Cost-effectiveness of interventions to control cardiovascular diseases and type 2 diabetes mellitus in South Asia: protocol for a systematic review Influence of dietary protein on postprandial blood glucose levels in individuals with Type 1 diabetes mellitus using intensive insulin therapy Yoga Practice for the Management of Type II Diabetes Mellitus in Adults: A systematic review The Influence of Yoga-Based Programs on Risk Profiles in Adults with Type 2 Diabetes Mellitus: A Systematic Review Nonpharmacological interventions to prevent type 2 diabetes in women diagnosed with gestational diabetes mellitus: a systematic overview Quality of Life of Patients with Type 1 Diabetes Mellitus Using Insulin Analog Glargine Compared with NPH Insulin: A Systematic Review and Policy Implications Intensive low-glycaemic-load dietary intervention for the management of glycaemia and serum lipids among women with gestational diabetes: a randomized control trial. Breakfast replacement with a low-glycaemic response liquid formula in patients with type 2 diabetes: a randomised clinical trial. The effectiveness of group medical visits on diabetes mellitus type 2 (dm2) specific outcomes in adults: a systematic review Lowering dietary glycaemic index through nutrition education among Malaysian women with a history of gestational diabetes mellitus. Effect of daily supplementation of fruits on oxidative stress indices and glycaemic status in type 2 diabetes mellitus. Training in flexible, intensive insulin management to enable dietary freedom in people with Type 1 diabetes: dose adjustment for normal eating (DAFNE) randomized controlled trial Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial Improving glycaemic control self-efficacy and glycaemic control behaviour in Chinese patients with type 2 diabetes mellitus: randomised controlled trial. Efficacy and safety of the dipeptidyl peptidase-4 inhibitor sitagliptin as monotherapy in patients with type 2 diabetes mellitus Dietary carbohydrates, glycaemic load, food groups and newly detected type 2 diabetes among urban Asian Indian population in Chennai, India (Chennai Urban Rural Epidemiology Study 59). Effectiveness of educational interventions to promote oral hypoglycaemic adherence in adults with Type 2 diabetes: a systematic review Exercise for people with cancer: a clinical practice guideline. Cost Effectiveness of Adding Dapagliflozin to Insulin for the Treatment of Type 2 Diabetes Mellitus in the Netherlands The effectiveness of yoga to prevent diabetes mellitus type 2 Improved glycaemic control with metformin–glibenclamide combined tablet therapy (Glucovance®) in Type 2 diabetic patients inadequately controlled on metformin Trial protocol to compare the efficacy of a smartphone-based blood glucose management system with standard clinic care in the gestational diabetic population Dietary and physical activity strategies to prevent type 2 diabetes in South Asian adults: protocol for a systematic review
Introduction While a number of strategies are being implemented to control cardiovascular diseases ( CVDs ) and type 2 diabetes mellitus ( T2DM ) , the cost-effectiveness of these in the South Asian context has not been systematic ally evaluated . We aim to systematic ally review the economic ( cost-effectiveness ) evidence available on the individual- , group- and population -level interventions for control of CVD and T2DM in South Asia . Methods and analysis This review will consider all relevant economic evaluations , either conducted alongside r and omised controlled trials or based on decision modelling estimates . These studies must include participants at risk of developing CVD/T2DM or with established disease in one or more of the South Asian countries ( India , Bangladesh , Pakistan , Sri Lanka , Nepal , Maldives , Bhutan and Afghanistan ) . We will identify relevant papers by systematic ally search ing all major data bases and registries . Selected articles will be screened by two independent research ers . Method ological quality of the studies will be assessed using a modified Drummond and a Phillips checklist . Cochrane guidelines will be followed for bias assessment in the effectiveness studies . Results Results will be presented in line with the PRISMA ( Preferred Reporting Items for Systematic review and Meta- analysis ) checklist , and overall quality of evidence will be presented as per the GRADE ( Grade s of Recommendation , Assessment , Development and Evaluation ) approach . Ethics and dissemination The study has received ethics approval from the All India Institute of Medical Sciences , New Delhi , India . The results of this review will provide policy-relevant recommendations for the uptake of cost-effectiveness evidence in prioritising decisions on essential chronic disease care packages for South Asia . Study registration number PROSPERO CRD42013006479 Abstract Aim To determine the effects of protein alone ( independent of fat and carbohydrate ) on postpr and ial glycaemia in individuals with Type 1 diabetes mellitus using intensive insulin therapy .  Methods Participants with Type 1 diabetes mellitus aged 7–40 years consumed six 150 ml whey isolate protein drinks [ 0 g ( control ) , 12.5 , 25 , 50 , 75 and 100 ] and two 150 ml glucose drinks ( 10 and 20 g ) without insulin , in r and omized order over 8 days , 4 h after the evening meal . Continuous glucose monitoring was used to assess postpr and ial glycaemia . Results Data were collected from 27 participants .  Protein loads of 12.5 and 50 g did not result in significant postpr and ial glycaemic excursions compared with control ( water ) throughout the 300 min study period ( P > 0.05 ) . Protein loads of 75 and 100 g result ed in lower glycaemic excursions than control in the 60–120 min postpr and ial interval , but higher excursions in the 180–300 min interval . In comparison with 20 g glucose , the large protein loads result ed in significantly delayed and sustained glucose excursions , commencing at 180 min and continuing to 5 h. Conclusions Seventy‐five grams or more of protein alone significantly increases postpr and ial glycaemia from 3 to 5 h in people with Type 1 diabetes mellitus using intensive insulin therapy . The glycaemic profiles result ing from high protein loads differ significantly from the excursion from glucose in terms of time to peak glucose and duration of the glycaemic excursion . This research supports recommendations for insulin dosing for large amounts of protein The effect of practicing yoga for the management of type II Diabetes  was assessed in this systematic review through search ing related electronic data bases and the grey literature to the end of May 2007 using Ovid . All r and omized controlled clinical trials ( RCTs ) comparing yoga practice with other type of intervention or with regular practice or both , were included regardless of language or type of publication . Each study was assessed for quality by two independent review ers . Mean difference was used for summarizing the effect of each study outcomes with 95 % confidence intervals . Pooling of the studies did not take place due to the wide clinical variation between the studies . Publication bias was assessed by statistical methods . Five trials with 363 participants met the inclusion criteria with medium to high risk of bias and different intervention characteristics . The studies ’ results show improvement in outcomes among patients with diabetes type II .  These improvements were mainly among short term or immediate diabetes outcomes and not all were statistically significant . The results were inconclusive and not significant for the long-term outcomes . No adverse effects were reported in any of the included studies . Short-term benefits for patients with diabetes  may be achieved from practicing yoga . Further research is needed in this area . Factors like quality of the trials and other method ological issues should be improved by large r and omized control trials with allocation concealment to assess the effectiveness of yoga on diabetes type II . A definitive recommendation for physicians to encourage their patients to practice yoga can not be reached at present There is growing evidence that yoga may offer a safe and cost-effective intervention for Type 2 Diabetes mellitus ( DM 2 ) . However , systematic review s are lacking . This article critically review s the published literature regarding the effects of yoga-based programs on physiologic and anthropometric risk profiles and related clinical outcomes in adults with DM 2 . We performed a comprehensive literature search using four computerized English and Indian scientific data bases . The search was restricted to original studies ( 1970–2006 ) that evaluated the metabolic and clinical effects of  yoga in adults with DM 2 . Studies targeting clinical population s with cardiovascular disorders that included adults with comorbid DM were also evaluated . Data were extracted regarding study design , setting , target population , intervention , comparison group or condition , outcome assessment , data analysis and presentation , follow-up , and key results , and the quality of each study was evaluated according to specific predetermined criteria . We identified 25 eligible studies , including 15 uncontrolled trials , 6 non-r and omized controlled trials and 4 r and omized controlled trials ( RCTs ) . Overall , these studies suggest beneficial changes in several risk indices , including glucose tolerance and insulin sensitivity , lipid profiles , anthropometric characteristics , blood pressure , oxidative stress , coagulation profiles , sympathetic activation and pulmonary function , as well as improvement in specific clinical outcomes .  Yoga may improve risk profiles in adults with DM 2 , and may have promise for the prevention and management of cardiovascular complications in this population . However , the limitations characterizing most studies preclude drawing firm conclusions . Additional high- quality RCTs are needed to confirm and further eluci date the effects of st and ardized yoga programs in population s with DM 2 This systematic overview summarizes the relevant evidence from multiple systematic review s of the benefits of nonpharmacological interventions for preventing  type 2 diabetes mellitus ( T2MD ) in women diagnosed with gestational diabetes mellitus ( GDM ) . A comprehensive search using the Cochrane Library , CINAHL , EMBASE and MEDLINE via Ovid SP , and PubMed data bases was completed on 18 November 2015 . Any systematic review s that evaluated r and omized controlled trials ( RCTs ) with defined nonpharmacological interventions for preventing T2DM in women diagnosed with GDM were eligible for inclusion . The authors independently performed critical appraisal s and quality assessment s of the included review s using the AMSTAR tool , and extracted data were converted to coherent values for tabular summarization . Six eligible review s of diet and /or exercise , breastfeeding , and reminder interventions were identified ; however , the method ologies of the review s varied greatly , and the majority of the evidence suggested unclear bias . We found inconsistent reporting on the rates at which diet and exercise interventions reduced the risk of T2DM progression , but these interventions were found to be effective at reducing glycemic load . Combined diet , exercise , and breastfeeding interventions proved to be effective at returning women to their postpartum weight . Neither diet alone nor exercise alone proved to be effective at lowering the risk of T2DM . Overall , there was no robust evidence to support the hypothesis that nonpharmacological interventions are effective at lowering the risk of T2DM in women diagnosed with GDM , and there was no consistent evidence showing that these interventions improved the predictor outcomes of T2DM , such as glycemic load or anthropometric changes Introduction Insulin analog glargine ( GLA ) has been available as one of the therapeutic options for patients with type 1 diabetes mellitus to enhance glycemic control . Studies have shown that a decrease in the frequency of hypoglycemic episodes improves the quality of life ( QoL ) of diabetic patients . However , there are appreciable acquisition cost differences between different insulins . Consequently , there is a need to assess their impact on QoL to provide future guidance to health authorities . Method A systematic review of multiple data bases including Medline , LILACS , Cochrane , and EMBASE data bases with several combinations of agreed terms involving r and omized controlled trials and cohorts , as well as manual search es and gray literature , was undertaken . The primary outcome measure was a change in QoL. The quality of the studies and the risk of bias was also assessed . Results Eight studies were eventually included in the systematic review out of 634 publications . Eight different QoL instruments were used ( two generic , two mixed , and four specific ) , in which the Diabetes Treatment Satisfaction Question naire ( DTSQ ) was the most used . The systematic review did not consistently show any significant difference overall in QoL scores , whether as part of subsets or combined into a single score , with the use of GLA versus neutral protamine Hagedorn ( NPH ) insulin . Only in patient satisfaction measured by DTSQ was a better result consistently seen with GLA versus NPH insulin , but not using the Well-being Inquiry for Diabetics ( WED ) scale . However , none of the cohort studies scored a maximum on the Newcastle – Ottawa scale for quality , and they generally were of moderate quality with bias in the studies . Conclusion There was no consistent difference in QoL or patient-reported outcomes when the findings from the eight studies were collated . In view of this , we believe the current price differential between GLA and NPH insulin in Brazil can not be justified by these findings OBJECTIVE The present study aim ed to compare the effects of a general dietary intervention and an intervention with low glycaemic load ( GL ) on glycaemic control , blood lipid metabolism and pregnancy outcomes in women with gestational diabetes mellitus . DESIGN Participants were r and omly assigned to two groups , receiving either an individualized general dietary intervention ( Control group ) or an intensive low-GL intervention ( Low-GL group ) every two weeks , from 24 - 26 weeks of gestation to delivery . SETTING The Center of Maternal Primary Care in Guangdong General Hospital , China . SUBJECTS Ninety-five women with gestational diabetes mellitus were enrolled from June 2008 to July 2009 . RESULTS After the intervention , both groups significantly decreased their dietary intakes of energy , fat and carbohydrate . The Low-GL group had significantly lower values for GL ( 122 v. 136 ) and glycaemic index ( 50 v. 54 ) but greater dietary fibre intake ( 33 v. 29 g/d ) than did the Control group ( all P<0·01 ) . Significantly greater decreases in fasting plasma glucose ( -0·33 v. -0·02 mmol/l , P<0·01 ) and 2 h postpr and ial glucose ( -2·98 v. -2·51 mmol/l , P<0·01 ) , significantly lower increases in total cholesterol ( 0·12 v. 0·23 mmol/l ) and TAG ( 0·41 v. 0·56 mmol/l ) and a significantly lower decrease in HDL cholesterol ( -0·01 v. -0·11 mmol/l ) were also observed in the Low-GL group compared with the Control group ( all P<0·05 ) . There were no significant differences in body weight gain , birth weight or other maternal-fetal perinatal outcomes between the two groups . CONCLUSIONS The low-GL targeted dietary intervention outperformed the general dietary intervention in glycaemic control and the improvement of blood lipid levels in women with gestational diabetes mellitus Low-glycaemic index diets reduce glycated Hb ( HbA1c ) in patients with type 2 diabetes , but require intensive dietary support . Using a liquid meal replacement with a low glycaemic response ( GR ) may be an alternative dietary approach . In the present study , we investigated whether breakfast replacement with a low-GR liquid meal would reduce postpr and ial glycaemia and /or improve long-term glycaemia . In the present r and omised , controlled , cross-over design , twenty patients with type 2 diabetes consumed either a breakfast replacement consisting of an isoenergetic amount of Glucerna SR or a free-choice breakfast for 3 months  . Postpr and ial AUC levels were measured using continuous glucose measurement at home . After the 3-month dietary period , meal profiles and oral glucose tolerance were assessed in the clinical setting . The low-GR liquid meal replacement reduced the AUC of postpr and ial glucose excursions at home compared with a free-choice control breakfast ( estimated marginal mean 141 ( 95 % CI 114 , 174 ) v. estimated marginal mean 259 ( 95 % CI 211 , 318 ) mmol × min/l ; P= 0·0002 ) . The low-GR liquid meal replacement also reduced glucose AUC levels in the clinical setting compared with an isoenergetic control breakfast ( low GR : median 97 ( interquartile range ( IQR ) 60 - 188 ) mmol × min/l ; control : median 253 ( IQR 162 - 386 ) mmol × min/l ; P < 0·001 ) . However , the 3-month low-GR liquid meal replacement did not affect fasting plasma glucose , HbA1c or lipid levels , and even slightly reduced oral glucose tolerance . In conclusion , the low-GR liquid meal replacement is a potential dietary approach to reduce postpr and ial glycaemia in patients with type 2 diabetes . However , clinical trials into the effects of replacing multiple meals on long-term glycaemia in poorly controlled patients are required before a low-GR liquid meal replacement can be adopted as a dietary approach to the treatment of type 2 diabetes Background The prevalence of diabetes mellitus is ubiquitous . Complications and costs of diabetes are rising and are depleting limited re sources . It is imperative for healthcare professionals and patients alike to confront this chronic condition by exploring new interventions . An innovative health care delivery model has emerged in the last 25 years in the form of the group medical visit . Group medical visits can range from of six to twenty patients scheduled together with time allotted for individual care as well as in the group setting . Objectives The review objective was to conduct a systematic review and meta‐ analysis to synthesize the best available evidence related to effectiveness of group medical visits on HbA1c , blood pressure and cholesterol measurements /levels for adult patients with type II diabetes in outpatient setting s. Search strategy A three‐step literature search for studies in English language from 1990 to 2010 was conducted utilising ( a ) a primary search of Medline , CINAHL , PsycINFO and Cochrane Central Register of Controlled Trials , ( b ) a secondary search of non‐indexed data bases , and ( c ) a search of the grey literature . In addition , a manual review of the reference lists of all identified reports and articles was performed to identify additional studies . Inclusion criteria All r and omised and quasi‐experimental studies of adult patients ( > 18 ) with type II diabetes mellitus seen in outpatient health setting s were considered if they met one or more of the following diagnostic outcome measurements : haemoglobin A1c , systolic and diastolic blood pressure , and low density lipoprotein cholesterol . Critical appraisal , data collection and analysis Each of the eligible articles was review ed by two independent review ers . Disagreements between the review ers were resolved through discussion , or with a third review er . Studies that met the inclusion criteria were assessed for method ological quality using the JBI st and ardized critical appraisal tools . Data extraction was undertaken using the st and ardised data extraction tool from JBI‐MAStARI . Main results The search strategy identified 2,040 articles in the published and unpublished literature . Of these , 11 r and omised controlled trials and 4 quasi‐experimental trials met the inclusion criteria and represented 2240 patients included in the final review . There are clear benefits of group medical visits for patients ' HbA1c levels which are consistent in the post‐intervention and change from baseline effect sizes . The most significant effect observed is with the change from baseline results . Some evidence suggests post‐intervention and change from baseline systolic blood pressure improvement at the nine to twelve month interval and change from baseline improvement at the 4 year timeframe . There is no evidence that group visits improve LDL cholesterol values of the group visit participants . Conclusions Group medical visits should be considered by clinicians as an effective non‐pharmacologic intervention that can have a positive impact on biologic markers such as haemoglobin A1c and systolic blood pressure . Implication s for practice The evidence suggests that the most powerful model of Group medical visits ( GMV ) is when a clinician prescriber is present during or immediately after GMV sessions for medication reconciliation or individual patient needs . Implication s for research Future research should include this GMV intervention in r and omised controlled trials across different health systems and socio‐economic and ethnic groups INTRODUCTION Gestational diabetes mellitus ( GDM ) increases risks for type 2 diabetes and cardiovascular diseases . Low glycaemic index ( GI ) diets improve cardio-metabolic outcomes in insulin-resistant individuals . We examined the feasibility of lowering GI through GI-based-education among Asian post-GDM women . METHODS A 3-month investigation was carried out on 60 Malaysian women with a mean age of 31.0 + /- 4.5 years and a history of GDM . Subjects were r and omised into two groups : LGIE and CHDR . The CHDR group received conventional healthy dietary recommendations only . The LGIE group received GI based-education in addition to conventional healthy dietary recommendations . At baseline and after 3-months , dietary intake of energy and macronutrient intakes including GI diet and glycaemic load was assessed using 3-day food records .  Diabetes-Diet and GI-concept scores and physical activity levels were assessed using a question naire . Adherence to dietary instructions was measured at the end of 3 months . RESULTS At the end of 3 months , the LGIE group had significant reductions in energy intake ( 241.7 + /- 522.4Kcal , P = 0.037 , ES=0.463 ) , total carbohydrate ( 48.7 + /- 83.5 g , P = 0.010 , ES = 0.583 ) , GI ( 3.9 + /- 7.1 , P = 0.017 , ES = 0.549 ) and GL ( 39.0 + /- 55.3 , P = 0.003 , ES = 0.705 ) and significant increases in protein ( 3.7 + /- 5.4 g , 0.003 , ES = 0.685 ) and diet fibre ( 4.6 + /- 7.3 g , P = 0.06 ) . The CHDR group had a significant reduction in fat only ( 5.7 + /- 9.4 g , P = 0.006 , ES = 0.606 ) . There was a 30 % increase in GI-concept scores in the LGIE group ( p < 0.001 ) . Changes in GI-concept scores correlated significantly to the reduction in dietary GI ( r = -0.642 , P = 0.045 ) . Dietary adherence was comparable in both groups . CONCLUSION GI-education improves GI-concept knowledge and helps lower dietary glycaemic index among women with a history of GDM This study sought to examine whether consumption of two low-calorie fruit/day for 3-months can effectively improve oxidative stress , anthropometry , blood pressure and glycaemic control in type 2 diabetes mellitus . Study involved 123 patients who were assigned to receive either st and ard care or with additional dietary therapy .  Dietary intervention result ed in significant reduction in malondialdehyde , plasma glucose , glycated haemoglobin and improvement in antioxidants like vitamin C and reduced glutathione when compared to controls . Mean plasma levels of vitamin C increased by 64 % ( p < 0.001 ) . There were no differences in waist circumference , waist-to-hip ratio , blood pressure , vitamin E and superoxide dismutase in the intervention group at follow-up . Diet rich in fruits can improve some antioxidants which are likely to reduce oxidative stress in type 2 diabetes . Regular consumption of fruits can lower the glycaemic status in these patients . The study supports the usefulness of plasma vitamin C as a biomarker for fruit intake Objectives To evaluate whether a course teaching flexible intensive insulin treatment combining dietary freedom and insulin adjustment can improve both glycaemic control and quality of life in type 1 diabetes . Design R and omised design with participants either attending training immediately ( immediate DAFNE ) or acting as waiting list controls and attending “ delayed DAFNE ” training 6 months later . Setting Secondary care diabetes clinics in three English health districts . Participants 169 adults with type 1 diabetes and moderate or poor glycaemic control . Main outcome measures Glycated haemoglobin ( HbA1c ) , severe hypoglycaemia , impact of diabetes on quality of life ( ADDQoL ) . Results At 6 months , HbA1c was significantly better in immediate DAFNE patients ( mean 8.4 % ) than in delayed DAFNE patients ( 9.4 % ) ( t=6.1 , P < 0.0001 ) . The impact of diabetes on dietary freedom was significantly improved in immediate DAFNE patients compared with delayed DAFNE patients ( t= − 5.4 , P < 0.0001 ) , as was the impact of diabetes on overall quality of life ( t=2.9 , P < 0.01 ) . General wellbeing and treatment satisfaction were also significantly improved , but severe hypoglycaemia , weight , and lipids remained unchanged . Improvements in “ present quality of life ” did not reach significance at 6 months but were significant by 1 year . Conclusion Skills training promoting dietary freedom improved quality of life and glycaemic control in people with type 1 diabetes without worsening severe hypoglycaemia or cardiovascular risk . This approach has the potential to enable more people to adopt intensive insulin treatment and is worthy of further investigation Abstract Objectives : To evaluate whether a course teaching flexible intensive insulin treatment combining dietary freedom and insulin adjustment can improve both glycaemic control and quality of life in type 1 diabetes . Design : R and omised design with participants either attending training immediately ( immediate DAFNE ) or acting as waiting list controls and attending “ delayed DAFNE ” training 6 months later . Setting : Secondary care diabetes clinics in three English health districts . Participants : 169 adults with type 1 diabetes and moderate or poor glycaemic control . Main outcome measures : Glycated haemoglobin ( HbA1c ) , severe hypoglycaemia , impact of diabetes on quality of life ( ADDQoL ) . Results : At 6 months , HbA1c was significantly better in immediate DAFNE patients ( mean 8.4 % ) than in delayed DAFNE patients ( 9.4 % ) ( t=6.1 , P<0.0001 ) . The impact of diabetes on dietary freedom was significantly improved in immediate DAFNE patients compared with delayed DAFNE patients ( t=−5.4 , P<0.0001 ) , as was the impact of diabetes on overall quality of life ( t=2.9 , P<0.01 ) . General wellbeing and treatment satisfaction were also significantly improved , but severe hypoglycaemia , weight , and lipids remained unchanged . Improvements in “ present quality of life ” did not reach significance at 6 months but were significant by 1 year . Conclusion : Skills training promoting dietary freedom improved quality of life and glycaemic control in people with type 1 diabetes without worsening severe hypoglycaemia or cardiovascular risk . This approach has the potential to enable more people to adopt intensive insulin treatment and is worthy of further investigation AIMS AND OBJECTIVES To examine the effect of a hospital-based clinic intervention on glycaemic control self-efficacy and glycaemic control behaviour of Chinese patients with type 2 diabetes mellitus ( DM ) . BACKGROUND Self-efficacy expectations are related to self-management of diabetes and , in conjunction with environmental support , are better predictors of behaviour than are knowledge and skills . Enhancing self-efficacy in patients with DM has been shown to have a positive effect on behavioural change and positively influence long-term glycaemic control . DESIGN A r and omised controlled trial study consisting of two-group pretest-post-test . METHODS One hundred and fifty-seven patients with type 2 DM were r and omly divided into two groups : ( 1 ) the experimental group ( 77 patients ) receiving one-month hospital-based clinic intervention and ( 2 ) the control group ( 80 patients ) receiving usual care . Data collection instruments used in this study were Diabetes Management Self-Efficacy Scale and Summary of Diabetes Self-Care Activities Measure . Outcomes were determined by changes in glycaemic control self-efficacy and glycaemic control behaviour of patients with type 2 DM . RESULTS The findings revealed that the experimental group showed statistically significant improvement in glycaemic control self-efficacy and glycaemic control behaviour immediately and four months after the intervention ( F = 26.888 , df = 1 , 155 , p < 0.05 and F = 18.619 , df = 1 , 155 , p < 0.05 , respectively ) . CONCLUSIONS One-month hospital-based clinic intervention could be useful in improving glycaemic control self-efficacy and glycaemic control behaviour . RELEVANCE TO CLINICAL PRACTICE Nurses can learn and use the sources of self-efficacy to enhance patients ' self-efficacy on their glycaemic control in clinical care . The health education is most important in nursing care and should be considered while organising the hospital-based clinic intervention Aims /hypothesisThe aim of this study was to assess the efficacy and safety of sitagliptin ( MK-0431 ) as monotherapy in patients with type 2 diabetes mellitus and inadequate glycaemic control ( HbA1c ≥7 % and ≤10 % ) on exercise and diet . Methods A total of 521 patients aged 27–76 years with a mean baseline HbA1c of 8.1 % were r and omised in a 1:2:2 ratio to treatment with placebo , sitagliptin 100 mg once daily , or sitagliptin  200 mg once daily , for 18 weeks . The efficacy analysis was based on an all- patients -treated population using an analysis of covariance , excluding data obtained after glycaemic rescue . Results After 18 weeks , HbA1c was significantly reduced with sitagliptin 100 mg and 200 mg compared with placebo ( placebo-subtracted HbA1c reduction : −0.60 % and −0.48 % , respectively ) . Sitagliptin also significantly decreased fasting plasma glucose relative to placebo . Patients with higher baseline HbA1c ( ≥9 % ) experienced greater placebo-subtracted HbA1c reductions with sitagliptin ( −1.20 % for 100 mg and −1.04 % for 200 mg ) than those with HbA1c < 8 % ( −0.44 % and −0.33 % , respectively ) or ≥8 % to 8.9 % ( −0.61 % and −0.39 % , respectively ) . Homeostasis model assessment beta cell function index and fasting proinsulin : insulin ratio , markers of insulin secretion and beta cell function , were significantly improved with sitagliptin . The incidence of hypoglycaemia and gastrointestinal adverse experiences was not significantly different between sitagliptin and placebo . Sitagliptin had a neutral effect on body weight . Conclusions /interpretationSitagliptin significantly improved glycaemic control and was well tolerated in patients with type 2 diabetes mellitus who had inadequate glycaemic control on exercise and diet The aim of the study was to examine the association of dietary carbohydrates and glycaemic load with the  risk of type 2 diabetes among an urban adult Asian Indian population . Adult subjects aged > 20 years ( n 1843 ) were r and omly selected from the Chennai Urban Rural Epidemiology Study , in Chennai city in southern India .  Dietary carbohydrates , glycaemic load and food groups were assessed using FFQ . Oral glucose tolerance tests were performed using 75 g glucose in all subjects . Diagnosis of diabetes  was based on WHO Consulting Group criteria . OR for newly detected diabetes were calculated for carbohydrates , glycaemic load and specific food groups comparing subjects in the highest with those in the lowest quartiles , after adjustment for potential confounders such as age , sex , BMI , family history of diabetes , physical activity , current smoking , alcohol consumption and relevant dietary factors . We identified 156 ( 8.5 % ) newly diagnosed cases of type 2 diabetes .  Refined grain intake  was positively associated with the risk of type 2 diabetes ( OR 5.31 ( 95 % CI 2.98 , 9.45 ) ; P < 0.001 ) . In the multivariate model , after adjustment for potential confounders , total carbohydrate ( OR 4.98 ( 95 % CI 2.69 , 9.19 ) , P < 0.001 ) , glycaemic load ( OR 4.25 ( 95 % CI 2.33 , 7.77 ) ; P < 0.001 ) and glycaemic index ( OR 2.51 ( 95 % CI 1.42 , 4.43 ) ; P = 0.006 ) were associated with type 2 diabetes . Dietary fibre intake was inversely associated with diabetes ( OR 0.31 ( 95 % CI 0.15 , 0.62 ) ; P < 0.001 ) . In urban south Indians , total dietary carbohydrate and glycaemic load are associated with increased , and dietary fibre with decreased , risk of type 2 diabetes Executive summary Background As a chronic condition , the prevalence of Type 2 diabetes is increasing worldwide and adherence to oral medications , an essential component of self‐management , has been shown to improve glycaemic control . However compliance with oral medication adherence remains poor . Educating people with Type 2 diabetes is an important strategy to enhance self‐management ability , including medication‐taking behaviour . Objectives The overall objective of the review was to determine the effectiveness of educational interventions to promote oral hypoglycaemic adherence in adults with Type 2 diabetes . Inclusion criteria Types of participants Studies involving adults over 18 years old with Type 2 diabetes , with or without co‐morbidities , currently taking oral hypoglycaemic medication without insulin treatment , and with aglycated haemoglobin ( HbA1c ) > 7.0 % prior to the intervention were considered . Aglycated haemoglobin ( HbA1c ) concentration of less than 7.0 % , is important in order to delay or prevent diabetes‐related complications . Participants could be from the primary , tertiary or acute care setting . Types of intervention The review focused on various forms of educational interventions delivered by healthcare professionals aim ed at improving participants ’ knowledge . Types of outcomes The review evaluated outcomes measuring oral hypoglycaemic adherence including HbA1c , fasting blood glucose levels and other relevant indicators . Types of studies Studies that were r and omized controlled trials ( RCTs ) or case‐control studies were considered . Search strategy A three‐stage search strategy was employed . Papers in English and between the years 1990‐2009 were search ed in the following data bases : CINAHL , Medline , Mosby 's Nursing Consult , PsycINFO , PubMed , ScienceDirect , Scopus , TRIP and Web of Science . Full text was retrieved when the titles and abstract s of studies fulfilled the inclusion criteria . Method ological quality Full papers were assessed for method ological quality independently by two review ers using critical appraisal checklists from the Joanna Briggs Institute ( JBI ) . A third review er was consulted whenever there were disagreements between the two review ers . Data collection / extraction Details of each study included in the review were extracted using st and ardized data extraction forms developed by JBI . Extraction was conducted independently by two review ers . Data synthesis Meta‐ analysis was not possible due to method ological and statistical heterogeneity of the included studies . Hence study findings are presented in narrative form . Results Seven studies included in the final review consisted of seven RCTs . Five studies concluded that the educational intervention was effective in promoting oral hypoglycaemic adherence compared to usual care . These included pharmacist‐led interventions , individual diabetes education provided by nurses and diabetes group education based on a self‐management approach . Similarities among these interventions were provision of information on oral hypoglycaemic medication and the need for regular education sessions . However , small sample s in some studies limited generalization of results . Conclusions Implication s for practice Increased knowledge of oral hypoglycaemic issues and reinforcement of the importance of medication adherence were useful in promoting adherence . Regular education sessions allow individuals to reinforce information and educators to identify barriers to medication adherence . Educational interventions focusing on self‐management strategies appear more likely to achieve positive outcomes . Implication s for research Further trials involving larger sample s and population s with poor glycaemic control are needed . The effects of educational interventions , influence of additional take‐home written material , the optimal interval length of follow‐up and duration of education sessions , and specific processes of individual or group education which have been identified as effective need further exploration BACKGROUND Development of this guideline was undertaken by the Exercise for People with Cancer Guideline Development Group , a group organized by Cancer Care Ontario 's Program in Evidence -Based Care ( pebc ) . The purpose of the guideline was to provide guidance for clinicians with respect to exercise for patients living with cancer , focusing on the benefits of specific types of exercise , recommendations about screening requirements for new referrals , and safety concerns . METHODS Consistent with the pebc 's st and ardized approach , a systematic search was conducted for existing guidelines , and systematic literature search es were performed in medline and embase for both systematic review s and primary literature . Content and methodology experts performed an internal review , which was followed by an external review by targeted experts and intended users . RESULTS The search identified three guidelines , eighteen systematic review s , and twenty-nine r and omized controlled trials with relevance to the topic . The present guideline provides recommendations for the duration , frequency , and intensity of exercise appropriate for people living with cancer . It also provides recommendations for pre-exercise assessment , safety concerns , and delivery models . CONCLUSIONS There is sufficient evidence to show that exercise provides benefits in quality of life and muscular and aerobic fitness for people with cancer both during and after treatment , and that it does not cause harm . The present guideline is intended to support the Canadian Society for Exercise Physiology 's Canadian physical activity guidelines . The recommendations are intended for clinicians and institutions treating cancer patients in Ontario , and for policymakers and program planners involved in the delivery of exercise programs for cancer patients Background and Objective Many patients with type 2 diabetes mellitus ( T2DM ) on insulin therapy  have inadequate glycaemic control . In such cases , Dutch guidelines recommend unlimited up-titration of insulin , yet in practice many patients never reach their glycaemic target . Clinical evidence shows that dapagliflozin — a highly selective sodium – glucose cotransporter 2 inhibitor — meets a need for these patients , i.e. by reducing glycated haemoglobin levels and bodyweight . We estimated the cost effectiveness and cost utility of adding dapagliflozin to insulin compared with not adding dapagliflozin in patients with T2DM who have inadequate glycaemic control while on insulin . Methods The cost effectiveness of dapagliflozin was estimated using the Cardiff Diabetes Model , using direct comparative efficacy data from a r and omized placebo-controlled trial ( Clinical Trials.gov identifier NCT00673231 ) . In this trial , up-titration of insulin was allowed in case of severe glycaemic imbalance . Risk factor progression and the occurrence of future vascular events were estimated using the United Kingdom Prospect i ve Diabetes Study 68 risk equations . Costs and utilities were derived from the literature . The analysis was conducted from the societal perspective , simulating the remaining lifetime of the patients . Results The overall incidence of macro- and microvascular complications was lower , and life expectancy was greater ( 19.43 versus 19.35 life-years [ LYs ] ) in patients receiving dapagliflozin than in those not receiving dapagliflozin . Patients in the dapagliflozin arm obtained an incremental benefit of 0.42 quality -adjusted life-years ( QALYs ) . The lifetime incremental cost per patient in the dapagliflozin arm was € 2,293 , result ing in an incremental cost-effectiveness ratio of € 27,779 per LY gained and an incremental cost – utility ratio of € 5,502 per QALY gained . Sensitivity and scenario analyses showed that the results were insensitive to variations in modelling assumptions and input variables . Conclusion Dapagliflozin in combination with insulin was estimated to be a cost-effective treatment option for patients with T2DM whose insulin treatment regimen does not provide adequate glycaemic control in a Dutch healthcare setting Background : Type 2 diabetes mellitus ( T2DM ) is becoming a leading problem worldwide . Emerging reports reveal alarming evidence of increasing prevalence of T2DM that has reached p and emic levels . Despite the significant incidence , there are limited reliable data re sources and comprehensive systematic review and meta- analysis on the effects of yoga on people who are a prediabetic or high risk for developing T2DM . Objective : The objective of this protocol is to conduct a full-scale systematic review and meta-analyses on the effects of yoga on people who are prediabetes or high risk of developing T2DM . Methods : The articles enrolled in the study will be retrieved from the online data bases between 2002 and the date the search es are executed . The search es will be repeated just before the final analyses and further relevant studies for inclusion . We will conduct a bibliographic search in data bases : Medline / PubMed , Scopus , Cochrane Library , EBSCO , and IndMED using keywords including prediabetes state , high risk for diabetes , metabolic syndrome , and yoga . A defined search strategy will be implemented along with selection criteria to obtain full-text articles of relevant studies . This study protocol was prepared according to the Preferred Reporting Items for Systematic Review s and Meta- Analysis for Protocol s 2015 guidelines . There will be no language restrictions . Ethics and dissemination : The proposed study will be based on published studies and publicly available anonymized data without directly involving human participants and therefore requires neither formal human ethical review nor approval by a human research ethics committee . We published an outline of the protocol in the International Prospect i ve Register of Systematic Review s ( PROSPERO ) in 2018 . We plan to disseminate the findings of this systematic review and meta- analysis through publication in a peer- review ed journal and presentation at relevant conference proceedings . In addition , we believe the results of the systematic review will have implication s for policy and practice . We will prepare policymaker summary using a vali date d format , disseminate through social media and email discussion groups . Review registration number : PROSPERO registration number CRD Aims To evaluate the efficacy and safety of two dosage strengths of a single‐tablet metformin – glibenclamide ( glyburide ) combination , compared with the respective monotherapies , in patients with Type 2 diabetes mellitus ( DM ) inadequately controlled by metformin monotherapy Introduction The prevalence of gestational diabetes mellitus ( GDM ) is rising in the UK . Good glycaemic control improves maternal and neonatal outcomes . Frequent clinical review of patients with GDM by healthcare professionals is required owing to the rapidly changing physiology of pregnancy and its unpredictable course . Novel technologies that allow home blood glucose ( BG ) monitoring with results transmitted in real time to a healthcare professional have the potential to deliver good- quality healthcare to women more conveniently and at a lower cost to the patient and the healthcare provider compared to the conventional face-to-face or telephone-based consultation . We have developed an integrated GDm-health management system and aim to test the impact of using this system on maternal glycaemic control , costs , patient satisfaction and maternal and neonatal outcomes compared to st and ard clinic care in a single large publicly funded ( National Health Service ( NHS ) ) maternity unit . Methods and analysis Women with confirmed gestational diabetes in a current pregnancy are individually r and omised to either the GDm-health system and half the normal clinic visits or normal clinic care . Primary outcome is mean BG in each group from recruitment to delivery calculated , with adjustments made for number of BG measurements , proportion of prepr and ial and postpr and ial readings and length of time in study , and compared between the groups . The secondary objective will be to compare the two groups for compliance to the allocated BG monitoring regime , maternal and neonatal outcomes , glycaemic control using glycated haemoglobin ( HbA1c ) and other BG metrics , and patient attitudes to care assessed using a question naire and re source use . Ethics and dissemination Thresholds for treatment , dietary advice and clinical management are the same in both groups . The results of the study will be published in a peer- review ed journal and disseminated electronically and in print . Trial registration number NCT01916694 ; Pre- results Introduction Type 2 diabetes ( T2D ) is a major health concern among population s of South Asian ethnicity . Although dietary and physical activity interventions may reduce the risk of T2D , the effectiveness has been moderate among South Asians . This might ( in part ) be because this subgroup follows strategies that were originally developed for interventions among other population s. Therefore , this review aims to assess the evidence for the current dietary and physical activity strategies recommended in T2D prevention intervention studies and guidelines for South Asians . Methods and analysis Included will be all studies and guidelines on dietary and /or physical activity strategies to prevent T2D in adult South Asians . Two review ers will search online data bases from their start until the present date for published and unpublished experimental/quasiexperimental studies , with at least an abstract in English . References of identified articles and key review s will be screened for additional studies . Guidelines will be identified by search es in online data bases and websites of public organisations . Finally , expert consultations will be held to supplement any missing information . Trial quality will be assessed with the Quality Assessment Tool for Quantitative Studies Data , and guidelines with the Appraisal of Guidelines for Research & Evaluation II . Data on the strategies recommended , targeting and evidence on effectiveness will be extracted by two review ers and presented in tabular and narrative forms . Recommendations will be compared with the National Institute for Health and Care Excellence guidelines [ PH35 ] . Overall findings on  dietary and physical activity recommendations , as well as findings for specific subgroups ( eg , by sex ) , will be discussed . Ethics and dissemination Ethics assessment is not required . Start date : 1 January 2016 , finishing and reporting date 31 July 2016 . Results will be published in a peer- review ed scientific journal , the project report of EuroDHYAN ( www.eurodhyan.eu ) and in a PhD dissertation . Trial registration number The protocol is registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) registration number CRD42015027067
According to the network meta- analysis the Mediterranean diet is the most effective and efficacious dietary approach to improve glycaemic control in type 2 diabetes patients
The aim of the present study is to assess the comparative efficacy of different dietary approaches on glycaemic control in patients with type 2 diabetes mellitus using a systematic review of the literature .