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.

Development of Carrot Nutraceutical Products as an Alternative Supplement for the Prevention of Nutritional Diseases

Nutraceuticals can serve as an alternative supplement to overcome nutritional deficiency for a healthy lifestyle. They can also play a key role in disease management. To develop carrot nutraceutical products, 64 genotypes from four different continents were evaluated for a range of morpho-nutrition variables. Genetic variability, heritability, strength and direction of association among variables, and direct and indirect relationships among physiochemical and nutritional traits with β-carotene content were evaluated. Core diameter, foliage weight, root weight and shoulder weight showed significant association with β-carotene accumulation. Principal component analysis for physiochemical and nutritional assessment divided these genotypes into two distinctive groups, Eastern carrots and Western carrots. Caloric and moisture content had high positive associations with β-carotene content while carbohydrate content was negatively associated. Five genotypes (T-29, PI 634658, PI 288765, PI 164798, and Ames 25043) with the highest β-carotene contents were selected for making three nutraceutical supplements (carrot-orange juice, carrot jam and carrot candies). These nutraceutical supplements retained high β-carotene content coupled with antioxidant properties. Carrot jam (6.5 mg/100 g) and carrot candies (4.8 mg/100 g) had greater concentrations of β-carotene than carrot-orange juice (1.017 mg/100 g). Carrot jam presented high antioxidant activity with the highest values in T-29 (39% inhibition of oxidation) followed by PI 634658 (37%), PI 164798 (36.5%), Ames 25043 (36%) and PI 288765 (35.5%). These nutraceutical products, with 4–6.5 mg/100 g β-carotene content, had higher values than the USDA recommended dietary intake of 3–6 mg β-carotene/day can be recommended for daily use to lower the risk of chronic disease.

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.

Ethnopharmacological exploration of medicinal mushroom from Pakistan

BACKGROUND

The chief aim of this study was to enlist the ethnopharmacological aspect of mushrooms from four Provinces of Pakistan. Due to the seasonal variation and extreme geographical conditions, Pakistan has great mushroom diversity. Mushrooms have been used by the indigenous people for the treatment of different ailments in many regions of Pakistan. They still depend on the mushrooms for treatment of various ailments. Moreover, mushrooms are used as first aid to treat cold, cough, influenza, asthma, cancer, gastric and hepatic disorders. Traditional uses of medicinal mushrooms lead to the discovery of alternative source of synthetic medicines. This is basically the first quantitative ethnopharmcological documentation of medicinal mushrooms from Pakistan.

MATERIALS AND METHOD

Ethnopharmacological information was collected from the 950 informants including male and female. The informative data was based on semi-structured interviews, group discussions, and field visits. Data was analyzed by applying different quantitative indices such as informant consent factor (ICF), Use value (UV), Relative Frequency of Citation (RFC), the Fidelity level (FL) and Jaccard Index (JI).

RESULT

Almost 50 mushrooms belonging to 24 families were reported. Most-frequently cited families were Agaricaceae (13 species) and Morchellaceae (5 species). Extract was the common mode of preparation reported (63.33%), followed by Powder (36.67%). Mostly these medicinal mushrooms were present as wild (62.90%), followed by cultivated (37.10%). Among all 11.75% mushrooms were toxic and inedible, 75% were nontoxic, whereas the remaining 13.46% may be toxic or nontoxic because of their dual attitude. New medicinal uses of 23 mushrooms were explored in this study.

CONCLUSION

This ethnopharmacological documentation revealed that the mushrooms are still used by natives of rural area in their day-to-day lives. This study provides the basis for the conservation of mushrooms. Mushrooms with high ICF, UV and FL were further used for phytochemical and pharmacological studies. This documentation is baseline information which can be used to develop new mushroom-based medicines.