Prevalence of hypertension among type 2 diabetes mellitus patients in Ethiopia: a systematic review and meta-analysis

Association between medication adherence and cardiovascular outcomes in patients with both diabetes and hypertension in primary care settings in Canada: A retrospective cohort study

OBJECTIVES

The impact of concurrent adherence to antihypertensives, antidiabetics, and statins on cardiovascular disease (CVD) outcomes and intermediate clinical outcomes in people with hypertension and diabetes remains unclear. This study aimed to evaluate the association between medication adherence and CVD outcomes in such patients.

METHODS

This retrospective cohort study analyzed the electronic medical records of 36,211 adults aged 18 or older diagnosed with hypertension and diabetes between January 2008 and June 2016 in Canada. Patients were prescribed antihypertensives, antidiabetics, and statins, with a minimum 1-year follow-up post-diagnosis. Medication adherence was determined by the proportion of days covered (PDC). For monotherapy, a PDC≥80% and <80% was reflected high and low adherence respectively. In multiple medication scenarios, adherence was considered high when each medication was at PDC≥80%; low when any medication fell below 80%. The primary outcome encompassed cardiac events, including coronary heart disease, stroke, and heart failure. Intermediate clinical outcomes included changes in diastolic blood pressure (DBP), Systolic Blood Pressure (SBP), glycated hemoglobin (HbA1c), low-density lipoprotein cholesterol (LDL-C), and total cholesterol (TC). Cox regression models assessed the association between medication adherence and CVD morbidity, all-cause mortality, and intermediate clinical outcomes.

RESULTS

High adherence to antidiabetic and statin monotherapy was associated with a lower all-cause mortality risk (aHR=0.67, P=0.001; aHR=0.68, P<0.001, respectively). For patients simultaneously prescribed three medications, higher adherence was linked to significant reductions in DBP (6 months: coefficient -0.52, P=0.01; 12 months: coefficient -0.44, P=0.02; 18 months: coefficient -0.55, P=0.004) and LDL-C (6 months: coefficient -0.04, P=0.02; 12 months: coefficient -0.05, P=0.01; 18 months: coefficient -0.04, P=0.02).

CONCLUSIONS

High adherence to antidiabetic and statin monotherapy correlated with lower all-cause mortality risk and improved intermediate clinical outcomes. However, simultaneous adherence to three medications did not significantly affect CVD outcomes, but influenced intermediate outcomes. Therefore, improving adherence to antihypertensives, antidiabetics, and statins among patients with hypertension and diabetes is important in primary care settings.

Hypertension and associated factors among patients with diabetes mellitus attending a follow-up clinic in central Ethiopia

Hypertension and diabetes mellitus are highly prevalent chronic diseases worldwide, and their coexistence presents a growing public health challenge, particularly in low-resource settings like Ethiopia. Thus, this study aimed to assess hypertension and its associated factors in patients with diabetes mellitus attending a follow-up clinic in central Ethiopia. A health facility-based cross-sectional study was conducted. Study participants were selected using a systematic random sampling method. Data were collected through a structured, interviewer-administered questionnaire and patient record reviews. A binary logistic regression model was employed to examine the association between hypertension and the explanatory variables. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated to estimate the strength of associations, and statistical significance was determined at a p-value of < 0.05. A total of 379 patients with diabetes mellitus participated in the study. The prevalence of hypertension was 34.6% (95% CI: 29.8-39.4). Being aged 41-60 years (AOR = 2.26, 95% CI: 1.23-4.15), having type 2 diabetes (AOR = 3.83, 95% CI: 1.07-13.65), the presence of comorbidities (AOR = 2.72, 95% CI: 1.59-4.67), and poor medication adherence (AOR = 2.06, 95% CI: 1.12-3.77) were statistically significant factors associated with hypertension among diabetes mellitus patients. More than one-third of patients with diabetes mellitus had hypertension. Older age, type 2 diabetes, the presence of comorbidities, and poor medication adherence were factors associated with hypertension. Regular blood pressure checks, especially for older patients, managing comorbidities, and improving medication adherence through education and simpler regimens are recommended.

Comparison of efficacy and safety of dual orexin receptor antagonists lemborexant and daridorexant for the treatment of insomnia: a systematic review and meta-analysis

OBJECTIVE

To systematically evaluate the clinical efficacy of lemborexant (LEM) and daridorexant (DAR) for the treatment of insomnia, including the difference in efficacy and safety.

METHODS

In this systematic review and meta-analysis, we searched the randomized controlled trials (RCTs) comparing the efficacy and safety of LEM and DAR in patients with insomnia in five databases from database inception to Mar 16, 2024. We evaluate the quality of studies. Besides, we perform the meta-analysis and detect publication bias.

RESULTS

A total of 8 RCTs with 5077 patients were included in this study, including 2239 in the LEM treatment group, 1397 in the DAR treatment group, and 1441 in the placebo (PBO) control group. Both LEM and DAR significantly improved sleep outcomes compared to placebo. LEM was more effective in reducing the time of wake after sleep onset (WASO) (MD, -45.15; 95% CI: -51.75 to -38.56; P < 0.001) and improving subjective sleep onset latency (sSOL) (MD, -25.01; 95% CI: -28.58 to -21.44; P < 0.001) than DAR (WASO: MD: -12.6; 95% CI: -18.71 to -6.5; P < 0.001; sSOL: MD, -2.33; 95% CI: -7.1 to 2.45; P = 0.24). In terms of dosing, DAR at 50 mg demonstrated superior efficacy compared to the 5 mg, 10 mg, and 25 mg doses, indicating a dose-dependent effect. The efficacy of LEM was consistent across the 5 mg and 10 mg doses. Safety profiles revealed that DAR (RR, 1.16; 95% CI: 1.03 to 1.29; P = 0.01) treatment was associated with higher rates of treatment-emergent adverse events (TEAEs) compared to placebo, particularly at the 25 mg dose (RR, 1.15; 95% CI: 1.02 to 1.31; P = 0.03), while LEM (RR, 1.21; 95% CI: 0.98 to 1.50; P = 0.08) showed no significant difference in TEAEs rates compared to placebo. However, LEM (RR, 5.62; 95% CI: 2.92 to 10.83; P < 0.001) was associated with a higher risk of somnolence compared to DAR (RR, 1.55; 95% CI: 0.86 to 2.81; P = 0.15). The overall quality of the included studies was moderate to high based on the risk of bias assessment.

CONCLUSION

Both LEM and DAR are effective and generally safe options for the treatment of insomnia, with LEM showing greater efficacy in improving WASO and sSOL. The choice between LEM and DAR should consider individual patient needs, including the risk of daytime drowsiness and other adverse events. Further direct comparative trials are needed to confirm these findings and inform clinical decision-making.

Epidemiology of hypertension among patients with type 2 diabetes in the Democratic Republic of Congo

BACKGROUND

 Hypertension is a common comorbidity among patients with type 2 diabetes (T2D) and is associated with poorer treatment outcomes.

AIM

 To describe the epidemiology of hypertension among patients with T2D in Kinshasa, Democratic Republic of the Congo.

SETTING

 A multisite study among 20 randomly selected health facilities in Kinshasa.

METHODS

 This was an analytical cross-sectional study among 620 participants with T2D. The overall prevalence of hypertension and uncontrolled hypertension was determined. Multivariable mixed effects logistic regression determined factors associated with hypertension and hypertension control among participants with T2D.

RESULTS

 One-third (34.7%) of study participants were classified as having hypertension. The factors associated with hypertension were unemployment (adjusted odds ratio [aOR] = 1.93, 95% confidence interval [CI]: 1.18-3.17), overweight (aOR = 2.71; 95% CI: 1.78-4.13), diabetes duration ≥ 5 years (aOR = 1.84, 95% CI: 1.24-2.73), protestant religion (aOR = 0.48, 95% CI: 0.29-0.82) and severe diabetes distress (aOR = 0.47; 95% CI: 0.28-0.79). The prevalence of uncontrolled hypertension among participants with diabetes-hypertension comorbidity was 50.2%. Being overweight was associated with uncontrolled hypertension (aOR = 2.02; 95% CI: 1.08-3.79).

CONCLUSION

 Hypertension was common among patients with T2D in Kinshasa, Democratic Republic of Congo (DRC), and in most patients it was uncontrolled. There is a need to strengthen the hypertension prevention and control strategies among patients with T2D, including lifestyle modifications to maintain optimal body weight.Contribution: This study provides insight into the diabetes-hypertension comorbidity in an African urban setting.

SGLT2 Inhibitors: The First Endothelial-Protector for Diabetic Nephropathy

Sodium-glucose co-transporter type 2 inhibitors (SGLT2i) have emerged as a class of agents relevant for managing diabetic nephropathy and cardiopathy. In a previous report, we noticed that these drugs share, with other drugs with "nephroprotective" effects, the ability to reduce the glomerular filtration rate (GFR), thus suggesting the kidney hemodynamic effect as a proxy for optimal drug dosage. We also noticed that all known nephroprotective drugs exert cardioprotective functions, suggesting the possibility of activities not mediated by the kidney. Finally, we observe that nephroprotective drugs can be grouped according to their effects on hemoglobin levels, thus suggesting their mechanism of action. While the primary mechanism of SGLT2i involves glycosuria and natriuria, growing evidence suggests broader therapeutic effects beyond hemodynamic modulation. Specifically, the evidence that SGLT2 can be expressed in several atypical regions under pathological conditions, supports the possibility that its inhibition has several extratubular effects. Evidence supports the hypothesis that SGLT2i influence mitochondrial function in various cell types affected by diabetes, particularly in the context of diabetic nephropathy. Notably, in SGLT2i-treated patients, the extent of albumin-creatinine ratio (ACR) reduction post-treatment may be correlated with mitochondrial staining intensity in glomerular endothelial cells. This implies that the anti-proteinuric effects of SGLT2i could involve direct actions on glomerular endothelial cell. Our investigation into the role of SGLT2 inhibitors (SGLT2i) in endothelial function suggests that the aberrant expression of SGLT2 in endothelial cells in T2DM would lead to intracellular accumulation of glucose; therefore, SGLT2i are the first type of endothelial protective drugs available today, with potential implications for ageing-related kidney disease. The review reveals two major novel findings: SGLT2 inhibitors are the first known class of endothelial-protective drugs, due to their ability to prevent glucose accumulation in endothelial cells where SGLT2 is aberrantly expressed in Type 2 Diabetes. Additionally, the research demonstrates that SGLT2 inhibitors share a GFR-reducing effect with other nephroprotective drugs, suggesting both a mechanism for optimal drug dosing and potential broader applications in ageing-related kidney disease through their effects on mitochondrial function and glomerular endothelial cells.

Carob leaves: Phytochemistry, antioxidant properties, vasorelaxant effect and mechanism of action

ETHNOPHARMACOLOGICAL RELEVANCE

Ceratonia siliqua L., is a species of significant nutritional and industrial interest with extensive traditional uses. This fabaceae is renowned for its medicinal properties, including the treatment of high blood pressure. Due to its chemical composition, carob exhibits several valuable therapeutic functions such as antioxidant, antidiarrheal, antidiabetic, and antibacterial actions.

AIM OF THE REVIEW

This study investigates the chemical composition of Ceratonia siliqua L. leaves aqueous extract (CsAE) and explores the vasorelaxant effect and its underlying mechanisms. Acute toxicity and antioxidant activity of CsAE were also examined.

METHODS

The phytochemical profile was elucidated using TLC and UHPLC-MS. The vasorelaxant effect and mechanisms were studied on thoracic aortic rings from normotensive rats, using various antagonists. Acute toxicity was assessed by orally administering the extract to mice. Antioxidant activity was evaluated using β-carotene bleaching and DPPH.

RESULTS

TLC analysis of CsAE reveals flavonoids and hydrolysable tannins. Gallic acid, myricitrin, quercitrin as well as galloylglucopyranoside derivatives were identified by UHPLC-MS. CsAE relaxed phenylephrine-precontracted aorta in a concentration-dependent manner. This response was reduced when the aorta was denuded or pretreated with L-NAME, hydroxocobalamin, ODQ, 4-AP, TEA, calmidazolium chloride, and thapsigargin. CsAE showed significant antioxidant activity with no observed toxicity in the experimental animals.

CONCLUSION

CsAE has a significant vasodilatory effect, mediated through the CaM/eNOS/sGC pathway, activation of Kca and Kv, and intracellular calcium mobilization into SERCA. It also exhibits strong antioxidant activity, with no observed toxicity in the experimental animals. These findings represent the first evidence of the vasorelaxant effect of Ceratonia siliqua L. leaves from Eastern Morocco.

The effect of an educational program on the knowledge and practices of diabetic patients regarding sharps waste disposal at home

The disposal of sharp waste generated at home by diabetic patients poses a major public health problem. This study evaluated an educational program designed to improve patients' knowledge and practices around sharps disposal. A non-equivalent quasi-experimental study was performed at a main diabetic center in Egypt on 100 participants divided into intervention and non-intervention groups. The effect of the interventional program was tested by the evaluation of the improvement in participants' knowledge and practice after two and four months of the program. Initially, there were no differences in knowledge or practice scores between the groups. After the implementation of the program, there was a noticeable difference in subjects' knowledge levels and scores between the two groups, with the intervention group significantly outperforming the non-intervention group (p < 0.001). There was a significant improvement in overall practice scores in the intervention group across post-intervention visits, and they registered a score of 14/16, which matches a good practice level, while in the non-intervention group, the score remained unchanged at 4.4/16, which corresponds to a poor practice level (p < 0.001). These findings suggest that educational programs can effectively increase diabetic patients' knowledge and improve their sharps waste disposal practices.Clinical trial registration number: PACTR202310841894237. Date: 05 October 2023, "retrospectively registered".

Prevalence of cognitive impairment and its associated factors in type 2 diabetes mellitus patients with hypertension in Hunan, China: a cross-sectional study

Background

Individuals with both type 2 diabetes mellitus (T2DM) and hypertension have an increased risk of cognitive impairment (CI) compared to those with either T2DM or hypertension. Therefore, this study aims to identify the prevalence of CI and its associated factors in T2DM patients with hypertension in Hunan, China.

Methods

This cross-sectional study included T2DM patients with hypertension admitted to the Department of Endocrinology of Yuanjiang People's Hospital in Hunan Province from July 2022 to February 2023. Data on sociodemographic, lifestyle, disease-related characteristics, and cognitive function were collected through face-to-face interviews. Cognitive function was assessed using the Mini-Mental State Examination. Backward stepwise multivariable logistic regression analysis was used to identify factors associated with CI. The predictive power was examined using the receiver operating characteristic (ROC) curve.

Results

A total of 475 participants were included. The prevalence of CI was 38.9% (95% confidence interval [95% CI]: 34.5%-43.3%). Multivariable logistic regression analysis showed that advanced age (odds ratio [OR]=3.21, 95% CI: 1.74-5.93), elementary school or below (OR=3.51, 95% CI: 1.19-10.31), per capita monthly household income ≤2000 RMB (OR=5.29, 95% CI: 2.66-10.51), not current reading books or newspapers (OR=4.48, 95% CI: 1.26-15.99), not current playing cards or mahjong (OR=3.52, 95% CI: 1.91-6.47), current average time of physical activity ≤30 minutes per day (OR=8.66, 95% CI: 4.65-16.12), diabetic nephropathy (OR=1.95, 95% CI: 1.05-3.61) and stroke (OR=7.41, 95% CI: 3.41-16.11) were associated with a higher risk of CI in T2DM patients with hypertension. The area under the ROC curve of this model was 0.925 (95% CI: 0.902-0.949).

Conclusions

The prevalence of CI was high in T2DM patients with hypertension in Hunan, China. Age, educational level, household income, current reading books or newspapers status, current playing cards or mahjong status, current average time of physical activity per day, diabetic nephropathy, and stroke were associated with CI in T2DM patients with hypertension.

Prevalence of Hypertension and Its Clinical and Psychological Factors in Type 2 Diabetes Patients in Ghana: A Secondary Analysis of a Cross-Sectional Study

Background: Hypertension (HTN) is common in patients with type 2 diabetes mellitus (T2DM). Patients with both T2DM and HTN have a higher risk of heart disease, kidney disorders, and mortality than those with either HTN or T2DM alone. Patients' psychological well-being plays a significant role in the optimum management of these chronic conditions. This study is aimed at determining the current prevalence of HTN and its related clinical and psychological factors in patients with T2DM. Methods: This cross-sectional study was conducted at the Korle-Bu Teaching Hospital with 156 patients diagnosed with T2DM. A structured questionnaire was used to obtain information on sociodemographic and clinical characteristics. In addition, the following information was obtained from the patients' clinical files: blood pressure, height, weight, waist circumference, serum creatinine, and urine protein. Depression, resilience, and coping skills of the participants were measured using the Brief Symptom Inventory-18, Resilience Scale for Adults, and Brief COPE Inventory, respectively. Data were analyzed using STATA version 18, with a significance level of p < 0.05. Results: The median age of respondents was 62.0 (IQR: 51.50, 67.00) years. The majority was female (76.3%). The prevalence of HTN among the patients with T2DM was 79.9% (95% CI: 72.7-85.9). The average body mass index (BMI) of the patients was 28871kg/m2 with 34.8% and 36.2% being overweight and obese, respectively. The average HBA1C level was 8.6 ± 2.1 with 71.8% of the patients having poor glycemic control. Increasing age, caregiver, and personal resilience were factors significantly associated with HTN (p value of <0.05) among patients with T2DM. Conclusion: The prevalence of HTN among T2DM patients was high; age, caregiver, and personal resilience significantly predicted HTN among T2DM patients. These findings have implications for healthcare providers in implementing strategies to reduce central obesity and incorporating resilience as an important factor in improving treatment outcomes in patients with T2DM.

Prevalence of metabolic syndrome and its components according to altitude levels: a systematic review and meta-analysis

Metabolic syndrome has a multifactorial origin; however, epidemiological data correspond to populations located at sea level. It has been reported that the altitude can affected the prevalence due to physiological changes. The aim of this study is to show the global prevalence of metabolic syndrome at altitude and its components. We use four databases, all studies published up to November 2023. The prevalences from studies were meta-analyzed using a random-effects model. To assess sources of heterogeneity, subgroup analyses were performed. We included 28 studies. The number of participants was 29 195. The prevalence of metabolic syndrome was 30.3% (95% CI 22.8-38.4%). According to the altitude level, at 1500-2500 was 36.5%, 2500-3500 (21.8%), and > 3500 (30.9%), also it was higher in women (35.5%) that men (26.8%). It was observed that there is an inverse relationship between higher altitude and the prevalence of metabolic syndrome. Among its components, abdominal obesity and low HDL were present in more than 40.0%, while high blood pressure, high triglycerides and impaired glucose were present in less than 30.0%. We recommend that our results be considered for future research in populations living at altitude since they have different characteristics from populations at sea level.

Clinical Profile and Risk Factors for Complication of Type 2 Diabetes Mellitus at the National Referral Hospital, Bhutan: A Descriptive Cross-Sectional Study

Background and Aim

Globally, diabetes mellitus is a major public health concern affecting 10.5% of the population. Nearly 90% of these people have Type 2 diabetes mellitus (T2DM). In Bhutan, T2DM is prevalent in 5.6% of the population, and around 60% are unaware of their diagnosis of diabetes. There is no baseline information on the rate and the risk factors for complications of diabetes in Bhutan. The study assessed the clinical profile and the risk factors for complications of T2DM at the Jigme Dorji Wangchuk (JDW) National Referral Hospital, Bhutan.

Methods

A descriptive cross-sectional study was conducted at the JDW National Referral Hospital, Bhutan, from January to December 2019. Patients with T2DM attending diabetic clinics were included in the study. Demographic variables and metabolic profiles were recorded using a standard pro forma. Descriptive statistics were used to express the results. The association of clinical profiles with the microvascular complication was assessed using multivariate logistic analysis with statistical significance at p < 0.05.

Results

There were 292 patients with T2DM during the study period. The rate of microvascular complication is around 25% in T2DM. Among the complications, diabetic retinopathy occurred in over 51%, followed by neuropathy (29.7%) and nephropathy (18.9%). Over 1/3rd of patients had a duration of diabetes over 10 years with a mean duration of 6.3 (5.4) years, and around 44% (127/292) of them had poor glycemic control (HbA1C ≥ 7%). The age ≥ 60 years and the duration of diabetes ≥ 10 years were independent risk factors for microvascular complications in T2DM patients. Regular exercise prevents retinopathy (OR 0.4, 95%CI 0.2-0.9, p = 0.026).

Conclusion

There is a microvascular complication in 1 in 4 of type 2 diabetic patients. Age over 60 years and a duration of diabetes of more than 10 years are independent risk factors for microvascular complications, and regular exercise is preventive for microvascular complications.

Efficacy and safety of semaglutide: real-world tertiary care experience from Saudi Arabia

BACKGROUND

Semaglutide, a glucagon-like peptide-1, is an effective antidiabetic drug promoting weight loss and providing cardiovascular protection. The original trials did not include participants from Saudi Arabia; hence, the study's findings are expected to be useful.

OBJECTIVES

Explore the efficacy, safety, and favorable effects of once-weekly subcutaneous semaglutide (1 mg) in patients with type 2 diabetes and those who received it as an off-license prescription without having diabetes.

DESIGN

Retrospective review of medical records.

SETTING

Department of medicine at our institution.

PATIENTS AND METHODS

This retrospective observational study evaluated patients receiving the glucagon-like peptide-1 analog semaglutide, with the trade name Ozempic. The weight, height, body mass index, blood pressure, and laboratory data, including serum creatinine and hemoglobin A1c (HbA1c) levels and urine albumin/creatinine ratio, were recorded. Moreover, any history of medical comorbidities, such as cardiovascular diseases, cerebrovascular diseases, and heart failure, was documented before and after drug administration.

MAIN OUTCOME MEASURES

Glycemic and weight loss efficacy.

SAMPLE SIZE

1007 patients.

RESULTS

The median age of the patients was 57.0 years, comprising 60.28% females. Among them, 955 and 442 patients received the medication for at least 3 and 6 months, respectively. Our results show a 4.4% weight loss and 0.4% improvement in HBA1c in patients with diabetes. Similar results were observed in the patients without diabetes in terms of weight along with a significant decrease in diastolic blood pressure. Our results also show stability in the serum creatinine and urine albumin creatinine ratio. The drug was equally effective in males and females.

CONCLUSION

Treatment with once-weekly subcutaneous semaglutide (1 mg) led to clinically significant weight loss and improved HbA1c level and cardiometabolic risk factors such as blood pressure.

LIMITATIONS

Retrospective design.

Antidiabetic Advancements In Silico: Pioneering Novel Heterocyclic Derivatives through Computational Design

Background::

Deficiency of insulin signaling in type 2 diabetes results from insulin resistance or defective insulin secretion and induced hyperglycemia. By reducing glycated hemoglobin, SGLT2 inhibitors improve hyperuricemia, blood lipids, and weight loss without increasing the risk of hypoglycemia. By targeting this pathway, SGLT2 inhibitors can become a prominent target in the management of type 2 diabetes.

Objective::

This study aimed to carry out the molecular docking and ADMET prediction of novel imidazo(2,1-b)-1,3,4 thiadiazole derivatives as SGLT2 inhibitors.

Methods::

The chemical structures of 108 molecules were drawn by using ChemDraw Professional 15.0. Further, their energy minimization was also carried out by using Chem Bio Draw three-dimensional (3D) Ultra 12.0. Molecular docking was also carried out using a Molegro Virtual Docker to identify the best-fitting molecules and to identify the potential leads on the basis of dock score. The predicted parameters of drug-likeness according to Lipinski’s rule of five, such as molecular weight, log P, hydrogen bond acceptor, hydrogen bond donors, and number of rotatable bonds of the selected compounds, were predicted using pKCSM software.

Results::

About 108 molecules were designed by employing different substitutions on imidazothiadiazole nucleus as SGLT2 inhibitors. Out of these, 10 compounds were found to have better interactions with the active site of SGLT2 protein and the highest dock scores compared to canagliflozin. Compounds 39a and 39b demonstrated good interactions and the highest docking scores of -155.428 and -142.786, respectively. The in silico physicochemical properties of the best compounds were also determined. Additionally, these compounds suggested a good pharmacokinetic profile as per Lipinski's rule of five (orally active drugs).

Conclusion::

Novel imidazo (2,1-b)-1,3,4 thiadiazole derivatives were strategically designed, and their binding affinity was meticulously evaluated against the SGLT2 protein. This endeavor yielded pioneering lead compounds characterized by ultimate binding affinity, coupled with optimal ADMET properties in adherence to Lipinski's rule of five and favourable noncarcinogenic profile.

Melatonin as an add-on treatment for epilepsy: A systematic review and meta-analysis

PURPOSE

Epilepsy, one severe prevalent brain disorder, primarily relies on drug treatment. However, approximately one-third of patients with epilepsy do not achieve effective control with current medications, underscoring the need for more innovative treatment approaches. Notably, melatonin has gained attention for its anti-seizure properties and favourable safety profile. This systematic review aimed to evaluate the efficacy and safety of melatonin as an add-on treatment for epilepsy.

METHODS

We searched for articles published before June 2023 in Web of Science, Cochrane Library, and PubMed. We used RevMan 5.4 software to compute relative risks (RRs) and 95 % confidence intervals (CIs). Key outcomes included total sleep time, wakefulness after sleep onset, sleep latency, seizure frequency, seizure severity, and safety. The quality of randomised controlled studies (RCTs) was assessed using the Cochrane Risk of Bias tool.

RESULTS

Of the 264 publications retrieved, 10 RCTs were included in the meta-analysis. Add-on melatonin treatment improved sleep latency (RR: 0.56; 95 %CI: 0.10-1.02; P = 0.02) and seizure severity (RR: 0.33; 95 %CI: 0.04-0.62; P = 0.03) compared with placebo treatment. Adverse events (increased headache severity in children with a history of migraines, bronchitis, ear infections, agitation, and urinary frequency) were reported in only one trial.

CONCLUSION

This systematic review found that add-on melatonin therapy improved sleep latency and seizure severity in patients with epilepsy. However, several of the included studies did not systematically assess sleep quality, seizures, and safety and lacked long-term follow-up data. Further RCTs with extended follow-up periods are required to definitively determine the efficacy and safety of melatonin.

Factors influencing medication adherence in co-morbid hypertension and diabetes patients: A scoping review

Introduction

Interest in medication adherence has expanded significantly, especially in relation to the management of hypertension or diabetes in recent years. A scoping review that focuses on medication adherence in the co-morbidity of hypertension and diabetes provides crucial guidance for effective management of these interrelated diseases.

Aim

To conduct a scoping review of factors associated with medication adherence among individuals with co-morbid hypertension and diabetes.

Methods

The evaluation was conducted in accordance with the PRISMA-ScR guidelines to ensure the quality of the study. We searched three databases (Scopus, CINAHL, Medline) and one search engine (Google Scholar) from April 2023 to July 2023 on studies related to medication adherence in co-morbid hypertension and diabetes. Except for reviews there were no restrictions on design, location, and time of study.

Results

In total, 972 studies that were not duplicated were obtained. After eligibility and screening procedures were completed, 31 articles were ultimately included in the scoping review. Medication adherence was significantly affected by patient, condition, therapy, socio-economic and health related factors. Intervention trials revealed that education and counselling by pharmacists, nurses, physicians, diabetes educators, community health workers and the use of telephone to motivate patients significantly improved medication adherence.

Conclusion

This review shows the intricate factors influencing medication adherence in patients with co-morbid hypertension and diabetes, emphasizing the need for tailored interventions involving healthcare professionals, policymakers, and researchers.

Can pharmaceutical care decrease the oxidative stress in type 2 diabetes mellitus?

Type 2 diabetes mellitus (T2D) is a chronic metabolic disorder characterized by an increase in oxidative stress, which is itself related to development of T2D's main chronic complications. Oxidative stress caused by elevated production of reactive species of oxygen and decrease of antioxidant defense system level, leads to activation of lipid peroxidation (LPO) and oxidative lipoprotein modification with increasing atherogenicity. Therefore, the aim of this study was to evaluate whether pharmacotherapeutic follow-up in patients with T2D, users and non-users of insulin, interferes with the levels of oxidative stress, measuring lipid peroxidation and protein oxidation, nitric oxide and superoxide dismutase levels. After the follow-up, there was a decrease in nitric oxide levels and an increase in superoxide dismutase concentration for the group with insulin therapy. Accordingly, these results show that the proposed pharmaceutical care program reduced the oxidative stress levels, mainly in patients in insulin therapy, as a consequence, can impact in the surging of the main chronic complications in T2D.

Regional prevalence of hypertension among people diagnosed with diabetes in Africa, a systematic review and meta-analysis

Hypertension and diabetes comorbidity can increase healthcare expenditure and the risk of coronary heart disease. We conducted a systematic review and meta-analysis to estimate the prevalence of hypertension among people with diabetes in African countries. We searched EMBASE, PubMed and HINARI databases from inception to March 2023. Cross-sectional studies reporting the prevalence of hypertension among people with diabetes and published in English in Africa were eligible for inclusion. The cross-sectional study design component of the mixed method appraisal tool was used to assess the quality of the included studies. We quantified the overall and regional prevalence of hypertension among people with diabetes using random-effects meta-analysis. We assessed heterogeneity and publication bias using I2 statistics and funnel plots. Out of 3815 articles retrieved from the various databases, 41 met the inclusion criteria with sample sizes ranging from 80 to 116726. The mean age was 58 years (± 11) and 56% were women. The pooled prevalence of hypertension in people diagnosed with diabetes was 58.1% [95% CI: 52.0% - 63.2%]. By region, Central Africa had the highest hypertension prevalence; 77.6% [95% CI: 53.0% - 91.4%], Southern Africa 69.1% [95% CI: 59.8% - 77.1%;], North Africa 63.4% [95% CI: 37.1% - 69.1%;], West Africa 51.5% [95% CI: 41.8% - 61.1%] and East Africa 53.0% [95% CI: 45.8% - 59.1%]. Increasing age, being overweight/obese, being employed, longer duration of diabetes, urban residence, and male sex were reported to be associated with a higher likelihood of developing hypertension. The high prevalence of hypertension among people with diabetes in Africa highlights the critical need for an integrated differentiated service delivery to improve and strengthen primary care and prevent cardiovascular disease. Findings from this meta-analysis may inform the delivery of interventions to prevent premature cardiovascular disease deaths among persons in the region.

Mechanisms of Diabetic Nephropathy Not Mediated by Hyperglycemia

Diabetes mellitus (DM) is characterized by the appearance of progressive kidney damage, which may progress to end-stage kidney disease. The control of hyperglycemia is usually not sufficient to halt this progression. The kidney damage is quantitatively and qualitatively different in the two forms of diabetes; the typical nodular fibrosis (Kimmelstiel Wilson nodules) appears mostly in type 1 DM, whereas glomerulomegaly is primarily present in type 2 obese DM. An analysis of the different metabolites and hormones in type 1 and type 2 DM and their differential pharmacological treatments might be helpful to advance the hypotheses on the different histopathological patterns of the kidneys and their responses to sodium/glucose transporter type 2 inhibitors (SGLT2i).

Tenecteplase vs. Alteplase for Intravenous Thrombolytic Therapy of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

INTRODUCTION

In recent years, as one of the drugs for the treatment of acute ischemic stroke (AIS), the clinical application of tenecteplase is still controversial. Therefore, we aimed to evaluate the safety and efficacy of tenecteplase versus alteplase to guide clinical practice.

METHODS

A search of PubMed, MEDLINE, EMBASE, Cochrane Library, and Web of Science databases until February 15, 2023 was conducted to identify eligible articles. The quality of the included studies was assessed using the Cochrane Risk of Bias tool. RevMan 5.3 and Stata 17 were used to perform the meta-analysis and detect publication bias, and risk ratios (RRs) with 95% confidence intervals (95% CIs) were reported for each outcome measure.

RESULTS

A total of 1326 records were retrieved in this meta-analysis. As a result of the limited reports on tenecteplase in patients with AIS and the lack of high-quality randomized controlled trials (RCTs), and considering the impact of publication bias, we did not include any of these studies published before 2015. Ultimately we included 16 RCTs with a total of 7508 patients, including 3940 patients treated with alteplase and 3568 patients treated with tenecteplase. Tenecteplase was associated with better early neurological improvement (RR 0.10; 95% CI 0.00-0.19; P = 0.04), recanalization of blood vessels (RR 0.24; 95% CI 0.07-0.40; P = 0.01), and 90-day excellent neurological recovery (RR 0.12; 95% CI 0.01-0.24; P = 0.04). In addition, there were no significant differences in other efficacy and safety outcomes between the two groups. The funnel plot and Begg's as well as Egger's tests showed no significant publication bias.

CONCLUSIONS

This meta-analysis showed that tenecteplase was not inferior to alteplase in early thrombolytic therapy in patients with AIS, and was even better than alteplase on some efficacy outcomes with no significant differences in safety. However, as a result of some inherent limitations of this study, more high-quality prospective clinical studies are needed to confirm these results.

Incidence and predictors of hypertension among diabetic patients attending a diabetic follow-up clinic in Ethiopia: a retrospective cohort study

OBJECTIVE

To assess the incidence and predictors of hypertension among patients with diabetes attending a diabetes follow-up clinic.

METHODS

This institution-based retrospective cohort study was conducted among patients with diabetes who attended a diabetic follow-up clinic at Asella Referral and Teaching Hospital between January 2017 and December 2021. Patients diagnosed with hypertension prior to diabetes, or diagnosed with hypertension at the start of follow-up, were excluded. Data were extracted from medical records and analysed.

RESULT

A total of 351 patients with diabetes were included. The incidence density rate (IDR) of hypertension during 688.98 person-years of observation was 58.05 per 1000 (95% confidence interval [CI] 42.58, 79.14) person-years. The cumulative incidence of hypertension was 11.4% (95% CI 8.05, 14.7%) over 5 years. The 25th percentile survival time to hypertension development was 4.6 years. Multivariable Cox proportional hazard regression analysis showed that older age (adjusted hazard ratio [HR] 6.24, 95% CI 3.13, 12.45), family history of hypertension (adjusted HR 1.67, 95% CI 1.22, 9.65), comorbidity (adjusted HR 2.20, 95% CI 1.94, 5.21) and higher body mass index (adjusted HR 2.07, 95% CI 1.23, 5.63) were statistically significant predictors of hypertension development.

CONCLUSION

Among patients with diabetes in Ethiopia, the IDR of hypertension was high; and older age, family history of hypertension, comorbidity and higher body mass index were statistically significant predictors of hypertension development.

Determinants of hypertension among diabetic patients in southern Ethiopia: a case-control study

BACKGROUND

Hypertension, among diabetic patients, is a worldwide public-health challenge and a number one modifiable risk factor for other cardiovascular diseases and death. The prevalence of hypertension among the diabetic population is nearly twice of nondiabetic patients. Screening and prevention of risk factors for hypertension based on evidence from local studies is required to minimize the burden of hypertension among diabetic patients. This study is aimed at assessing the determinants of hypertension among diabetic patients in Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia, 2022.

METHODS

Facility-based unmatched case-control study design was conducted from March 15 to April 15, 2022, at the outpatient diabetic clinic, Wolaita Sodo University Comprehensive Specialized Hospital. A total of 345 diabetic patients were selected using systematic random sampling techniques. Data were collected using a structured questionnaire by interviewing and extracting from the medical chart of patients. Bivariate logistic regression followed by multiple logistic analysis was used to identify the determinants of hypertension among diabetic patients. A p-value less than 0.05 is considered to be statistically significant.

RESULTS

The significant determinants of hypertension among diabetes patients were being overweight [AOR = 2.06, 95% CI (1.1, 3.89), P = 0.025], being obese [AOR = 2.64, 95% CI (1.22, 5.70), P = 0.013], lack of Moderate intensity exercise [AOR = 2.41, 95% CI (1.36,4.24), P = 0.002], age [AOR = 1.03, 95% CI (1.01, 1.06), P = 0.011], Type 2 diabetes mellitus [AOR = 5.05, 95% CI (1.28, 19.88), P = 0.021], duration of diabetes mellitus ≥ 6 years [AOR = 7.47, 95% CI (2.02, 27.57), P = 0.003], diabetic nephropathy [AOR = 3.87, 95% CI (1.13, 13.29), P = 0.032], and urban residence [AOR = 2.11, 95% CI (1.04,4.29), P = 0.04].

CONCLUSION

Being overweight and obese, lack of moderate-intensity exercise, age, type 2 diabetes mellitus, duration of Diabetes ≥ 6 years, presence of diabetic nephropathy, and being urban residents were significant determinants of hypertension among diabetic patients. These risk factors can be targeted by health professionals for prevention and earlier detection of hypertension among diabetic patients.

Green Coffee Bean Extract Potentially Ameliorates Liver Injury due to HFD/STZ-Induced Diabetes in Rats

The goal of the current study was to examine the therapeutic potential of green coffee bean extract (GCBE) in the treatment of diabetic hepatic damage induced by high-fat diet (HFD) and streptozotocin (STZ) administration. The novelty of this study lies in constructing a newly stabilized in vivo obese diabetic animal model in rats using HFD/STZ for investigating the dose-dependent effect of two commonly used doses of GCBE in hepatoprotection against oxidative stress-induced hepatic damage by measuring many parameters that have not been carried out previously in other studies. GCBE that was used in this study was a hot water extract of green coffee beans with a concentration of 0.1 g ml−1. Male albino rats were given a single dose of STZ (35 mg kg−1), and HFD to induce diabetes mellitus (DM). For 28 days, two separate doses of GCBE 50 mg kg−1 and 100 mg kg−1 were administered orally to diabetic animals. Leptin, liver enzymes, oxidative stress parameters, inflammatory parameters, fasting plasma glucose (FPG), fasting plasma insulin (FPI), and lipid profile levels were examined. Real-time PCR and ELISA were used to quantitatively detect the mRNAs of the genes involved in the insulin signaling pathway, the genes involved in glucose metabolism, and the amounts of proteins. The levels of FPG, lipid profile, liver enzymes, inflammatory markers, and leptin in the HFD/STZ diabetic group revealed a considerable spike, while they considerably decreased after GCBE treatment in a dose-dependent manner. After GCBE treatment, the diabetic group showed a significant rise in the antioxidant markers glutathione, superoxide dismutase, and catalase, as well as a decrease in malondialdehyde and nitric oxide levels. The liver changes caused by HFD/STZ were entirely reversed by GCBE, and most intriguingly, in a dose-dependent manner. We concluded that GCBE can repair the hepatic oxidative damage caused by HFD and STZ by reversing all the previously measured parameters and improving the insulin signaling pathways. GCBE demonstrated strong antifree radical activity and significantly protected cells from oxidative damage caused by HFD/STZ.

A Meta-analysis of Randomized Controlled Trials Comparing the Efficacy and Safety of Pregabalin and Gabapentin in the Treatment of Postherpetic Neuralgia

OBJECTIVE

To systematically evaluate the clinical efficacy of pregabalin and gabapentin in the treatment of postherpetic neuralgia (PHN), including the difference in pain control and occurrence of adverse reactions.

METHODS

PubMed, MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were searched for randomized controlled trials (RCTs) comparing the efficacy of pregabalin and gabapentin in patients with PHN. Data from studies meeting the inclusion criteria were extracted and the Cochrane Risk of Bias risk assessment tool was used to evaluate the quality of the included studies. Revman 5.3 and Stata17 were used to perform the meta-analysis and to detect publication bias.

RESULTS

A total of 14 RCTs with 3545 patients were included in this study, including 926 in the pregabalin treatment group, 1256 in the gabapentin treatment group, and 1363 in the placebo control group. Pregabalin was better than gabapentin in alleviating pain and improving the global perception of change in pain and sleep (P < 0.05). Gabapentin was associated with a lower incidence of adverse events than pregabalin (P < 0.05). Funnel plot and Begg's and Egger's tests showed no significant publication bias.

CONCLUSION

Pregabalin appears to have a better overall therapeutic effect than gabapentin for patients with PHN, but gabapentin has a lower incidence of adverse reactions and a better safety profile. Clinicians should comprehensively consider patient factors and fully evaluate the advantages and disadvantages of each treatment option to select the most suitable drugs for patient use. Considering the limited quantity and quality of the existing literature, high-quality RCTs are needed to confirm the advantages of pregabalin over gabapentin in the treatment of PHN and guide clinical decision-making.