ObjectivesTo systematically review the detection rate of depression in Chinese individuals with type 2 diabetes mellitus (T2DM).MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect observational studies on the detection rate of depression in Chinese with T2DM from inception to January, 2019. Two reviewers independently screened literature, extracted data and evaluated the quality of included studies. Meta-analysis was performed by R 3.6.1 software.ResultsA total of 29 studies involving 96 557 cases were included. Meta-analysis results showed that the total detection rate of depression in Chinese with T2DM was 27% (95%CI 24% to 30%). Subgroup analysis showed that the detection rate of depression in female was 32% (95%CI 20% to 45%), and in male was 26% (95%CI 18% to 37%). The detection rate of depression in rural areas was 36% (95%CI 18% to 54%), and in urban areas was 30% (95%CI 16% to 43%). The detection rate of depression in individuals aged 60 and above was 31% (95%CI 24% to 39%), and in individuals aged less than 60 was 23% (95%CI 10% to 36%). Individuals with a primary school education and below, a middle or high school education and college degree and above education had detection rate of 31%, 23% and 22%, respectively. Individuals with diabetes duration less than 5 years, 5 to 10 years and more than 10 years had detection rates of 23%, 25% and 30%, respectively. Individuals with and without complications had detection rates of 43% and 26%, respectively. The detection rates of mild and moderate to major depression were 20% and 10%, respectively.ConclusionsThe detection rate of depression in Chinese with T2DM is high. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion.
Objective To explore the effects on quality of life (QOL), the targeted rates of metabolic parameters and cost-effectiveness in newly diagnosed type 2 diabetic patients who underwent multifactorial intensive intervention. Methods One hundred and twenty seven cases in an intensive intervention and 125 cases in a conventional intervention group were investigated by using the SF-36 questionnaire. The comparison of QOL and the targeted rates of metabolic parameters between the two groups were made. We assessed the influence factors of QOL by stepwise regression analysis and evaluated the efficiency by pharmacoeconomic cost-effectiveness analysis. Results The targeted rates of blood glucose, blood lipid and blood pressure with intensive policies were significantly higher than those with conventional policy (P＜0.05). The intensive group’s role limitations due to physical problems (RP), general health (GH), vitality (VT), role limitation due to emotional problems (RE) and total scores after 6 months intervention were significantly higher than those of baseline (P＜0.05). The vitality scores and health transition (HT) of the intensive group were better than those of the conventional group after 6 months intervention. But the QOL scores of the conventional group were not improved after intervention. The difference of QOL’s total scores after intervention was related to that of HbA1c. The total cost-effectiveness rate of blood glucose, blood lipid, blood pressure control and the total cost-effectiveness rate of QOL with intensive policy were higher than those with the conventional policy. Conclusions Quality of life and the targeted rates of blood glucose, blood lipid and blood pressure in newly diagnosed type 2 diabetic patients with multifactorial intensive intervention policy are better and more economic than those with conventional policy.
Objective To assess the effects and safety of sitagliptin combined with metformin in treating type 2 diabetes mellitus. Methods The Cochrane Library, PubMed, EMbase, CNKI, WanFang Data, VIP and CBM were searched to collect the randomized controlled trials (RCTs) on sitagliptin combined with metformin in treating Type 2 diabetes mellitus (T2DM) from inception to November, 2012. References of included studies were also retrieved. Two reviewers independently screened studies according to exclusion and inclusion criteria, extracted data, and assessed the methodological quality. Then, meta-analysis was performed using RevMan 5.1 software. Results 7 RCTs involving 2 917 patients were included. The results of meta-analysis showed that, compared with metformin alone, sitagliptin combined with metformin effectively improved HbA1c levels (WMD= –0.62%, 95%CI –0.76 to –0.47, Plt;0.000 1) and fasting plasma glucose levels (WMD= –0.7 mmol/L, 95%CI –1.03 to –0.37, Plt;0.000 01), and increased insulin sensitivity and β-cell function. But there was no significant difference between the two groups in the incidences of gastrointestinal reactions and hypoglycemia. Conclusion Compared with using metformin alone, sitagliptin combined with metformin can improve glycemic control, enhance insulin sensitivity and better β-cell function more effectively and both have a similar effect on weight lose, but there is no significant difference he incidences of gastrointestinal reactions and hypoglycemia. The above conclusion should be verified by more large-scale high-quality studies in future due to the limitations of the methodological quality and sample size of the included studies.
Objective To evaluate efficacy and safety of domestic Nateglinide tablet in comparison with domestic Repaglinide in Type 2 diabeties. Methods A multi-centre, double-blind, dummy trial was conducted.Two hundred and thirty type 2 diabetic patients recuited from 5 clinical centers were randomly allocated into Group A (domestic Repaglinide, 1.0 mg tid, n =115) and Group B (domestic Nateglinide, 90 mg tid, n =115).The trial consisted of a 4 weeksequilibrated period followed by 12 weeks treatment course. Results Ninety seven percent of patients(223) completed the trial (110 in Group A and 113 in Group B). The mean of fasting blood glucose (FBG) in both Group A and B was decreased statistically (P＜ 0.000 1) after 2, 6 and 12 weeks duration. At week 12, the mean FBG in Group A and B was reduced by 1.68±1.81 mmol/L (17.27%) and 1.17±1.67 mmol/L (12.53%) respectively with statistically significant difference between the two groups (P=0.017 7). The mean of 120 minutes postprandial blood glucose (PBG) also lowered markedly in 2, 6, and 12 weeks in both groups. At the end of therapy, PBG of 30, 60, 120 minutes were reduced significantly, mean of 120 minutes PBG was reduced 3.95±3.25 mmol/L (26.12%), and 3.81±3.05 mmol/L (26.22%) respectively in Group A and B , the differences in reduction between Group A and B had no statistical significance (P =0.726 9). In Group A and B, the mean of Alc was reduced significantly after 12 weeks duration. At week 12, the mean of Alc in Group A and B was lowered by 1.21% and 0.68% respectively, with statistical difference between the two groups (P =0.002 3). Though fasting insulin level in both groups had no change after 12 weeks duration, the insulin level at 30, 60 and 120 min increased significantly in both groups (P＜0.000 1). It suggested that both Nateglinide and Repaglinide promoted insulin secretion in early phase with maximal value at 60 min in Repaglinide group and 30 min in Nateglinide group, respectively. The adverse reaction rate in Group A including hypoglycemic reaction, thrombocytopenia and recrudescence of HBV was 4.5% when compared to only one case of thrombocytopenia in Group B (0.87%). Conclusions Both domestic Nateglinide and Repaglinide have similar effect on reducing postprandial blood glucose, but Repaglinide has ber effect on reducing FBG and A1c than Nateglinide. The results suggest that both domestic Nateglinide and Repaglinide are safe and generally well-tolerated in type 2 diabetic patients.
Based on literatures on Meta-analysis and randomized controlled trial, drug use and some geriatrics syndromes such as cognitive impairment and depression, in elderly diabetic patients were reviewed. Insulin plus oral hypoglycemic drugs was more rational therapy for insulin resistance and islet dysfunction in type 2 diabetes mellitus. We should pay more attention to cognitive impairment and depression in elderly type 2 diabetic patients.
ObjectiveTo systematically review the correlation between type 2 diabetes mellitus (T2DM) and the risk of kidney cancer. MethodsPubMed, EMbase, Web of Science, CBM, VIP and CNKI databases were electronically searched to collect cohort studies on the association between T2DM and kidney cancer from inception to August 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis then performed by using Stata 15.0 software. ResultsA total of 17 cohort studies involving 2 003 165 T2DM patients were included. The results of meta-analysis showed that patients with T2DM had a higher kidney cancer risk than controls (RR=1.51, 95%CI 1.39 to 1.64, P<0.001). Subgroup analysis showed that the incidence of kidney cancer in T2DM patients was higher in different gender, region, population, follow-up time, diabetes assessment method and other subgroups. ConclusionsCurrent evidence shows that T2DM is a risk factor for kidney cancer.
ObjectiveTo systematically evaluate the effects of vitamin D supplementation on fasting blood glucose, insulin resistance, β cell function in type 2 diabetes mellitus. MethodsDatabases including PubMed, The Cochrane Library (Issue 12, 2015), Web of Science, ScienceDirect Online, VIP, CNKI, WanFang Data, and CBM were searched to collect randomized controlled trials (RCTs) about vitamin D supplementation for type 2 diabetes mellitus from inception to December 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was conducted by RevMan 5.3 and Stata12.0 softwares. ResultsA total of 22 RCTs involving 1 756 patients were included. The results of meta-analysis showed that, compared with the control group, the vitamin D supplementation group had a significant improvement in insulin resistance (SMD=–0.68, 95%CI –1.23 to –0.12, P=0.02), but there were no significant differences in levels of FPG, HbA1c and HOMA-β between the two groups (all P value > 0.05). Subgroup analysis showed that, the levels of FPG and HOMA-IR were significantly decreased in the vitamin D supplementation group in Middle Easterners and patients whose follow-up duration was less than three months. ConclusionVitamin D supplementation could improve HOMA-IR but could not improve the levels of FPG, HbA1c and HOMA-β. However, the evidence is weak to recommend vitamin D as a means of improving glycemic control, insulin resistance and β cell function in type 2 diabetes mellitus. Further larger, high quality trials are warranted.
Objective Methods of evidence-based medicine were used to make an individulized treatment plan concerning newly diagnosed type 2 diabetes mellitus in elderly patients. Method After clinical problems were put forward, evidence was collected from third issue, 2003, Cochrane Library, Medline (PubMed 1990.1-2003.2) and http:// sumsearch.uthscsa.edu/ searchform4.htm according to the search strategy. Subject words were: diabetes mellitus non-insulin-dependent; self-monitor of blood glucose; micro-and macro-vascular complications; sulphonylureas; insulin ; aspirin; metformin; acarbose; self-monitor of blood glucose; older patient; hypertension management; Lipid management; RCT; human; meta-analysis；systmatic review. Results A total of 112 RCTs, and 24 systematic reviews were identified. A rational treatment plan was made upon a serious evaluation of the data. After one year follow-up, the plan was proved optimal. Conclusions The treatment efficacy in newly diagnosed type 2 diabetes mellitus in the elderly has been improved by determining an individulized treatment plan according to evidence-based methods.
Objective To systematically review the effectiveness of empowerment education in patients with type 2 diabetes. Methods Databases including The Cochrane Library (Issue 12, 2012), PubMed, Ovid, EMbase, Web of Science, CNKI, WanFang Data, VIP, CBM, digital journals of the Chinese Medical Association and Google Scholar were electronically searched for the randomized controlled trials (RCTs) on empowerment education in patients with type 2 diabetes from inception to January 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Then, meta-analysis was performed using RevMan 5.2 software. Results A total of seven RCTs involving 749 Type 2 diabetic patients were finally included. The results of meta-analysis showed that, compared with the control group, the empowerment education group was better in decreasing HbA1c levels, with a significant difference (MD= –0.27, 95%CI –0.51 to –0.03, P=0.03), but no significant difference was found between the two groups in improving body mass index (BMI) (MD= 0.25, 95%CI –1.07 to 1.57, P=0.71). Conclusion The program of empowerment education could improve HbA1c levels of diabetic patients, patients’ knowledge and illness attitudes on diabetes mellitus, but its influence on patients’ BMI, LDL and self-efficacy is still unclear.
Objective To assess the therapeutic effect of gastric bypass on type 2 diabetes mellitus (T2DM) after a one-year treatment in Mainland China. Methods Databases including The Cochrane Central Register of Controlled Trials, MEDLINE, EMbase, CBM and CNKI were searched from inception to February 2012, and the relevant journals and references of articles were also searched to collect randomized controlled trials (RCTs) or before-after self-controlled trials on gastric bypass in treating T2DM in Mainland China. Two reviewers independently screened articles according to the predefined inclusion and exclusion criteria, extracted data, and evaluated quality of the included studies. Then meta-analyses were performed using RevMan 5.1.0. Results A total of 6 before-after self-controlled trials involving 131 patients were finally included. All these trials were graded as low quality. The results of meta-analysis showed that the therapeutic effect of gastric bypass on T2DM after a one-year treatment was good. There were significant reductions in both fasting plasma glucose (1 year: SMD=–2.55, 95%CI –3.40 to –1.69, Plt;0.000 01) and glycosylated hemoglobin (1 year: SMD=–1.98, 95%CI –2.33 to –1.62, Plt;0.000 01); there was no marked change in fasting insulin (SMD=–2.03, 95%CI –4.41 to 0.35, P=0.10). Sensitivity analysis indicated that these results were stable, but funnel-plots indicated possible publication bias existed. Conclusion One year after gastric bypass, T2DM patients in Mainland China get reduced in both fasting plasma glucose and glycosylated hemoglobin, but get no improvement in fasting insulin. However, this conclusion still needs to be further proved by more high-quality and large-scale clinical trials with long-term follow-up because of the limitation of quantity, scale and quality of the included studies.