Effects of a healthy Nordic diet on cardiovascular risk factors in hypercholesterolaemic subjects: a randomized controlled trial (NORDIET). Influence of a prudent diet on circulating cathepsin S in humans Plasma alkylresorcinols C17:0/C21:0 ratio, a biomarker of relative whole-grain rye intake, is associated to insulin sensitivity: a randomized study Plasma alkylresorcinols reflect important whole-grain components of a healthy Nordic diet. Nonpharmacological interventions to prevent type 2 diabetes in women diagnosed with gestational diabetes mellitus: a systematic overview Influence of a healthy Nordic diet on serum fatty acid composition and associations with blood lipoproteins – results from the NORDIET study Association between Mediterranean and Nordic diet scores and changes in weight and waist circumference: influence of FTO and TCF7L2 loci. The effectiveness of nurse‐led care in general practice on clinical outcomes in adults with type 2 diabetes Gastric Bypass Leads to Improvement of Diabetic Neuropathy Independent of Glucose Normalization—Results of a Prospective Cohort Study (DiaSurg 1 Study) Comparative Effectiveness of Dipeptidylpeptidase-4 Inhibitors in Type 2 Diabetes: A Systematic Review and Mixed Treatment Comparison Complementary therapies and integrative medicine. Physical Activity/Exercise and Type 2 Diabetes Glycemic load, exercise, and monitoring blood glucose (GEM): A paradigm shift in the treatment of type 2 diabetes mellitus. Sources of evidence for systematic reviews of interventions in diabetes. Dietary fiber and the glycemic index: a background paper for the Nordic Nutrition Recommendations 2012 Dietary fiber, glycemic index, glycemic load and renal cell carcinoma risk. Nerve decompression after diabetic foot ulceration may protect against recurrence: a 3-year controlled, prospective analysis. Behavioural interventions for type 2 diabetes: an evidence-based analysis. A Summary of the ADVANCE Trial How to write an evidence-based clinical review article. Some problems with Cochrane reviews of diet and chronic disease A randomized trial of a low fat high fibre diet in the recurrence of colorectal polyps. Toronto Polyp Prevention Group. Mixed treatment comparison analysis provides internally coherent treatment effect estimates based on overviews of reviews and can reveal inconsistency. Reporting of prognostic markers: current problems and development of guidelines for evidence-based practice in the future Continuous wave Nd:YAG laser photocoagulation in proliferative diabetic retinopathy. The rationale for paired pre- and postprandial self-monitoring of blood glucose: the role of glycemic variability in micro- and macrovascular risk Mineral Trioxide Aggregate vs. Calcium Hydroxide in Primary Molar Pulpotomy: A Systematic Review Predictors of nicotine dependence symptoms among never-smoking adolescents: a longitudinal analysis from the Nicotine Dependence in Teens Study. Mobile App-Based Interventions to Support Diabetes Self-Management: A Systematic Review of Randomized Controlled Trials to Identify Functions Associated with Glycemic Efficacy Calcium intake in health maintenance – a systematic review Efficacy of vitamin D supplementation in depression in adults: a systematic review protocol No association between adherence to the healthy Nordic food index and cardiovascular disease amongst Swedish women: a cohort study. Ehealth: low FODMAP diet vs Lactobacillus rhamnosus GG in irritable bowel syndrome. Program of rehabilitative exercise and education to avert vascular events after non-disabling stroke or transient ischemic attack (PREVENT Trial): a multi-centred, randomised controlled trial Effectiveness of educational interventions to promote oral hypoglycaemic adherence in adults with Type 2 diabetes: a systematic review
OBJECTIVE the aim of this study was to investigate the effects of a healthy Nordic diet ( ND ) on cardiovascular risk factors . DESIGN AND SUBJECTS in a r and omized controlled trial ( NORDIET ) conducted in Sweden , 88 mildly hypercholesterolaemic subjects were r and omly assigned to an ad libitum ND or control diet ( subjects ' usual Western diet ) for 6 weeks . Participants in the ND group were provided with all meals and foods . Primary outcome measurements were low-density lipoprotein ( LDL ) cholesterol , and secondary outcomes were blood pressure ( BP ) and insulin sensitivity ( fasting insulin and homeostatic model assessment -insulin resistance ) . The ND was rich in high-fibre plant foods , fruits , berries , vegetables , whole grains , rapeseed oil , nuts , fish and low-fat milk products , but low in salt , added sugars and saturated fats . RESULTS the ND contained 27 % , 52 % , 19 % and 2 % of energy from fat , carbohydrate , protein and alcohol , respectively . In total , 86 of 88 subjects r and omly assigned to diet completed the study . Compared with controls , there was a decrease in plasma cholesterol ( -16 % , P < 0.001 ) , LDL cholesterol ( -21 % , P < 0.001 ) , high-density lipoprotein ( HDL ) cholesterol ( -5 % , P < 0.01 ) , LDL/HDL ( -14 % , P < 0.01 ) and apolipoprotein (apo)B/apoA1 ( -1 % , P < 0.05 ) in the ND group . The ND reduced insulin ( -9 % , P = 0.01 ) and systolic BP by -6.6 ± 13.2 mmHg ( -5 % , P < 0.05 ) compared with the control diet . Despite the ad libitum nature of the ND , body weight decreased after 6 weeks in the ND compared with the control group ( -4 % , P < 0.001 ) . After adjustment for weight change , the significant differences between groups remained for blood lipids , but not for insulin sensitivity or BP . There were no significant differences in diastolic BP or triglyceride or glucose concentrations . CONCLUSIONS a healthy ND improves blood lipid profile and insulin sensitivity and lowers blood pressure at clinical ly relevant levels in hypercholesterolaemic subjects Background Increased circulating cathepsin S levels have been linked to increased risk of cardiometabolic diseases and cancer . However , whether cathepsin S is a modifiable risk factor is unclear . We aim ed to investigate the effects of a prudent diet on plasma cathepsin S levels in healthy individuals . Findings Explorative analyses of a r and omized study were performed in 88 normal to slightly overweight and hyperlipidemic men and women ( aged 25 to 65 ) that were r and omly assigned to ad libitum prudent diet , i.e. healthy Nordic diet ( ND ) or a control group ( habitual Western diet ) for 6 weeks . Whereas all foods in the ND were provided , the control group was advised to consume their habitual diet throughout the study . The ND was in line with dietary recommendations , e.g. low in saturated fats , sugars and salt , but high in plant-based foods rich in fibre and unsaturated fats . The ND significantly decreased cathepsin S levels ( from 20.1 ( + /-4.0 SD ) to 19.7 μg/L ( + /-4.3 SD ) ) compared with control group ( from 18.2 ( + /-2.9 SD ) to 19.1 μg/L ( + /-3.8 SD ) ) . This difference remained after adjusting for sex and change in insulin sensitivity ( P = 0.03 ) , and near significant after adjusting for baseline cathepsin S levels ( P = 0.06 ) , but not for change in weight or LDL-C. Changes in cathepsin S levels were directly correlated with change in LDL-C. Conclusions Compared with a habitual control diet , a provided ad libitum healthy Nordic diet decreased cathepsin S levels in healthy individuals , possibly mediated by weight loss or lowered LDL-C. These differences between groups in cathepsin S were however not robust and therefore need further investigation Background / Objectives : Few studies have used biomarkers of whole-grain intake to study its relation to glucose metabolism . We aim ed to investigate the association between plasma alkylresorcinols ( AR ) , a biomarker of whole-grain rye and wheat intake , and glucose metabolism in individuals with metabolic syndrome (MetS).Subjects/ Methods : Participants were 30–65 years of age , with body mass index 27–40 kg/m2 and had MetS without diabetes . Individuals were recruited through six centers in the Nordic countries and r and omized to a healthy Nordic diet ( ND , n=96 ) , rich in whole-grain rye and wheat , or a control diet ( n=70 ) , for 18–24 weeks . In addition , associations between total plasma AR concentration and C17:0/C21:0 homolog ratio as an indication of the relative whole-grain rye intake , and glucose metabolism measures from oral glucose tolerance tests were investigated in pooled ( ND+control ) regression analyses at 18/24 weeks . Results : ND did not improve glucose metabolism compared with control diet , but the AR C17:0/C21:0 ratio was inversely associated with fasting insulin concentrations ( P=0.002 ) and positively associated with the insulin sensitivity indices Matsuda ISI ( P=0.026 ) and disposition index ( P=0.022 ) in pooled analyses at 18/24 weeks , even after adjustment for confounders . The AR C17:0/C21:0 ratio was not significantly associated with insulin secretion indices . Total plasma AR concentration was not related to fasting plasma glucose or fasting insulin at 18/24 weeks . Conclusions : The AR C17:0/C21:0 ratio , an indicator of relative whole-grain rye intake , is associated with increased insulin sensitivity in a population with Biomarkers of dietary intake can be important tools in nutrition research . Our aim was to assess whether plasma alkylresorcinol ( AR ) and β-carotene concentrations could be used as dietary biomarkers for whole-grain , fruits and vegetables in a healthy Nordic diet ( ND ) . Participants ( n = 166 ) , 30 - 65 y with a body mass index of 27 - 40 kg/m(2 ) and two more features of metabolic syndrome ( International Diabetes Federation definition , slightly modified ) , were recruited through six centers in the Nordic countries and r and omly assigned to an ND or control diet for 18 or 24 wk , depending on study center . Plasma AR and β-carotene were analyzed and nutrient intake calculated from 4-d food records . Median fiber intake increased in the ND group from 2.5 g/MJ at baseline to 4.1 g/MJ ( P < 0.001 ) at end point ( week 18 or 24 ) , and median ( IQR ) fasting plasma total AR concentration increased from 73 ( 88 ) to 106 ( 108 ) nmol/L , or 45 % , from baseline to end point ( P < 0.001 ) . The AR concentration was significantly higher in the ND group ( P < 0.001 ) than in the control group at end point . β-Carotene intake tended to increase in the ND group ( P = 0.07 ) , but the plasma β-carotene concentration did not change significantly throughout the study and did not differ between the groups at follow-up . In conclusion , an ND result ed in higher dietary fiber intake and increased plasma total AR concentration compared with the control diet , showing that the total AR concentration might be a valid biomarker for an ND in which whole-grain wheat and rye are important components . No significant difference in plasma β-carotene concentrations was observed between the ND and control groups , suggesting that β-carotene may not be a sensitive enough biomarker of the ND 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 Background The fatty acid ( FA ) composition of serum lipids is related to the quality of dietary fat intake . Objective To investigate the effects of a  healthy Nordic diet ( ND ) on the FA composition of serum cholesterol esters ( CE-FA ) and assess the associations between changes in the serum CE-FA composition and blood lipoproteins during a controlled dietary intervention . Design The NORDIET trial was a 6-week r and omised , controlled , parallel-group dietary intervention study that included 86 adults ( 53±8 years ) with elevated low-density lipoprotein cholesterol ( LDL-C ) . Serum CE-FA composition was measured using gas chromatography . Diet history interviews were conducted , and daily intake was assessed using checklists . Results Food and nutrient intake data indicated that there was a reduction in the intake of fat from dairy and meat products and an increase in the consumption of fatty fish with the ND . The levels of saturated fatty acids in cholesterol esters ( CE-SFA ) 14:0 , 15:0 , and 18:0 , but not 16:0 , showed a significant decrease after intake of ND compared to the control diet ( p<0.01 ) . Also , a significant increase in serum 22:6n – 3 was observed compared with the control diet ( p<0.01 ) . The changes in CE-SFA 14:0 , 15:0 , and 18:0 correlated positively with changes in LDL-C , HDL-C , LDL-C/HDL-C , ApoA1 , and ApoB ( p<0.01 ) , respectively , whereas the changes in polyunsaturated fatty acids in cholesterol esters ( CE-PUFA ) 22:6n – 3 were negatively correlated with changes in the corresponding serum lipids . Conclusions The decreased intake of saturated fat and increased intake of n-3 PUFA in a  healthy ND is partly reflected by changes in the serum CE-FA composition , which are associated with an improved serum lipoprotein pattern BACKGROUND Several studies have shown that adherence to the Mediterranean Diet measured by using the Mediterranean diet score ( MDS ) is associated with lower obesity risk . The newly proposed Nordic Diet could hold similar beneficial effects . Because of the increasing focus on the interaction between diet and genetic predisposition to adiposity , studies should consider both diet and genetics . OBJECTIVE We investigated whether FTO rs9939609 and TCF7L2 rs7903146 modified the association between the MDS and Nordic diet score ( NDS ) and changes in weight ( Δweight ) , waist circumference ( ΔWC ) , and waist circumference adjusted for body mass index ( BMI ) ( ΔWC BMI ) . DESIGN We conducted a case-cohort study with a median follow-up of 6.8 y that included 11,048 participants from 5 European countries ; 5552 of these subjects were cases defined as individuals with the greatest degree of unexplained weight gain during follow-up . A r and omly selected subcohort included 6548 participants , including 5496 noncases . Cases and noncases were compared in analyses by using logistic regression . Continuous traits ( ie , Δweight , ΔWC , and ΔWC BMI ) were analyzed by using linear regression models in the r and om subcohort . Interactions were tested by including interaction terms in models . RESULTS A higher MDS was significantly inversely associated with case status ( OR : 0.98 ; 95 % CI : 0.96 , 1.00 ) , ΔWC ( β = -0.010 cm/y ; 95 % CI : -0.020 , -0.001 cm/y ) , and ΔWC BMI ( β = -0.008 ; 95 % CI:-0.015 , -0.001 ) per 1-point increment but not Δweight ( P = 0.53 ) . The NDS was not significantly associated with any outcome . There was a borderline significant interaction between the MDS and TCF7L2 rs7903146 on weight gain ( P = 0.05 ) , which suggested a beneficial effect of the MDS only in subjects who carried 1 or 2 risk alleles . FTO did not modify observed associations . CONCLUSIONS A high MDS is associated with a lower ΔWC and ΔWC BMI , regardless of FTO and TCF7L2 risk alleles . For Δweight , findings were less clear , but the effect may depend on the TCF7L2 rs7903146 variant . The NDS was not associated with anthropometric changes during follow-up Background In Australia , diabetes was identified as a national health priority area in 1996 ; nevertheless the prevalence of type 2 diabetes has increased dramatically since then . Nurses have been working within Australian general practice s for several decades but only in recent years has the role of the practice nurse in primary health care increased . Objectives This review aims to identify the effectiveness of nurse‐led care in general practice as compared to general practitioner care on clinical outcomes in adults with type 2 diabetes . Inclusion criteria Types of participants Participants were adults ( aged > 18 years ) , with diabetes type 2 attending a general/family practice . Types of intervention Interventions of interest include nurse‐led care in general practice in which the nurse is identified as taking a lead role in the care of patients with type 2 diabetes compared to general practitioner‐led care . Types of studies To evaluate the effectiveness of nurse‐led diabetes care in general practice , this review sought r and omised controlled trials as the study design of choice . Other research design s such as controlled clinical trials , interrupted time series and controlled before and after design s were also considered . Types of outcomes The outcomes of interest were clinical outcomes including changes in systolic and diastolic blood pressure , body mass index , cholesterol levels , HbA1c ( glycated haemoglobin ) and fasting blood glucose . Search strategy A three step literature search was conducted for English language articles from January 1990 to December 2011 . Method ological quality Quantitative papers selected for retrieval were assessed by two independent review ers for method ological validity prior to inclusion in the review using st and ardised critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument . Data collection Quantitative data was extracted from papers included in the review using the st and ardised data extraction tool from the Joanna Briggs Institute . The data extracted included specific details about the interventions , population s , study methods and outcomes of significance to the review question and specific objectives . Data synthesis Data from quantitative papers , where possible , were pooled in statistical meta‐ analysis using the Meta‐ Analysis of Statistics Assessment and Review Instrument . Additionally , RevMan 5 was used for presenting forest plots of the meta‐ analysis . Results The electronic search yielded 804 potentially relevant papers of which 49 papers appeared to satisfy the criteria for inclusion and full texts of these papers were assessed against the inclusion criteria by two independent review ers . From these papers , five were included in the review , four r and omised control trials and one quasi‐experimental study . These articles provided evidence that nurse‐led care improves blood pressure and cholesterol levels for patients with type 2 diabetes attending a general practice . Conclusions There is some evidence to support the use of nurse‐led care in general practice for patients with type 2 diabetes . Implication s for Practice If nurse‐led care is implemented in the care of people with type 2 diabetes consideration needs to be given to the use of clinical algorithms , goal setting , individualised care plans , self management and follow up of lifestyle risk factors . Implication for Research More r and omised controlled trials are required to assess the efficacy of nurse‐led care including cost effectiveness Objective : Surprisingly , 40 % to 95 % of patients with type 2 diabetes mellitus ( T2DM ) show early remission of hyperglycemia after obesity surgery . It is unknown to what extent other diabetes-associated comorbidities such as distal peripheral neuropathy ( DPN ) might be influenced by obesity surgery . This pilot study aim ed at providing further evidence for the impact of Roux-en-Y gastric bypass ( RYGB ) on both glycemic control and DPN in nonseverely obese patients with insulin-dependent T2DM . Methods : In the present prospect i ve cohort study , 20 patients with long-st and ing , insulin-dependent T2DM and a body mass index ( BMI ) between 25 and 35 kg/m2 underwent laparoscopic RYGB .  Body mass index , glycosylated hemoglobin ( HbA1c ) , and DPN [ quantified by the Neuropathy Symptom Score ( NSS ) and the Neuropathy Deficit Score ( NDS ) ] were investigated . Results : Six months after surgery , the preoperative BMI of 32.8 ± 2.1 kg/m2 ( mean ± st and ard deviation ) dropped to 25.6 ± 2.5 kg/m2 ( P < 0.001 ) . Preoperative HbA1c levels decreased from 8.5 ± 1.2 % to 7.1 ± 1.2 % ( P < 0.001 ) , with 15 % of patients having a normalized HbA1c level lower than 6.2 % . Of 12 patients with documented DPN , the median NSS was 8 ( range , 0–10 ) preoperatively and 0 ( range , 0–9 ) postoperatively ( P = 0.004 ) , with 8 patients scoring an NSS of 0 . The median NDS was 6 ( range , 2–8 ) preoperatively and 4 ( range , 0–8 ) postoperatively ( P = 0.027 ) , with 1 patient scoring an NDS of 0 . All patients had an improvement or normalization in either 1 or both scores . Conclusions : As expected , BMI and HbA1c levels improved significantly after RYGB . More interestingly , neuropathy scores , such as NSS and NDS , improved significantly early after surgery . Symptomatic neuropathy was completely reversible in 67 % of the patients . These findings add further evidence to the fact that RYGB might be a valuable treatment option not only for improving glycemic control but also for reducing diabetes-associated comorbidities , such as DPN . This points to a complex metabolic effect of RYGB that exceeds glucose normalization . However , the results still need to be confirmed in controlled trials Objective To compare the safety and efficacy of the dipeptidylpeptidase-4 ( DPP-4 ) inhibitors in patients with type 2 diabetes and inadequate glycemic control . Design Systematic review of r and omized controlled trials ( RCTs ) , health economic evaluation studies , systematic review s , and meta-analyses , followed by primary Bayesian mixed treatment comparison meta-analyses ( MTCs ) , and secondary frequentist direct-comparison meta-analyses using a r and om-effects model . Outcomes were reported as weighted mean change from baseline , or odds ratio ( OR ) with 95 % credible interval . Data sources MEDLINE , MEDLINE In-Process , EMBASE , and BIOSIS via Dialog ProQuest ; Cochrane Central Register of Controlled Trials and Cochrane Data base of Systematic Review s via EBSCO ; four diabetes and two technical congress abstract s ; and health technology assessment organization websites . Eligibility criteria Patients with type 2 diabetes and inadequate glycemic control receiving any pharmacological anti-diabetic treatment . Data extraction and analysis Title/ abstract s were review ed for eligibility , followed by full-text review of publications remaining after first pass . A three-person team filtered articles and an independent review er checked a r and om selection ( 10 % ) of filtered articles . Data extraction and quality assessment of studies were also independently review ed . Five DPP-4 inhibitors ( alogliptin , linagliptin , saxagliptin , sitagliptin , and vildagliptin ) were compared via meta- analysis ( where data were available ) as monotherapy , dual therapy ( plus metformin , sulfonylurea , pioglitazone , or insulin ) , and triple therapy ( plus metformin/sulfonylurea ) . Results The review identified 6,601 articles ; 163 met inclusion criteria and 85 publications from 83 RCTs contained sufficient or appropriate data for analysis . MTCs demonstrated no differences between DPP-4 inhibitors in mean change from baseline in glycosylated hemoglobin ( HbA1c ) or body weight , or the proportions of patients achieving HbA1c < 7 % or experiencing a hypoglycemic event , apart from in patients on alogliptin plus metformin , who achieved HbA1c < 7 % more frequently than those treated with saxagliptin plus metformin [ OR 6.41 ( 95 % CI 3.15–11.98 ) versus 2.17 ( 95 % CI 1.56–2.95 ) ] . Conclusions This systematic review and MTC showed similar efficacy and safety for DPP-4 inhibitors as treatment for type 2 diabetes , either as monotherapy or combination therapy It is a pleasure to accept the role of Editor-in-Chief of Comlementary Therapies in Medicine . I am humbled to attempt to fill he large shoes left by the previous Editor-in-Chief Robbert van aselen . Robbert led the way to creating journal characterized by global awareness of the field and strong st and ards for publicaion , including a high proportion of r and omized controlled trials nd systematic review s. Robbert also built a stellar editorial board , articularly the Associate Editors , for whom I ’m deeply grateful . I m also grateful for the superb support afforded by the publishng team at Elsevier , especially Ian Salusbury , Gwen Pointereau , nd Swetha Gudiseva . Peer support is also essential , and I ’m grateul to two other Editors-in-Chief , David Riley and Steve Roach , for enerously sharing their hard-earned wisdom For decades , exercise has been considered a cornerstone of diabetes management , along with diet and medication . However , high- quality evidence on the importance of exercise and fitness in diabetes was lacking until recent years . The present document summarizes the most clinical ly relevant recent advances related to people with type 2 diabetes and the recommendations that follow from these . Our recently published technical review on physical activity/exercise and type 2 diabetes ( 1 ) includes greater detail on individual studies , on prevention of diabetes , and on the physiology of exercise . The present statement focuses on type 2 diabetes . Issues primarily germane to type 1 diabetes will be covered in a subsequent technical review and ADA Statement . The levels of evidence used are defined by the ADA in ref . 2 . Two r and omized trials each found that lifestyle interventions including ∼150 min/week of physical activity and  diet-induced weight loss of 5–7 % reduced the risk of progression from impaired glucose tolerance ( IGT ) to type 2 diabetes by 58 % ( 3,4 ) . A cluster-r and omized trial found that diet alone , exercise alone , and combined diet and exercise were equally effective in reducting the progression from IGT to diabetes ( 5 ) . Therefore , there is firm and consistent evidence that programs of increased physical activity  and modest weight loss reduce the incidence of type 2 diabetes in individuals with IGT . Boule et al. ( 6 ) undertook a systematic review and meta- analysis on the effects of structured exercise interventions in clinical trials of ≥8 weeks duration on HbA1c ( A1C ) and body mass in people with type 2 diabetes . Postintervention A1C was significantly lower in exercise than control groups ( 7.65 vs. 8.31 % , weighted mean difference −0.66 % ; P < 0.001 ) . In contrast , postintervention body weight did not differ between the exercise and control groups . Meta-regression confirmed that the beneficial effect of exercise on A1C AIMS This preliminary RCT investigated whether an integrated lifestyle modification program that focuses on reducing postpr and ial blood glucose through replacing high with low glycemic load foods and increasing routine physical activities guided by systematic self-monitoring of blood glucose ( GEM ) could improve metabolic control of adults with type 2 diabetes mellitus , without compromising other physiological parameters . METHODS Forty-seven adults ( mean age 55.3 years ) who were diagnosed with type 2 diabetes mellitus for less than 5 years ( mean 2.1 years ) , had HbA1c ≥ 7 % ( mean 8.4 % ) and were not taking blood glucose lowering medications , were r and omized to routine care or five 1-h instructional sessions of GEM .  Assessment s at baseline and 6 months included a physical exam , metabolic and lipid panels , and psychological question naires . RESULTS The GEM intervention led to significant improvements in HbA1c ( decreasing from 8.4 to 7.4 % [ 69 - 57 mmol/mol ] compared with 8.3 to 8.3 % [ 68 - 68 mmol/mol ] for routine care ; Interaction p<.01 ) and psychological functioning without compromising other physiological parameters . CONCLUSIONS Consistent with a patient-centered approach , GEM appears to be an effective lifestyle modification option for adults recently diagnosed with type 2 diabetes mellitus AIMS To analyse the effect on systematic review s in diabetes interventions of including only trials that are indexed in medline , and to assess the impact of adding trials from other data bases and the grey literature . METHODS All systematic review s of diabetes interventions which included a meta- analysis of r and omized controlled trials , and were published since 1996 , were selected . The impact on the meta- analysis of including only those trials indexed in medline , and the effect of then adding trials from other sources , was assessed . Where possible this was measured quantitatively , by redoing the meta- analysis , otherwise a qualitative estimate was made . RESULTS Forty-four systematic review s met our inclusion criteria . There were 120 articles reporting trial data which were not indexed in medline . These came from 52 % of the review s. In 34 % of the review s , basing a meta- analysis on a search of only medline would miss trials that could affect the result . Sources of non- medline data which had the biggest effect on the meta-analyses were journal articles from central and embase ( mainly in Diabetes , Nutrition and Metabolism ) and unpublished data ( mainly from industry ) . The exceptions were journal articles on herbal medicine , mostly indexed in Chinese language data bases . CONCLUSIONS A search of only the medline data base is insufficient for systematic review s of diabetes , because in about 34 % of review s the missed trials could affect the results of the meta- analysis . It is recommended that central ( on the Cochrane Library ) also be search ed . Scanning meeting abstract s , and seeking unpublished data are also recommended if the intervention has only recently been introduced The aim of this study is to review recent data on dietary fiber ( DF ) and the glycemic index ( GI ) , with special focus on studies from the Nordic countries regarding cardiometabolic risk factors , type 2 diabetes , cardiovascular disease , cancer , and total mortality . In this study , recent guidelines and scientific background papers or up date s on older reports on DF and GI published between 2000 and 2011 from the US , EU , WHO , and the World Cancer Research Fund were review ed , as well as prospect i ve cohort and intervention studies carried out in the Nordic countries . All of the reports support the role for fiber-rich foods and DF as an important part of a healthy diet . All of the five identified Nordic papers found protective associations between high intake of DF and health outcomes ; lower risk of cardiovascular disease , type 2 diabetes , colorectal and breast cancer . None of the reports and few of the Nordic papers found clear evidence for the GI in prevention of risk factors or diseases in healthy population s , although association was found in sub-groups , e.g. overweight and obese individuals and suggestive for prevention of type 2 diabetes . It was concluded that DF is associated with decreased risk of different chronic diseases and metabolic conditions . There is not enough evidence that choosing foods with low GI will decrease the risk of chronic diseases in the population overall . However , there is suggestive evidence that ranking food based on their GI might be of use for overweight and obese individuals . Issues regarding methodology , validity and practicality of the GI remain to be clarified Several epidemiological studies have investigated the potential association between dietary fiber , glycemic index ( GI ) or glycemic load ( GL ) , and renal cell carcinoma ( RCC ) risk with inconsistent results . The aim of this study was to systematic ally evaluate this issue with a meta- analysis approach . A comprehensive literature search up to March 2018 was performed in PubMed and Web of Science data bases . Summary relative risks ( RRs ) and 95 % confidence intervals ( CIs ) were estimated with a r and om-effects model . Twelve studies were finally included in this study ( eight for fiber analysis , five for GI and five for GL ) . A significant positive association was observed between GI and the risk of RCC ( summary RR 1.16 , 95 % CI 1.02 - 1.32 ) , and no significant heterogeneity was detected among studies ( I2 = 22.8 % , P = 0.262 ) . A significant inverse association was found between fiber intake and the risk of RCC ( summary RR 0.82 , 95 % CI 0.72 - 0.92 ) , and no significant heterogeneity was observed across studies ( I2 = 27.6 % , P = 0.218 ) . GL was not significantly associated with RCC risk ( summary RR 1.14 , 95 % CI 0.81 - 1.60 ) , and significant heterogeneity was found across studies ( I2 = 78.6 % , P < 0.001 ) . In conclusion , this systematic review and meta- analysis suggests that dietary GI and fiber may be associated with the risk of RCC . Further large prospect i ve cohort studies are still warranted to confirm our preliminary findings BACKGROUND Nerve entrapment , common in diabetes , is considered an associated phenomenon without large consequence in the development of diabetes complications such as ulceration , infection , amputation , and early mortality . This prospect i ve analysis , with controls , of the ulcer recurrence rate after operative nerve decompression ( ND ) offers an objective perspective on the possibility of frequent occult nerve entrapment in the diabetic foot complication cascade . METHODS A multicenter cohort of 42 patients with diabetic sensorimotor polyneuropathy , failed pharmacologic pain control , palpable pulses , and at least one positive Tinel 's nerve percussion sign was treated with unilateral multiple lower-leg external neurolyses for the indication of pain . All of the patients had healed at least one previous ipsilateral plantar diabetic foot ulceration ( DFU ) . This group was retrospectively evaluated a minimum of 12 months after operative ND and again 3 years later . The recurrence risk of ipsilateral DFU in that period was prospect ively analyzed and compared with new ulcer occurrence in the contralateral intact , nonoperated control legs . RESULTS Operated legs developed two ulcer recurrences ( 4.8 % ) , and nine contralateral control legs developed ulcers ( 21.4 % ) , requiring three amputations . Ulcer risk is 1.6 % per patient per year in ND legs and 7 % in nonoperated control legs ( P = .048 ) . CONCLUSIONS Adding operative ND at lower-leg fibro-osseous tunnels to st and ard postulcer treatment result ed in a significantly diminished rate of subsequent DFU in neuropathic high-risk feet . This is prospect i ve , objective evidence that ND can provide valuable ongoing protection from DFU recurrence , even years after primary ulcer healing UNLABELLED In June 2008 , the Medical Advisory Secretariat began work on the Diabetes Strategy Evidence Project , an evidence -based review of the literature surrounding strategies for successful management and treatment of diabetes . This project came about when the Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the Ministry 's newly released Diabetes Strategy .After an initial review of the strategy and consultation with experts , the secretariat identified five key areas in which evidence was needed . Evidence -based analyses have been prepared for each of these five areas : insulin pumps , behavioural interventions , bariatric surgery , home telemonitoring , and community based care . For each area , an economic analysis was completed where appropriate and is described in a separate report . To review these titles within the Diabetes Strategy Evidence series , please visit the Medical Advisory Secretariat Web site , http://www.health.gov.on.ca/english/providers/program/mas/mas_about.html,DIABETES STRATEGY EVIDENCE PLATFORM : Summary of Evidence -Based AnalysesContinuous Subcutaneous Insulin Infusion Pumps for Type 1 and Type 2 Adult Diabetics : An Evidence -Based Analysis Behavioural Interventions for Type 2 Diabetes : An Evidence -Based Analysis  BARIATRIC SURGERY FOR PEOPLE WITH DIABETES AND MORBID OBESITY : An Evidence -Based Summary Community-Based Care for the Management of Type 2 Diabetes : An Evidence -Based Analysis Home Telemonitoring for Type 2 Diabetes : An Evidence -Based Analysis Application of the Ontario Diabetes Economic Model ( ODEM ) to Determine the Cost-effectiveness and Budget Impact of Selected Type 2 Diabetes Interventions in Ontario OBJECTIVE The objective of this report is to determine whether behavioural interventions are effective in improving glycemic control in adults with type 2 diabetes . BACKGROUND Diabetes is a serious chronic condition affecting millions of people worldwide and is the sixth leading cause of death in Canada . In 2005 , an estimated 8.8 % of Ontario 's population had diabetes , representing more than 816,000 Ontarians . The direct health care cost of diabetes was $ 1.76 billion in the year 2000 and is projected to rise to a total cost of $ 3.14 billion by 2016 . Much of this cost arises from the serious long-term complications associated with the disease including : coronary heart disease , stroke , adult blindness , limb amputations and kidney disease . Type 2 diabetes accounts for 90 - 95 % of diabetes and while type 2 diabetes is more prevalent in people aged 40 years and older , prevalence in younger population s is increasing due to a rise in obesity and physical inactivity in children . Data from the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) has shown that tight glycemic control can significantly reduce the risk of developing serious complications in type 2 diabetics . Despite physicians ' and patients ' knowledge of the importance of glycemic control , Canadian data has shown that only 38 % of patients with diabetes have HbA1C levels in the optimal range of 7 % or less . This statistic highlights the complexities involved in the management of diabetes , which is characterized by extensive patient involvement in addition to the support provided by physicians . An enormous dem and is , therefore , placed on patients to self-manage the physical , emotional and psychological aspects of living with a chronic illness . Despite differences in individual needs to cope with diabetes , there is general agreement for the necessity of supportive programs for patient self-management . While traditional programs were didactic models with the goal of improving patients ' knowledge of their disease , current models focus on behavioural approaches aim ed at providing patients with the skills and strategies required to promote and change their behaviour . Several meta-analyses and systematic review s have demonstrated improved health outcomes with  self-management support programs in type 2 diabetics . They have all , however , either looked at a specific component of self-management support programs ( i.e. self-management education ) or have been conducted in specific population s. Most review s are also qualitative and do not clearly define the interventions of interest , making findings difficult to interpret . Moreover , heterogeneity in the interventions has led to conflicting evidence on the components of effective programs . There is thus much uncertainty regarding the optimal design and delivery of these programs by policymakers . EVIDENCE -BASED ANALYSIS OF EFFECTIVENESS : RESEARCH QUESTIONS Are behavioural interventions  effective in improving glycemic control in adults with type 2 diabetes?Is the effectiveness of the intervention impacted by intervention characteristics ( e.g. delivery of intervention , length of intervention , mode of instruction , interventionist etc . ) ? INCLUSION CRITERIA English Language Published between January 1996 to August 2008 Type 2 diabetic adult population ( > 18 years)R and omized controlled trials ( RCTs ) Systematic review s , or meta-analyses Describing a multi-faceted self-management support intervention as defined by the 2007 Self-Management Mapping Guide (1)Reporting outcomes of glycemic control ( HbA1c ) with extractable data Studies with a minimum of 6-month follow up EXCLUSION CRITERIA Studies with a control group other than usual care Studies with a sample size < 30 Studies without a clearly defined intervention OUTCOMES OF INTEREST PRIMARY OUTCOME glycemic control ( HbA1c ) SECONDARY OUTCOMES systolic blood pressure ( SBP ) control , lipid control , change in smoking status , weight change , quality of life , knowledge , self-efficacy , managing psychosocial aspects of diabetes , assessing dissatisfaction and readiness to change , and setting and achieving diabetes goals . SEARCH STRATEGY A search was performed in OVID MEDLINE , MEDLINE In-Process and Other Non-Indexed Citations , EMBASE , the Cumulative Index to Nursing & Allied Health Literature ( CINAHL ) , The Cochrane Library , and the International Agency for Health Technology Assessment ( INAHTA ) for studies published between January 1996 and August 2008 . Abstract s were review ed by a single author and studies meeting the inclusion criteria outlined above were obtained . Data on population characteristics , glycemic control outcomes , and study design were extracted . Reference lists were also checked for relevant studies . The quality of the evidence was assessed as being either high , moderate , low , or very low according to the GRADE methodology . SUMMARY OF FINDINGS The search identified 638 citations published between 1996 and August 2008 , of which 12 met the inclusion criteria and one was a meta- analysis ( Gary et al. 2003 ) . The remaining 11 studies were RCTs ( 9 were used in the meta- analysis ) and only one was defined as small ( total sample size N=47 ) . SUMMARY OF PARTICIPANT DEMOGRAPHICS ACROSS STUDIES : A total of 2,549 participants were included in the 11 identified studies . The mean age of participants reported was approximately 58 years and the mean duration of diabetes was approximately 6 years . Most studies reported gender with a mean percentage of females of approximately 67 % . Of the eleven studies , two focused only on women and four included only Hispanic individuals . All studies evaluated type 2 diabetes patients exclusively . STUDY CHARACTERISTICS : The studies were conducted between 2002 and 2008 . Approximately six of 11 studies were carried out within the USA , with the remaining studies conducted in the UK , Sweden , and Israel ( sample size ranged from 47 to 824 participants ) . The quality of the studies ranged from moderate to low with four of the studies being of moderate quality and the remaining seven of low quality ( based on the Consort Checklist ) . Differences in quality were mainly due to method ological issues such as inadequate description of r and omization , sample size calculation allocation concealment , blinding and uncertainty of the use of intention-to-treat ( ITT ) analysis . Patients were recruited from several setting s : six studies from primary or general medical practice s , three studies from the community ( e.g. via advertisements ) , and two from outpatient diabetes clinics . A usual care control group was reported in nine of 11 of the studies and two studies reported some type of minimal diabetes care in addition to usual care for the control group . INTERVENTION CHARACTERISTICS : All of the interventions examined in the studies were mapped to the 2007 Self-management Mapping Guide . The interventions most often focused on problem solving , goal setting and encouraging participants to engage in activities that protect and promote health ( e.g. modifying behaviour , change in diet , and increase physical activity ) . All of the studies examined comprehensive interventions targeted at least two self-care topics ( e.g. diet , physical activity , blood glucose monitoring , foot care , etc . ) . Despite the homogeneity in the aims of the interventions , there was substantial clinical heterogeneity in other intervention characteristics such as duration , intensity , setting , mode of delivery ( group vs. individual ) , interventionist , and outcomes of interest ( discussed below ) . DURATION , INTENSITY AND MODE OF DELIVERY : Intervention duration s ranged from 2 days to 1 year , with many falling into the range of 6 to 10 weeks . The rest of the interventions fell into categories of ≤ 2 weeks ( 2 studies ) , 6 months ( 2 studies ) , or 1 year ( 3 studies ) . Intensity of the interventions varied widely from 6 hours over 2 days , to 52 hours over 1 year ; however , the majority consisted of interventions of 6 to 15 hours . Both individual and group sessions were used to deliver interventions . Group counselling was used in five studies as a mode of instruction , three studies used both individual and group sessions , and one study used individual sessions as its sole mode of instruction . ( ABSTRACT The publication of the U.K. Prospect i ve Diabetes Study ( UKPDS ) in 1998 helped to shape the management of type 2 diabetes in recent years ( 1 ) . The study demonstrated several points . First , sulfonylureas are as safe as insulin in controlling blood glucose . Second , metformin reduced cardiovascular disease in an overweight subgroup . Third , the same benefit of glycemic control in reducing microvascular disease ( previously noted in type 1 diabetes ) is applied equally to patients with type 2 diabetes . A separation in A1C of ∼1 % in the UKPDS reduced the risk of microvascular disease ( largely diabetic retinopathy ) by ∼25 % . This reflected the data from the Diabetes Control and Complications Trial , where a separation in A1C of 2 % in intensive and st and ard groups led to a reduction in microvascular disease of ∼50 % ( 2 ) . A fourth demonstration was that there was no significant reduction in macrovascular disease but a trend toward fewer myocardial infa rct ions with more intensive glucose control . Fifth , using the current treatment of the time ( first-generation sulfonylureas , human ultratard insulin , or metformin ) , it proved impossible to maintain glucose control , which tended to deteriorate throughout the study . It is now generally believed that the progressive fall in endogenous insulin production as β-cell numbers decline makes it difficult , if not impossible , to maintain tight control using st and ard treatment . Sixth , the UKPDS also showed that in those patients with hypertension , lowering blood pressure ( BP ) to moderate levels with either captopril or atenolol could reduce microvascular disease ( 3 ) . In a subsequent study , the UKPDS investigators presented the rates of both micro- and macrovascular disease according to the achieved levels of A1C during the study ( 4 ) . They showed a linear relationship between A1C and both groups of complications . The implication of the article was that if glycemic control could be tightened below the levels achieved in the UKPDS , then it might be possible to reduce rates , not only of microvascular complications , but also cardiovascular disease as well . The aim of the glucose arm of the Action in Diabetes and Vascular Disease : Preterax and Diamicron MR Controlled Evaluation ( ADVANCE ) trial ( 5 ) was to build on the information gained by the UKPDS and to answer the question as to whether intensifying glucose control to achieve an A1C of < 6.5 % would provide additional benefit in reducing the risk of both micro- and macrovascular disease . ADVANCE also asked questions about BP lowering in patients with type 2 diabetes . The aims of the BP arm were to establish whether routine provision of  BP-lowering therapy  produced additional benefits in terms of macro- and microvascular disease , irrespective of baseline BP , and added to the benefits produced by other cardiovascular preventive therapies , including ACE inhibitors Traditional clinical review articles , also known as up date s , differ from systematic review s and meta-analyses . Up date s selectively review the medical literature while discussing a topic broadly . Non-quantitative systematic review s comprehensively examine the medical literature , seeking to identify and synthesize all relevant information to formulate the best approach to diagnosis or treatment . Meta-analyses ( quantitative systematic review s ) seek to answer a focused clinical question , using rigorous statistical analysis of pooled research studies . This article presents guidelines for writing an evidence -based clinical review article for American Family Physician . First , the topic should be of common interest and relevance to family practice . Include a table of the continuing medical education objectives of the review . State how the literature search was done and include several sources of evidence -based review s , such as the Cochrane Collaboration , BMJ 's Clinical Evidence , or the InfoRetriever Web site . Where possible , use evidence based on clinical outcomes relating to morbidity , mortality , or quality of life , and studies of primary care population s. In articles su bmi tted to American Family Physician , rate the level of evidence for key recommendations according to the following scale : level A ( r and omized controlled trial [ RCT ] , meta- analysis ) ; level B ( other evidence ) ; level C ( consensus/expert opinion ) . Finally , provide a table of key summary points The sum of evidence -based nutrition has to be more than a Cochrane-type meta- analysis of r and omised controlled trials ( RCTs ) . Most of the evidence base in nutrition is observational , especially cohort studies . RCTs of diet change through to disease outcome are uncommon and the change has usually been addition or removal of only a single food component . Trials with whole diets through to disease outcome are rare and dietary changes made by individuals are unlikely to be an exact copy of the prescription . It is hard to even imagine a trial in which half ( r and omised ) of a large group of middle-aged people agree to avoid vegetables for 5 y and be followed up to see who will develop cancer . Most of the USA 's health cl aims , permitted by the Food and Drug Administration , are not supported by RCTs . But where controlled trials of nutritional change and disease outcome have been achieved , they must be review ed very carefully . Two Cochrane review s on diet and cardiovascular disease ( CVD ) , published in the widely read British Medical Journal ( BMJ ) , were criticised after their publication and the conclusions have not been subsequently adopted by expert committees . The first of these review s was ‘ Dietary fat and prevention of CVD : a systematic review ’ . The second was ‘ Systematic review of long term effects of advice to reduce dietary salt in adults ’ . A critique of these two Cochrane review s is presented here as a contribution to our discussion of the potential of Cochrane methodology to the reliability of knowledge about diet and disease After polypectomy for adenomatous colorectal polyps , 201 persons were r and omized to receive counselling on a diet low in fat ( the lesser of 50 g/day or 20 % of energy ) and high in fibre ( 50 g/day ) ( LFHF ) , or to follow a normal western diet ( ND ) , high in fat and low in fibre . After 12 months of counselling , fat consumption was about 25 % of energy in the LFHF group and 33 % in the ND group ; fibre consumption was 35 g and 16 g respectively . After an average of two years of follow-up , an intention to treat analysis led to a ratio of cumulative incidence rates of 1.2 ( 95 % CL 0.6 - 2.2 ) for recurrence of neoplastic polyps , a finding which suggests no significant difference between dietary groups over the period of observation . An exploratory analysis conducted among 142 persons with substantial diet counselling indicated a reduced risk of neoplastic polyp recurrence in women ( RR = 0.5 ) , associated with reduced concentrations of faecal bile acids while on the LFHF diet , but indicated an increased risk of recurrence in men ( RR = 2.1 ) , associated with increased faecal bile acids . Although a larger study would be needed to rule out the role of chance , these findings of gender-specific associations between diet counselling and both faecal bile acid concentrations and recurrence of colorectal neoplasia are consistent with recently published evidence of differences between genders OBJECTIVES To propose methods for mixed treatment comparisons ( MTC ) based on pooled summaries of the type produced in overviews of review s. STUDY DESIGN AND SETTING Overviews of review s ( umbrella review s ) summarize the results of multiple systematic review s into a single document . They report the summary estimates from the original pairwise meta-analyses and discuss them in narrative form , with the intention of identifying the most effective treatment . We present methods for MTC synthesis , tailored for use with overviews of review s. These generate a single internally consistent summary of all the relative treatment effects and assessment s of whether the summary is consistent with the data . These methods are applied to a published overview of treatments for childhood nocturnal enuresis . We apply the methods to both fixed-effect ( FE ) and r and om-effects ( RE ) meta-analyses of the original trials . RESULTS The summary relative risks based on FE meta-analyses , as originally published , were highly inconsistent . Those based on RE meta-analyses were consistent and could , given st and ard assumptions on comparability of treatment effects in meta- analysis , form a basis for coherent decision making . CONCLUSION Along with the summaries from systematic review s , MTC methods should be used in overviews to provide a single coherent analysis of all treatment comparisons and to check for evidence consistency Prognostic markers help to stratify patients for treatment by identifying patients with different risks of outcome ( e.g. recurrence of disease ) , and are important tools in the management of cancer and many other diseases . Systematic review and meta-analytical approaches to identifying the most valuable prognostic markers are needed because ( sometimes conflicting ) evidence relating to markers is often published across a number of studies . To investigate the practicality of this approach , an empirical investigation of a systematic review of  tumour markers for neuroblastoma was performed ; 260 studies of prognostic markers were identified , which considered 130 different markers . The reporting of these studies was often inadequate , in terms of both statistical analysis and presentation , and there was considerable heterogeneity for many important clinical /statistical factors . These problems restricted both the extraction of data and the meta- analysis of results from the primary studies , limiting feasibility of the evidence -based approach . Guidelines for reporting the results of primary prognostic marker studies in cancer , and other diseases , are given in order to facilitate both the interpretation of individual studies and the undertaking of systematic review s , meta- analysis and , ultimately , evidence -based practice . General availability of full individual patient data is a necessary step forward and would overcome the majority of problems encountered , including poorly reported summary statistics and variability in cutoff level , outcome assessed and adjustment factors used . It would also limit the problem of reporting bias , although publication bias will remain a concern until studies are prospect ively registered . Such changes in practice would help important evidence -based review s to be conducted in order to establish the most appropriate prognostic markers for clinical use , which should ultimately improve patient care AIMS --The therapeutic efficacy of the continuous wave ( CW ) Nd : YAG laser ( working in the free running mode ) was investigated in proliferative diabetic retinopathy ( PDR ) comparing it with a conventional laser source such as the krypton laser . METHODS --Twenty four eyes of 12 patients affected with bilateral PDR were included and divided in two groups . The right eyes were treated with a red krypton laser and the left eyes with a CW Nd : YAG laser . RESULTS --Three months after krypton photocoagulation 10 eyes showed a reduction or a complete regression of PDR and two eyes were unchanged . In the CW Nd : YAG laser group no eyes showed any regression of new vessels , in seven eyes the angiographic features were unchanged , and in five eyes they worsened . All the eyes of the second group underwent retreatment with the krypton laser after 3 or 6 months . After a mean follow up of 13 months all eyes in the krypton group showed a reduction or complete regression of PDR ; in the retreated group 10 eyes improved and two were unchanged . CONCLUSIONS --The statistical analysis showed a highly significant difference ( p = 0.001 ) between krypton and CW Nd : YAG laser which indicated the lack of efficacy of the latter in the treatment of PDR . In the krypton laser group no significant difference ( p = 0.05 ) after the retreatment was found confirming the efficacy of this treatment ABSTRACT Background : Decisions regarding diabetes management traditionally have been driven by the results of fasting plasma glucose measurement or measurement of glycosylated hemoglobin ( A1C ) , yet glycemic control remains far from optimal in many individuals with diabetes . Mounting evidence implicates glycemic variability , manifested predominantly as postpr and ial glycemic spikes , as a key factor in the development of macrovascular complications . Recent studies suggest that newer therapies specifically targeting postpr and ial hyperglycemia can significantly reduce postpr and ial glucose levels and improve overall glycemic control . Methods : A Medline search was performed using the term ‘ postchallenge ’ or ‘ postpr and ial ’ , together with glucose or diabetes . After excluding review articles and case studies , we review ed primary articles , meta-analyses , and references therein and selected those that best addressed this topic . Selection bias may be considered a potential limitation of this approach . Findings : Although not conclusively demonstrated by prospect i ve studies , a wealth of evidence suggests that postpr and ial hyperglycemia should not be ignored as an important target for preventing complications of diabetes . Conclusions : Improved detection and management of postpr and ial hyperglycemia and glycemic variability is necessary to optimize glycemic control . Meal-based self-monitoring of blood glucose ( SMBG ) has been shown to improve glycemic control as part of a comprehensive management strategy by helping patients underst and the effects of food choices , physical activity , and medications on blood glucose concentrations . SMBG can also help healthcare professionals recognize postpr and ial hyperglycemia , guide therapeutic adjustments and receive more timely feedback regarding medication changes . The arrival of new therapies that specifically target postpr and ial hyperglycemia offer healthcare professionals the opportunity to optimally manage diabetes Introduction : The aim of this quantitative systematic review /meta- analysis was to compare the treatment outcomes of mineral trioxide aggregate ( MTA ) and calcium hydroxide ( CH ) in pulpotomy of human primary molars . The focused PICO question was “ in case of pulp exposure in vital primary molars , how does MTA pulpotomy compare to CH in terms of clinical /radiographic success ? ” Methods and Material s : We retrieved published r and omized clinical trials ( RCTs ) of at least 6-month duration ; our search included articles published up to March 2013 in five following data bases : PubMed ( Medline ) , Cochrane data base of systematic review s , Science Citation Index , EMBASE , and Google Scholar . Mantel Haenszel and Inverse Variance-weighted methods were applied by STATA ; the relative risk ( RR ) was calculated with 95 % confidence intervals ( CI ) . Results : A total of 282 English articles were collected . Two authors independently screened the articles and five RCTs were selected ; data extraction and quality assessment were then carried out . Four RCTs were appropriate for meta- analysis according to their follow-up times by Mantel Haenszel method . Statistically significant difference was found between success rate of MTA compared to CH , with RR=0.08 ( 95 % CI , 0.02 - 0.39 ) , RR=0.19 ( 95 % CI , 0.08 - 0.46 ) , and RR=0.38 ( 95 % CI , 0.21 - 0.68 ) for 6- , 12- , and 24-month follow-ups , respectively . A significant difference was also observed for all included RCTs after analyses using the Inverse Variance-weighted method ( RR=0.44 ; 95 % CI , 0.27 - 0.72 ) . Conclusions : Systematic review /meta- analysis of included RCTs revealed that for pulpotomy of vital primary molars , MTA has better treatment outcomes compared to CH BACKGROUND Recent cross-sectional studies suggest some adolescents who have never smoked cigarettes experience nicotine dependence ( ND ) symptoms and that exposure to second-h and smoke , social exposure to smoking , and alcohol use are plausible correlates . The aim of this study was to replicate and extend these findings by investigating possible predictors of ND symptoms longitudinally . METHOD Participants included 847 secondary school students who had never smoked cigarettes enrolled in the Nicotine Dependence in Teens Study . Adolescents completed self-report question naires measuring smoking status , ND symptoms , and risk factors for ND in smokers ( i.e. , socio-demographic indicators , social exposure to smoking , psychosocial indicators , and substance use ) in 20 survey cycles from 7 to 11th grade . Generalized estimating equations , which account for repeated measures within individuals , were used to test the predictors of ND symptoms . RESULTS Consistent with previous research , 7.8 % of never-smokers across all cycles endorsed at least one ND symptom . Younger age ( p ≤ .001 ) , country of birth ( p ≤ .05 ) , peer smoking ( p ≤ .001 ) , teacher smoking ( p ≤ .05 ) , depression ( p ≤ .05 ) , stress ( p ≤ .001 ) , lower self-esteem ( p ≤ .05 ) , impulsivity ( p ≤ .05 ) , and alcohol use ( p ≤ .001 ) predicted greater ND symptoms in multivariable modeling . CONCLUSIONS Replicating previous cross-sectional findings , peer smoking and alcohol use predicted ND symptoms among never-smoking adolescents . Extending these findings , previous predictors only observed among ever-smokers , including socio-demographic and psychosocial indicators , also predicted ND symptoms . This longitudinal investigation demonstrated the temporal relation of the predictors preceding ND symptoms . Future research should consider longer prospect i ve studies with younger children to capture early onset of ND symptoms and with longer follow-up to detect eventual smoking uptake Background Mobile health apps for diabetes self-management have different functions . However , the efficacy and safety of each function are not well studied , and no classification is available for these functions . Objective The aims of this study were to ( 1 ) develop and vali date a taxonomy of apps for diabetes self-management , ( 2 ) investigate the glycemic efficacy of  mobile app-based interventions among adults with diabetes in a systematic review of r and omized controlled trials ( RCTs ) , and ( 3 ) explore the contribution of different function to the effectiveness of entire app-based interventions using the taxonomy . Methods We developed a 3-axis taxonomy with columns of clinical modules , rows of functional modules and cells of functions with risk assessment s. This taxonomy was vali date d by review ing and classifying commercially available diabetes apps . We search ed MEDLINE , EMBASE , the Cochrane Central Register of Controlled Trials , the Chinese Biomedical Literature Data base , and Clinical Trials.gov from January 2007 to May 2016 . We included RCTs of adult out patients with diabetes that compared using  mobile app-based interventions with usual care alone . The mean differences ( MDs ) in hemoglobin A1c ( HbA1c ) concentrations and risk ratios of adverse events were pooled using a r and om-effects meta- analysis . After taxonomic classification , we performed exploratory subgroup analyses of the presence or absence of each module across the included app-based interventions . Results Across 12 included trials involving 974 participants , using app-based interventions was associated with a clinical ly significant reduction of HbA1c ( MD 0.48 % , 95 % CI 0.19%-0.78 % ) without excess adverse events . Larger HbA1c reductions were noted among patients with type 2 diabetes than those with type 1 diabetes ( MD 0.67 % , 95 % CI 0.30%-1.03 % vs MD 0.37 % , 95 % CI –0.12%-0.86 % ) . Having a complication prevention module in app-based interventions was associated with a greater HbA1c reduction ( with complication prevention : MD 1.31 % , 95 % CI 0.66%-1.96 % vs without : MD 0.38 % , 95 % CI 0.09%-0.67 % ; intersubgroup P=.01 ) , as was having a structured display ( with structured display : MD 0.69 % , 95 % CI 0.32%-1.06 % vs without : MD 0.69 % , 95 % CI –0.18%-0.53 % ; intersubgroup P=.03 ) . However , having a clinical decision-making function was not associated with a larger HbA1c reduction ( with clinical decision making : MD 0.19 % , 95 % CI –0.24%-0.63 % vs without : MD 0.61 % , 95 % CI 0.27%-0.95 % ; intersubgroup P=.14 ) . Conclusions The use of mobile app-based interventions yields a clinical ly significant HbA1c reduction among adult out patients with diabetes , especially among those with type 2 diabetes . Our study suggests that the clinical decision-making function needs further improvement and evaluation before being added to apps Background Calcium ( Ca ) is an essential nutrient for the human body . Despite lively research , there is uncertainty about Ca requirements in terms of desirable health outcomes including an upper intake level above which the potential for harm increases . Objectives The aim was to conduct a review to up date requirements and desirable or harmful health effects of Ca on the current scientific evidence . Methods We search ed Medline and Swemed from January 2000 to December 2011 and included all systematic review s that reported Ca supplementation or usual Ca intake on health outcomes . Meta-analyses , r and omized clinical trials and cohort studies were included in the second search between May 2009 and March 2011 and an additional search covering studies till the end of 2011 . This review concentrated on studies reporting independent effects of Ca , although a few recent trials report sole effects of Ca on health outcomes , most trials use Ca in combination with vitamin D vs. placebo . Results In total , we review ed 38 studies addressing the effects of Ca on bone , pregnancy-related outcomes , cancers , cardiovascular outcomes , obesity , and mortality .  There was a lot of heterogeneity in the study protocol s , which made it difficult to draw any strong conclusions . According to the literature , high Ca intake seems to have a small positive effect on bone mineral content ( BMC ) or bone mineral density ( BMD ) in children and postmenopausal women . We did not find any consistent evidence on the effects of Ca on bone health in premenopausal women or men . Also , the evidence that Ca supplementation reduces fracture incidence is scarce and inconsistent . Maternal diet may influence the peak bone mass of offspring but more studies are required . There was no overall effect of Ca intake on cancers . Ca was associated with a decreased risk of breast cancer and a slightly increased risk of prostate cancer in two of the three studies . No associations were found with other cancers . We found no consistent association between cardiovascular outcomes and  Ca  intake except for blood pressure . A small decrease of 2–4 mmHg in systolic blood pressure was found in pregnant and in hypertensive subjects with Ca supplementation . Review ed studies did not show consistent evidence relating Ca intake to either mortality or obesity . Conclusion Based on this evidence , there is no need to change the Nordic recommendations for Ca intake . However , due to heterogeneity in the studies it is difficult to interpret the results and provide single summary statement Background The role of vitamin D in management of depression is unclear . Results from observational and emerging r and omized controlled trials ( RCTs ) investigating the efficacy of vitamin D in depression lack consistency - with some suggesting a positive association while others show a negative or inconclusive association . Methods / Design The primary aim of this study is to conduct a systematic review of RCTs to assess the effect of oral vitamin D supplementation versus placebo on depression symptoms measured by scales and the proportion of patients with symptomatic improvement according to the authors ’ original definition . Secondary aims include assessing the change in quality of life , adverse events and treatment discontinuation . We will conduct the systematic review and meta- analysis according to the recommendations of the Cochrane H and book for Systematic Review s of Interventions . We will search the Cochrane Central Register of Controlled Trials ( CENTRAL ) , MEDLINE ( 1966 to present ) , EMBASE ( 1980 to present ) , CINAHL ( 1982 to present ) , PsychINFO ( 1967 to present ) and Clinical Trials.gov . Unpublished work will be identified by search ing two major conferences : the International Vitamin Conference , the Anxiety Disorders and Depression Conference , while grey literature will be acquired by contacting authors of included studies . We will use the r and om-effects meta- analysis to synthesize the data by pooling the results of included studies . Discussion The results of this systematic review will be helpful in clarifying the efficacy of vitamin D supplementation and providing evidence to establish guidelines for implementation of vitamin D for depression in general practice and other relevant setting s. Study registration Unique identifier : CRD42013003849 BACKGROUND In several intervention trials , a healthy Nordic diet showed beneficial effects on markers of cardiovascular disease . We investigated the association between a healthy Nordic diet and clinical diagnosis of cardiovascular disease . OBJECTIVE Our aim was first to examine the association between a healthy Nordic food index ( wholegrain bread , oatmeal , apples/pears , root vegetables , cabbages and fish ) and the incidence of overall cardiovascular disease ( ischaemic heart disease , stroke , arrhythmia , thrombosis and hypertensive disease ) , and secondly to test for possible effect modification by smoking , body mass index ( BMI ) , alcohol consumption and age . METHODS We conducted an analysis of data from the prospect i ve Swedish Women 's Lifestyle and Health cohort , including 43 310 women who completed a food frequency question naire in 1991 - 1992 , and followed up until 31 December 2012 through Swedish registries .  Hazard ratios ( HRs ) and 95 % confidence intervals ( CIs ) were calculated using Cox proportional hazards models . RESULTS During follow-up , 8383 women developed cardiovascular disease .  We found no association between the healthy Nordic food index and overall cardiovascular disease risk or any of the subgroups investigated . There was a statistically significant interaction with smoking status ( P = 0.02 ) , with a beneficial effect only amongst former smokers ( HR 0.96 , 95 % CI 0.94 - 0.99 per 1-point increment ) . CONCLUSION The present results do not support an association between a  healthy Nordic food index and risk of cardiovascular disease in Swedish women . There was also no effect modification by alcohol intake , BMI or age . Our finding of an interaction with smoking status requires reproduction AIM To investigate the effects of a low fermentable , oligosaccharides , disaccharides , monosaccharides and polyols diet ( LFD ) and the probiotic Lactobacillus rhamnosus GG ( LGG ) in irritable bowel syndrome ( IBS ) . METHODS R and omised , unblinded controlled trial on the effect of 6-wk treatment with LFD , LGG or a normal Danish/Western diet ( ND )  in patients with IBS fulfilling Rome III diagnostic criteria , recruited between November 2009 and April 2013 . Patients were required to complete on a weekly basis the IBS severity score system ( IBS-SSS ) and IBS quality of life ( IBS-QOL ) question naires in a specially developed IBS web self-monitoring application . We investigated whether LFD or LGG could reduce IBS-SSS and improve QOL in IBS patients . RESULTS One hundred twenty-three patients ( median age 37 years , range : 18 - 74 years ) , 90 ( 73 % ) females were r and omised : 42 to LFD , 41 to LGG and 40 to ND . A significant reduction in mean ± SD of IBS-SSS from baseline to week 6 between LFD vs LGG vs ND was revealed : 133 ± 122 vs 68 ± 107 , 133 ± 122 vs 34 ± 95 , P < 0.01 . Adjusted changes of IBS-SSS for baseline covariates showed statistically significant reduction of IBS-SSS in LFD group compared to ND ( IBS-SSS score 75 ; 95%CI : 24 - 126 , P < 0.01 ) , but not in LGG compared to ND ( IBS-SSS score 32 ; 95%CI : 18 - 80 , P = 0.20 ) . IBS-QOL was not altered significantly in any of the three groups : mean ± SD in LFD 8 ± 18 vs LGG 7 ± 17 , LFD 8 ± 18 vs ND 0.1 ± 15 , P = 0.13 . CONCLUSION Both LFD and LGG are efficatious in patients with IBS Background Despite lack of outward signs , most individuals after non-disabling stroke ( NDS ) and transient ischemic attack ( TIA ) have significant cardiovascular and cerebrovascular disease and are at high risk of a major stroke , hospitalization for other vascular events , or death . Most have multiple modifiable risk factors ( e.g. , hypertension , physical inactivity , hyperlipidaemia , diabetes , tobacco consumption , psychological stress ) . In addition , accelerated rates of depression , cognitive decline , and poor quality of sleep have been reported following TIA , which correlate with poor functional outcomes and reduced quality of life . Thus , NSD and TIA are important warning signs that should not be overlooked . The challenge is not unlike that facing other ' silent ' conditions - to identify a model of care that is effective in changing people 's current behaviors in order to avert further morbidity . Methods / Design A single blind , r and omized controlled trial will be conducted at two sites to compare the effectiveness of a program of rehabilitative exercise and education versus usual care in modifying vascular risk factors in adults after NDS/TIA . 250 adults within 90 days of being diagnosed with NDS/TIA will be r and omly allocated to a 12-week program of exercise and education ( PREVENT ) or to an outpatient clinic assessment and discussion of secondary prevention recommendations with return clinic visits as indicated ( USUAL CARE ) . Primary outcome measures will include blood pressure , waist circumference , 12-hour fasting lipid profile , and 12-hour fasting glucose/hemoglobin A1c . Secondary measures will include exercise capacity , walking endurance , physical activity , cognitive function , depression , goal attainment and health-related quality of life . Outcome assessment will be conducted at baseline , post-intervention , and 6- and 12-month follow-ups . Direct health care costs incurred over one year by PREVENT versus USUAL CARE participants will also be compared . Ethical approval for the trial has been obtained from the relevant Human Research Ethics Boards . Discussion Whether timely delivery of an adapted cardiac rehabilitation model is effective in attaining and maintaining vascular risk reduction targets in adults after NDS/TIA is not yet known . We anticipate that the findings of this trial will make a meaningful contribution to the knowledge base regarding secondary stroke prevention . Trial registration This trial is registered with the Clinical Trials.gov Registry ( NCT00885456 ) 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
This dietary pattern did not significantly affect 2-h post-pr and ial blood glucose and Matsuda index .
Conclusions Adherence to the ND might improve serum insulin and HOMA-IR levels ; however , this effect was not confirmed for other markers of blood glucose control .
Aims Investigations on the possible effect of the Nordic diet ( ND ) on the glycemic control and the risk of diabetes have led to inconsistent results .
The present study tried to determine the effect of the ND on the markers of blood glucose control using a systematic review and meta- analysis of r and omized controlled clinical trials ( RCTs ) .