Obesity association with antidiabetic drugs’ prescription among patients with type 2 diabetes mellitus: a systematic review and meta-analysis

Introduction

Type 2 diabetes mellitus (T2DM) is a chronic disease of persistent elevation in blood glucose level. Several antidiabetic drugs (ADDs) with different features are currently available for T2DM management (1). The selection of appropriate ADDs is crucial for preventing/attenuating diabetes-related complications(1). All guidelines agreed on metformin to be an initial therapy for patients diagnosed with T2DM, yet the selection of an intensifying therapy or alternative initial therapy are lacking any agreements (1). Consequently, the selection of ADDs could be linked to multiple factors (2). Since obesity is a risk factor for T2DM and ADDs have variable effect on body weight, obesity is an important factor that could be associated with ADDs’ selection.

Aim

This systematic review (SR) and meta-analysis (MA) aimed to overview and quantify obesity association with the selection of ADDs among type 2 diabetic patients.

Methods

A systematic literature search was conducted on multiple databases. Eligible studies were selected based on the following inclusion criteria: quantitative observational studies, evaluated obesity association with ADDs’ prescription, in outpatient setting, and published in English over the period of Jan/2009-April/2021. Studies on other types of diabetes, about switching therapy, or published before 2009 were excluded. The following items were extracted from identified articles: study details as author, year, and method, participants’ characteristics as age and gender, type of investigated ADDs, comparison group, and stage of treatment, as well as type of analysis test. Extracted data was synthesized quantitively utilising a three-level MA approach as some studies reported more than one effect-size because of examining multiple ADDs. It was based on odds ratio and 95%confidence interval.

Results

A total of 21 studies evaluated the association of obesity with ADDs’ prescription was identified. All except one were included in the MA which contributed to a total of 66 effect sizes from all investigated ADDs. The pooled estimate of obesity association with the prescription of ADDs including all groups was 1.19[0.85 -1.67]. A subgroup analysis showed a significant difference according to the type of ADDs (p< .0001). A positive significant association was found with glucagon-Like peptide receptor agonist (GLP1-RA), sodium glucose transporter 2 inhibitors (SGLT2-I), and metformin prescriptions (pooled estimate: 2.35 [1.54-3.59], 1.89[1.33-2.68], and 1.22[1.08-1.37], respectively). Whereas a negative significant association was found with sulfonylurea prescription (pooled estimate: 0.76 [0.62-0.93]). The pooled estimate of thiazolidinedione, dipeptidyl-peptidase 4 inhibitors, and insulin showed a non-significant association with obesity. None of the investigated variables showed significant influence on the overall result including stage of treatment and quality of study (p >0.05).

Conclusion

Obesity is an important factor influencing ADDs’ prescription. Patients with higher weight were more likely to get ADDs with weight losing or neutral effect as GLP1-RA, SGLT2-I, and metformin. This reflects some adherence of clinical practice to the variability in drugs’ features as indicated from the consistent findings of obesity as a factor affecting ADDs’ selection with the weight effect of ADDs. Yet, further studies are required because of limited number of studies examined each antidiabetic group.

References

1. American Diabetes A. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S98-S110.

2. Wilkinson S, Douglas I, Stirnadel-Farrant H, Fogarty D, Pokrajac A, Smeeth L, et al. Changing use of antidiabetic drugs in the UK: trends in prescribing 2000-2017. BMJ Open. 2018;8(7):e022768.

Ethanolic extract of okra has a potential gastroprotective effect on acute gastric lesions in Sprague Dawley rats

Okra (Abelmoschus esculentus) has various bioactive components used for the treatment of different diseases such as gastritis and ulcers. This research aims to examine the anti-inflammatory and anti-ulcer attributes of okra extract against gastric lesions. Adult Sprague Dawley male albino rats were divided into five groups. The negative control (G1) received normal feed, positive control (G2) received ulcer-inducing drug aspirin 150 mg/kg of body weight (b.w), G3 group received reference drug omeprazole 20 mg/kg of b.w, G4 group received okra extract 250 mg/kg of b.w, and G5 group received 500 mg/kg of b.w. Acute gastric damage was induced in G1, G2, G3, and G4 using aspirin 150 mg/kg of b.w, during 14-day-long efficacy trials after that all the animals were sacrificed. Anti-ulcer parameters and histopathological analysis of stomachs were performed to evaluate the degree of recovery against tissue damage by the administration of okra extract. The obtained results indicated that the 500 mg/kg of b.w okra extract exerted a protective effect in aspirin-induced gastric ulcers by significantly (p < .05) reducing ulcer score, ulcer area, total acidity, and gastric volume, and significantly (p < .05) increasing gastric pH. Moreover, histopathological observation revealed that gastric mucosa was normal in G1, G3, G4, and G5; however, disruptions in the gastric epithelium were observed in G2. Congestion was observed in all groups except G1 and G5. Gastric pits and gastric glands were increased in size in G2 and G4. A higher concentration of okra extract (500 mg/kg of b.w) showed almost similar results when compared to the reference drug omeprazole.

Equation of State Effects in Core-Collapse Supernovae

We investigate the impact of different properties of the nuclear equation of state in core-collapse supernovae, with a focus on the proto-neutron-star contraction and its impact on the shock evolution. To this end, we introduce a range of equations of state that vary the nucleon effective mass, incompressibility, symmetry energy, and nuclear saturation point. This allows us to point to the different effects in changing these properties from the Lattimer and Swesty to the Shen et al. equations of state, the two most commonly used equations of state in simulations. In particular, we trace the contraction behavior to the effective mass, which determines the thermal nucleonic contributions to the equation of state. Larger effective masses lead to lower pressures at nuclear densities and a lower thermal index. This results in a more rapid contraction of the proto-neutron star and consequently higher neutrino energies, which aids the shock evolution to a faster explosion.

Maternal Knowledge Of W.H.O Guidelines For Treatment Of Acute Respiratory Infections In Children Under Five In Pakistan

BACKGROUND

Acute Respiratory Infections (ARIs) are among the leading causes of morbidity and mortality in children under the age of five in Pakistan. Gauging the knowledge and practices of mothers related to ARIs may hold a key role in reducing the incidence and complications. Our study assessed the knowledge of mothers regarding ARIs among children under five years in accordance with WHO guidelines, and its association with education and socioeconomic status of mothers. In addition, we studied the association between education of mothers and socioeconomic status with vaccination status of child.

METHODS

This cross-sectional study was conducted from May to December 2016 at Civil Hospital, Ziauddin Hospital and Gulshan-e-Sikanderabad PHC Karachi and involved mothers with at least one child under the age of five years. Four hundred mothers were interviewed using a questionnaire. Results were analysed using SPSS 20.0.

RESULTS

51% of mothers were found to have an above average understanding about ARIs with a mean score of 13.35±3.03 out of a possible 20. There is no association between knowledge of mothers and their level of education. Education level of the mother was found to have a significant association with the vaccination status of youngest child. Mothers having no education or just religious education had the highest percentages of incomplete vaccinations.

CONCLUSIONS

Most mothers had above average knowledge of what classified as an ARI and could identify the danger signs. Uneducated mothers had incomplete vaccinations of their youngest child. The majority of mothers had satisfactory breastfeeding habits.