Objective
Sodium glucose cotransporter 2 (SGLT2) inhibitors may induce urinary glucose excretion via the inhibition of renal glucose reabsorption, improve glycemic control, and lower body weight. The ...aim of this meta‐analysis was to evaluate weight changes in patients who received different dosages of SGLT2 inhibitors.
Methods
Overall, 55 placebo‐controlled trials were included.
Results
The results indicated that treatment with 2.5 mg, 5 mg, 10 mg, and 20 mg of dapagliflozin led to significant decreases in body weight compared with a placebo (weighted mean difference WMD, −1.30 kg, −1.51 kg, −1.79 kg, −2.24 kg, respectively; P < 0.001). Treatment with 50 mg, 100 mg, 200 mg, and 300 mg of canagliflozin also led to significant decreases in weight (WMD, −1.20 kg, −1.82 kg, −1.83 kg, −2.37 kg, respectively; P < 0.001). In the treatment with empagliflozin, ipragliflozin, tofogliflozin, and luseogliflozin, body weight also significantly decreased. The decrease in weight was associated with the dosage of dapagliflozin (P < 0.05).
Conclusions
Body weight significantly decreased in patients with type 2 diabetes who received different dosages of SGLT2 inhibitors compared with patients who received a placebo. Moreover, in patients treated with dapagliflozin, there was a statistically significant dosage‐dependent trend in body weight reduction.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
3 Prediction of future ASCVD risk is crucial for the planning and resourcing of prevention and intervention efforts, as well as the identification of those most at risk. ...the primary aim of this ...study was to estimate the distribution of 10-year ASCVD risk among people with type 2 diabetes without prior glucose-lowering treatment as a proxy of “newly diagnosed” in the NEW2D study cohort using the China-PAR model. ...a total of 2301 participants were included in this analysis. The proportion of male was 55.3%, 24.2% were current smokers, the mean body mass index (BMI) was 25.1 kg/m2, the mean systolic blood pressure was 128.6 mmHg, the mean HDL-C was 1.22 mmol/L, and the mean low-density lipoprotein cholesterol (LDL-C) was 3.00 mmol/L. ...approximately half of the participants with type 2 diabetes not receiving glucose-lowering therapy in the nationwide Chinese NEW2D cohort have a medium or high risk of developing ASCVD.
The Named Entity Recognition (NER) task as a key step in the extraction of health information, has encountered many challenges in Chinese Electronic Medical Records (EMRs). Firstly, the casual use of ...Chinese abbreviations and doctors' personal style may result in multiple expressions of the same entity, and we lack a common Chinese medical dictionary to perform accurate entity extraction. Secondly, the electronic medical record contains entities from a variety of categories of entities, and the length of those entities in different categories varies greatly, which increases the difficult in the extraction for the Chinese NER. Therefore, the entity boundary detection becomes the key to perform accurate entity extraction of Chinese EMRs, and we need to develop a model that supports multiple length entity recognition without relying on any medical dictionary.
In this study, we incorporate part-of-speech (POS) information into the deep learning model to improve the accuracy of Chinese entity boundary detection. In order to avoid the wrongly POS tagging of long entities, we proposed a method called reduced POS tagging that reserves the tags of general words but not of the seemingly medical entities. The model proposed in this paper, named SM-LSTM-CRF, consists of three layers: self-matching attention layer - calculating the relevance of each character to the entire sentence; LSTM (Long Short-Term Memory) layer - capturing the context feature of each character; CRF (Conditional Random Field) layer - labeling characters based on their features and transfer rules.
The experimental results at a Chinese EMRs dataset show that the F1 value of SM-LSTM-CRF is increased by 2.59% compared to that of the LSTM-CRF. After adding POS feature in the model, we get an improvement of about 7.74% at F1. The reduced POS tagging reduces the false tagging on long entities, thus increases the F1 value by 2.42% and achieves an F1 score of 80.07%.
The POS feature marked by the reduced POS tagging together with self-matching attention mechanism puts a stranglehold on entity boundaries and has a good performance in the recognition of clinical entities.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Aims
This meta‐analysis aimed to evaluate the risk of developing bullous pemphigoid (BP) and other skin‐related adverse events (AEs) in patients with type 2 diabetes (T2DM) undergoing dipeptidyl ...peptidase‐4 inhibitor (DPP‐4i) treatment in randomized controlled trials (RCTs).
Methods
In this meta‐analysis, the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched for RCTs, which involve patients with T2DM reporting skin‐related AEs. RCTs that comparatively evaluated the effects of DPP‐4i treatment and placebo on patients with T2DM and reported skin‐related AEs were included in the analysis. The odds ratio (OR) and 95% confidence interval (CI) were calculated using the Peto's methods. The GRADE approach was used to rate the quality of evidence.
Results
A total of 46 randomized placebo‐controlled trials, including 3 trials with reports of BP (n = 38 011), that reported skin‐related AEs were included (n = 59 332). Compared to the placebo group, the risk of developing BP was significantly higher in the DPP‐4i treatment group (OR = 7.38, 95% CI 2.00‐27.25, I2 = 0%, P = .003; quality rating: very low). Additionally, DPP‐4i treatment was associated with an increased overall risk of developing skin‐related AEs (OR = 1.22, 95% CI 1.02‐1.46, I2 = 32%, P = .03; quality rating: moderate).
Conclusions
This meta‐analysis suggested that treatment with DPP‐4is, including sitagliptin, saxagliptin, and linagliptin, was associated with an increased risk of developing BP. Additionally, the risk of developing skin‐related AEs increased when all DPP‐4is were combined. Skin lesion, especially BP, should be monitored in patients with diabetes undergoing DPP‐4i treatment. Future studies should evaluate the susceptible population and develop strategies for early detection of skin‐related AEs.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
To investigate the effect of biologic therapy on risk of fracture in selected rheumatic and autoimmune diseases.
The PubMed, Cochrane library, and EMBASE databases were systematically searched from ...the inception dates to June 4, 2021. Randomized clinical trials (RCTs) comparing biological disease-modifying antirheumatic drugs (bDMARDs) with non-bDMARDs or placebo in patients with five selected rheumatic and autoimmune diseases were included. Meta-analyses were conducted to calculate the odds ratio (OR) with 95 % confidence intervals (CIs) for major osteoporotic fracture, hip fracture, osteoporotic non-vertebral fracture, and total fracture.
A total of 100 RCTs involving 51,413 participants fulfilled the inclusion criteria. In patients with psoriasis (Ps), and psoriatic arthritis (PsA), compared with placebo or non-bDMARDs therapy, the risk of major osteoporotic fracture (OR, 0.34 95 %Cl, 0.15–0.76, p = 0.009), hip fracture (OR, 0.22 95 %Cl, 0.05–0.89, p = 0.03), and osteoporotic non-vertebral fracture (OR, 0.26 95 %Cl, 0.10–0.62, p = 0.003) were significantly decreased with the use of bDMARDs. In patients with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), systemic lupus erythematosus (SLE), and inflammatory bowel diseases (IBD), the risk of fracture were not changed with biologic treatment.
The existing evidence from RCTs indicated the use of bDMARDs was associated with a low risk of major osteoporotic fracture, hip fracture, and osteoporotic non-vertebral fracture in patients with Ps and PsA. There are still urgent needs for studies regarding the actions of biologic therapies on the risk of bone fractures in systemic inflammatory diseases.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
There are multiple disease-modifying immunotherapies showing the potential of preventing or delaying the progression of type 1 diabetes (T1D). We designed and performed this systematic review and ...meta-analysis to gain an overview of what a role immunotherapy plays in the treatment of T1D. We searched PubMed, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to December 2023. We included clinical trials of immunotherapy conducted in patients with T1D that reported the incidence of hypoglycemia or changes from baseline in at least one of following outcomes: 2 h and 4 h mixed-meal-stimulated C-peptide area under the curve (AUC), fasting C-peptide, daily insulin dosage, glycated hemoglobin (HbA1c) and fasting plasma glucose (FPG). The results were computed as the weighted mean differences (WMDs) or odds ratios (ORs) and 95% confidence intervals (CIs) in random-effect model. In all, 34 clinical trials were included. When compared with control groups, 2 h C-peptide AUC was marginally higher in patient treated with nonantigen-based immunotherapies (WMD, 0.04nmol/L, 95% CI, 0.00–0.09 nmol/L, P=0.05), which was mainly driven by the effects of T cell-targeted therapy. A greater preservation in 4 h C-peptide AUC was observed in patients with nonantigen-based immunotherapies (WMD, 0.10nmol/L, 95% CI, 0.04–0.16 nmol/L, P=0.0007), which was mainly driven by the effects of tumor necrosis factor α (TNF-α) inhibitor and T cell-targeted therapy. After excluding small-sample trials, less daily insulin dosage was observed in patient treated with nonantigen-based immunotherapies when compared with control groups (WMD, −0.07units/kg/day, 95% CI, −0.11 to −0.03units/kg/day, P=0.0004). The use of antigen-based immunotherapies was also associated with a lower daily insulin dosage versus control groups (WMD, −0.11units/kg/day, 95% CI, −0.23 to −0.00units/kg/day, P=0.05). However, changes of HbA1c or FPG were comparable between nonantigen-based immunotherapies or antigen-based immunotherapies and control groups. The risk of hypoglycemia was not increased in patients treated with nonantigen-based immunotherapies or patients treated with antigen-based immunotherapies when compared with control groups. In conclusion, nonantigen-based immunotherapies were associated with a preservation of 2 h and 4 h C-peptide AUC in patients with T1D when compared with the controls, which was mainly driven by the effects of TNF-a inhibitor and T cell-targeted therapy. Both nonantigen-based immunotherapies and antigen-based immunotherapies tended to reduce the daily insulin dosage in patients with T1D when compared with the controls. However, they did not contribute to a substantial improvement in HbA1c or FPG. Both nonantigen-based immunotherapies and antigen-based immunotherapies were well tolerated with not increased risk of hypoglycemia in patients with T1D.
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•Immunotherapies were associated with the preservation of 2 h and 4 h C-peptide AUC in patients with T1D.•Immunotherapies tended to reduce the daily insulin dosage in patients with T1D.•Immunotherapies did not increase the risk of hypoglycemia in patients with T1D.•TNF-a inhibitor and T cell-targeted immunotherapy might be promising game changers to delay the development of T1D.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Aims/Introduction
To evaluate the efficacy and safety of alpha‐glucosidase inhibitors (AGI) in Asian and non‐Asian type 2 diabetes patients.
Materials and Methods
Studies were identified through a ...literature search of MEDLINE, EMBASE and other databases until December 2016. All statistical analyses were carried out in Review Manager statistical software by computing the weighted mean difference or odds ratio and 95% confidence interval.
Results
A total of 67 studies were included. AGI vs placebo: compared with the placebo, AGI treatment led to a greater decrease in hemoglobin A1c (HbA1c), fasting plasma glucose and postprandial plasma glucose. No significant difference was observed in HbA1c change, fasting plasma glucose change, postprandial plasma glucose change or incidence of hypoglycemia between Asian and non‐Asian patients. AGI vs active controls: in Asian patients, AGI treatment showed a lower reduction in HbA1c compared with dipeptidyl peptidase‐4 inhibitors and sulfonylurea. In non‐Asian patients, AGI treatment showed a lower reduction in HbA1c compared with thiazolidinedione. No significant difference was observed in HbA1c change and bodyweight change when comparing AGI with other oral hypoglycemic agents between Asian and non‐Asian patients.
Conclusions
The effects of AGI treatment on glycemic control and bodyweight reduction were superior to the placebo without an increased incidence of hypoglycemia, but with an increased incidence of gastrointestinal discomforts. The hypoglycemic effects of AGI were comparable between Asian and non‐Asian patients.
Our meta‐analysis evaluated the hypoglycemic effects and safety of AGI treatment compared with placebo or other oral hypoglycemic agents, and compared the differences between Asian and non‐Asian type 2 diabetes mellitus patients.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
The aim of the study was to evaluate the association between evening chronotype and social jetlag (SJL) with obesity, blood glucose and lipid levels in non-shift working adults.
The databases of ...MEDLINE, EMBASE and Cochrane Reviews were searched for studies analyzing the metabolic parameters among groups of different chronotypes or SJL until Feb 2022. Weighted mean difference (WMD) and 95% confidence intervals (CI) were used to analyze the association between these parameters and chronotypes or SJL.
A total of 27 studies were included in this meta-analysis. Compared with morning chronotype, the participants with evening chronotype had higher body mass index (BMI) (WMD= 0.44 kg/m
, 95%CI, 0.30 to 0.57 kg/m
, p<0.001), higher fasting blood glucose level (WMD= 5.83mg/dl, 95%CI, 3.27to 8.38 mg/dl, p<0.001), higher total cholesterol level (WMD= 6.63mg/dl, 95%CI, 0.69 to 12.56 mg/dl, p=0.03), and lower high density lipoprotein cholesterol (HDL-C) level (WMD= -1.80mg/dl, 95%CI, -2.30 to -1.31 mg/dl, p<0.001). Compared with the participants with small SJL, the participants with large SJL had larger waist circumference (WMD= 0.80cm, 95%CI, 0.77 to 0.83cm, p<0.001).
Evening chronotype and SJL were associated with obesity and unfavorable metabolic parameters of glucose and lipid metabolism.
https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022303401.
To exam the associations between the use of sodium glucose co-transporter 2 inhibitor (SGLT2i) and the risk of lower limb complications, and to analyze the associated factors.
Pubmed, Medline, ...Embase, the Cochrane Center Register of Controlled Trials for Studies and Clinicaltrial.gov were searched from the inception to November 2020. Randomized controlled trials of SGLT2i conducted in population containing diabetic patients with reports of amputation, peripheral arterial disease (PAD) and diabetic foot (DF) events were included. Random-effect model, fixed-effect model and meta-regression analysis were accordingly used.
The numbers of SGLT2i users versus non-SGLT2i users in the analyses of amputation, PAD and DF were 40,925/33,414, 36,446/28,685 and 31,907/25,570 respectively. Compared with non-SGLT2i users, the risks of amputation and PAD were slightly increased in patients with canagliflozin treatment (amputation: OR = 1.60, 95% CI 1.04 to 2.46; PAD: OR = 1.53, 95 % CI 1.14 to 2.05). Meta-regression analyses indicated that greater weight reduction in SGLT2i users was significantly associated with the increased risks of amputation (β = - 0.461, 95% CI - 0.726 to - 0.197), PAD (β = - 0.359, 95% CI - 0.545 to - 0.172) and DF (β = - 0.476, 95% CI - 0.836 to - 0.116). Lower baseline diastolic blood pressure (β = - 0.528, 95% CI - 0.852 to - 0.205), more systolic blood pressure reduction (β = - 0.207, 95% CI - 0.390 to - 0.023) and more diastolic blood pressure reduction (β = - 0.312, 95% CI - 0.610 to - 0.015) were significantly associated with the increased risks of amputation, PAD and DF respectively in patients with SGLT2i treatment.
The risks of amputation and PAD were slightly increased in patients with canagliflozin treatment. Reductions in body weight and blood pressure were associated with lower limb complications in patients with SGLT2i treatment.
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