the disease. The role and benefits of combination therapies for the management of type 2 diabetes are well-documented, while the comparative safety and efficacy among the different combination options have not been elucidated. We aimed to systematically synthesize the evidence on the comparative cardiovascular safety and efficacy of combination therapy with metformin-sodium-glucose cotransporter-2 inhibitors versus metformin-sulfonylureas in patients with type 2 diabetes. We searched MEDLINE-PubMed, Embase, Cochrane Library, and ClinicalTrials.gov up to 15 August 2019 without restriction in the year of publication. We included randomized controlled trials of patients with type 2 diabetes who were on metformin-sodium-glucose cotransporter-2 inhibitors or metformin-sulphonylureas combination therapy at least for a year. The primary endpoints were all-cause mortality and serious adverse events, and the secondary endpoints were cardiovascular mortality, non-fatal myocardial infarction, non-fatal stroke, hypoglycemia, and changes in glycated hemoglobin A1c (HbA1c), body weight, fasting plasma glucose, blood pressure, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. We used a random-effects meta-analysis model to estimate mean differences for continuous outcomes and risk ratio for dichotomous outcomes. We followed PICOS description model for defining eligibility and the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 guidelines for reporting results. Of 3,190 citations, we included nine trials involving 10,974 participants. The pooled analysis showed no significant difference in all-cause mortality (risk ration [RR] = 0.93, 95% CI [0.52, 1.67]), serious adverse events (RR = 0.96, 95% CI [0.79, 1.17]) and adverse events (RR = 1.00, 95% CI [0.99, 1.02]) between the two, but in hypoglycemia (RR = 0.13, 95% CI [0.10, 0.17], P < 0.001). Participants taking metformin-sodium glucose cotransporter-2 inhibitors showed a significantly greater reduction in HbA1c (mean difference [MD] = − 0.10%, 95% CI [− 0.17, − 0.03], body weight (MD = − 4.57 kg, 95% CI [− 4.74, − 4.39], systolic blood pressure (MD = − 4.77 mmHg, 95% CI [− 5.39, − 4.16]), diastolic blood pressure (MD = − 2.07 mmHg, 95% CI [− 2.74, − 1.40], and fasting plasma glucose (MD = − 0.55 mmol/L, 95% CI [− 0.69, − 0.41]), p < 0.001. Combination therapy of metformin and sodium-glucose cotransporter-2 inhibitors is a safe and efficacious alternative to combination therapy of metformin and sulphonylureas for patients with type 2 diabetes who are at risk of cardiovascular comorbidity. However, there remains a need for additional long-term randomized controlled trials as available studies are very limited and heterogeneous.

scholarly journals MANAGEMENT OF ENDOCRINE DISEASE: Effects of telecare intervention on glycemic control in type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials

2015 ◽  
Vol 172 (3) ◽  
pp. R93-R101 ◽  
Author(s):  
Zhenru Huang ◽  
Hong Tao ◽  
Qingdong Meng ◽  
Long Jing
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Randomized Controlled Trials ◽  
Sample Size ◽  
Plasma Glucose ◽  
Small Sample ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled

ObjectiveTo review the published literature on the effects of telecare intervention in patients with type 2 diabetes and inadequate glycemic control.Design and methodsA review of randomized controlled trials on telecare intervention in patients with type 2 diabetes, and a search of electronic databases such as The Cochrane Library, PubMed, EBSCO, CINAHL, Science Direct, Journal of Telemedicine and Telecare, and China National Knowledge Infrastructure (CNKI), were conducted from December 8 to 16, 2013. Two evaluators independently selected and reviewed the eligible studies. Changes in HbA1c, fasting plasma glucose (FPG), post-prandial plasma glucose (PPG), BMI, and body weight were analyzed.ResultsAn analysis of 18 studies with 3798 subjects revealed that telecare significantly improved the management of diabetes. Mean HbA1c values were reduced by −0.54 (95% CI, −0.75 to −0.34; P<0.05), mean FPG levels by −9.00 mg/dl (95% CI, −17.36 to −0.64; P=0.03), and mean PPG levels reduced by −52.86 mg/dl (95% CI, −77.13 to −28.58; P<0.05) when compared with the group receiving standard care. Meta-regression and subgroup analyses indicated that study location, sample size, and treatment-monitoring techniques were the sources of heterogeneity.ConclusionsPatients monitored by telecare showed significant improvement in glycemic control in type 2 diabetes when compared with those monitored by routine follow-up. Significant reduction in HbA1c levels was associated with Asian populations, small sample size, and telecare, and with those patients with baseline HbA1c greater than 8.0%.

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