Browsing Faculty of Health and Social Care by Publisher "Scientific Research Publishing"
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The Effectiveness of Glyburide Compared to Insulin in the Management of Gestational Diabetes Mellitus: A Systematic Review.Background: Insulin therapy has been the mainstay in managing women with gestational diabetes mellitus (GDM), but some disadvantages of insulin have led to the use of glyburide, which is inexpensive in some countries, to manage GDM. However, there has been debate over its effectiveness, efficacy and safety when compared to insulin for maternal glycaemic control, and some adverse neonatal outcomes in GDM. Method: A systematic review of eight randomised controlled trial (RCT) studies was undertaken to compare glyburide and insulin. Studies involving 849 participants were included in the quantitative analysis. Results: There was no significant difference between glyburide and insulin in maternal fasting (P = 0.09; SMD: 0.13; 95% CI: ﹣0.02 to 0.28) and postprandial (P = 0.45; SMD: 0.05; 95% CI: ﹣0.09 to 0.19) glycaemic control and glycosylated hae-moglobin (P = 0.35; SMD: 0.08; 95% CI: ﹣0.08 to 0.24). When compared with insulin, glyburide had an increase risk ratio (RR) for neonatal hypoglycaemia (P = 0.0002; RR: 2.27; 95% CI: 1.47 to 3.51) and large for gestational age babies (P = 0.03; RR: 1.60; 95% CI: 1.06 to 2.41). Estimation of standard mean difference shows that neonatal birth weight was significantly higher in subjects receiving glyburide than in the insulin group (P = 0.002; SMD: 0.21; 95% CI: 0.08 to 0.35). Conclusions: Glyburide was seen to be clinically effective and a safer alternative to insulin for maternal glycaemic control in GDM women. It is affordable, convenient and requires no comprehensive educative training at the time of initiation of therapy. However, its adverse outcomes—neonatal hypogly-caemia, high neonatal birth weight and large for gestational age babies—call for careful monitoring of GDM patients for any need for supplemental insulin.
Evaluating the Use of Vitamin D Supplementation to Improve Glycaemic Outcome in Type 2 Diabetes Mellitus Patients: A Systematic Review of EvidenceBackground: The evidence indicates that vitamin D [25(OH)D] improves glycaemic outcomes in type 2 Diabetes mellitus patients. The outcome measures used to determine the accuracy of this hypothesis are: glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG) and homeostasis model assessment-insulin resistance (HOMA-IR). Methods: We performed a systematic review and meta-analysis which included all previous randomised controlled trial (RCT) studies that assessed the effects of vitamin D on glucose metabolism. We carried out an extensive electronic database search of published and unpublished RCTs, evaluating the association between vitamin D and glycaemic outcomes in type 2 diabetes mellitus patients. We searched Cochrane Library, PubMed, EMBASE, CINAHL Plus with Full Text, MEDLINE, BioMed Central, Turning Research Into Practice (TRIP), Health Technology Assessment (HTA), and Latin American and Caribbean Health Sciences (LILIACS) between the years 2005 and 2016. The full texts of relevant studies were retrieved and a snowballing technique was used to discover further studies missed from the initial database search. This was done by hand-searching for references within the retrieved articles. Results: A total of 17 studies were included in the review. The pooled effect of 15 studies that measured HbA1c showed an insignificant effect of vitamin D on HbA1c (Mean difference (MD) = −0.06 mmol/l; 95% CI = −0.26 to 0.14; I2 = 76%). A pooled analysis of seven studies that measured the effect of vitamin D on blood glucose also found no significant effect of vitamin D on T2DM (MD = −0.03 mmol/l; 95% CI = −0.69 to 0.63; I2 = 76%). Three studies that analysed the effect of vitamin D on insulin sensitivity also observed no significant effect (MD = −1.51 mmol/l; 95% CI = −3.61 to 0.60; I2 = 67%). Conclusion: In conclusion, although vitamin D has been extensively studied in relation to some glycaemic outcomes and some indications that increased plasma vitamin D concentrations might be linked to prevention of T2DM, firm universal conclusions about its benefits cannot be drawn. Further studies with better designed trials and larger sample sizes are needed to draw firmer conclusions