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Introduction While a number of strategies are being implemented to control cardiovascular diseases ( CVDs ) and type 2 diabetes mellitus ( T2DM ) , the cost-effectiveness of these in the South Asian context has not been systematic ally evaluated . We aim to systematic ally review the economic ( cost-effectiveness ) evidence available on the individual- , group- and population -level interventions for control of CVD and T2DM in South Asia . Methods and analysis This review will consider all relevant economic evaluations , either conducted alongside r and omised controlled trials or based on decision modelling estimates . These studies must include participants at risk of developing CVD/T2DM or with established disease in one or more of the South Asian countries ( India , Bangladesh , Pakistan , Sri Lanka , Nepal , Maldives , Bhutan and Afghanistan ) . We will identify relevant papers by systematic ally search ing all major data bases and registries . Selected articles will be screened by two independent research ers . Method ological quality of the studies will be assessed using a modified Drummond and a Phillips checklist . Cochrane guidelines will be followed for bias assessment in the effectiveness studies . Results Results will be presented in line with the PRISMA ( Preferred Reporting Items for Systematic review and Meta- analysis ) checklist , and overall quality of evidence will be presented as per the GRADE ( Grade s of Recommendation , Assessment , Development and Evaluation ) approach . Ethics and dissemination The study has received ethics approval from the All India Institute of Medical Sciences , New Delhi , India . The results of this review will provide policy-relevant recommendations for the uptake of cost-effectiveness evidence in prioritising decisions on essential chronic disease care packages for South Asia . Study registration number PROSPERO CRD42013006479 Abstract Aim To determine the effects of protein alone ( independent of fat and carbohydrate ) on postpr and ial glycaemia in individuals with Type 1 diabetes mellitus using intensive insulin therapy .  Methods Participants with Type 1 diabetes mellitus aged 7–40 years consumed six 150 ml whey isolate protein drinks [ 0 g ( control ) , 12.5 , 25 , 50 , 75 and 100 ] and two 150 ml glucose drinks ( 10 and 20 g ) without insulin , in r and omized order over 8 days , 4 h after the evening meal . Continuous glucose monitoring was used to assess postpr and ial glycaemia . Results Data were collected from 27 participants .  Protein loads of 12.5 and 50 g did not result in significant postpr and ial glycaemic excursions compared with control ( water ) throughout the 300 min study period ( P > 0.05 ) . Protein loads of 75 and 100 g result ed in lower glycaemic excursions than control in the 60–120 min postpr and ial interval , but higher excursions in the 180–300 min interval . In comparison with 20 g glucose , the large protein loads result ed in significantly delayed and sustained glucose excursions , commencing at 180 min and continuing to 5 h. Conclusions Seventy‐five grams or more of protein alone significantly increases postpr and ial glycaemia from 3 to 5 h in people with Type 1 diabetes mellitus using intensive insulin therapy . The glycaemic profiles result ing from high protein loads differ significantly from the excursion from glucose in terms of time to peak glucose and duration of the glycaemic excursion . This research supports recommendations for insulin dosing for large amounts of protein The effect of practicing yoga for the management of type II Diabetes  was assessed in this systematic review through search ing related electronic data bases and the grey literature to the end of May 2007 using Ovid . All r and omized controlled clinical trials ( RCTs ) comparing yoga practice with other type of intervention or with regular practice or both , were included regardless of language or type of publication . Each study was assessed for quality by two independent review ers . Mean difference was used for summarizing the effect of each study outcomes with 95 % confidence intervals . Pooling of the studies did not take place due to the wide clinical variation between the studies . Publication bias was assessed by statistical methods . Five trials with 363 participants met the inclusion criteria with medium to high risk of bias and different intervention characteristics . The studies ’ results show improvement in outcomes among patients with diabetes type II .  These improvements were mainly among short term or immediate diabetes outcomes and not all were statistically significant . The results were inconclusive and not significant for the long-term outcomes . No adverse effects were reported in any of the included studies . Short-term benefits for patients with diabetes  may be achieved from practicing yoga . Further research is needed in this area . Factors like quality of the trials and other method ological issues should be improved by large r and omized control trials with allocation concealment to assess the effectiveness of yoga on diabetes type II . A definitive recommendation for physicians to encourage their patients to practice yoga can not be reached at present There is growing evidence that yoga may offer a safe and cost-effective intervention for Type 2 Diabetes mellitus ( DM 2 ) . However , systematic review s are lacking . This article critically review s the published literature regarding the effects of yoga-based programs on physiologic and anthropometric risk profiles and related clinical outcomes in adults with DM 2 . We performed a comprehensive literature search using four computerized English and Indian scientific data bases . The search was restricted to original studies ( 1970–2006 ) that evaluated the metabolic and clinical effects of  yoga in adults with DM 2 . Studies targeting clinical population s with cardiovascular disorders that included adults with comorbid DM were also evaluated . Data were extracted regarding study design , setting , target population , intervention , comparison group or condition , outcome assessment , data analysis and presentation , follow-up , and key results , and the quality of each study was evaluated according to specific predetermined criteria . We identified 25 eligible studies , including 15 uncontrolled trials , 6 non-r and omized controlled trials and 4 r and omized controlled trials ( RCTs ) . Overall , these studies suggest beneficial changes in several risk indices , including glucose tolerance and insulin sensitivity , lipid profiles , anthropometric characteristics , blood pressure , oxidative stress , coagulation profiles , sympathetic activation and pulmonary function , as well as improvement in specific clinical outcomes .  Yoga may improve risk profiles in adults with DM 2 , and may have promise for the prevention and management of cardiovascular complications in this population . However , the limitations characterizing most studies preclude drawing firm conclusions . Additional high- quality RCTs are needed to confirm and further eluci date the effects of st and ardized yoga programs in population s with DM 2 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 Introduction Insulin analog glargine ( GLA ) has been available as one of the therapeutic options for patients with type 1 diabetes mellitus to enhance glycemic control . Studies have shown that a decrease in the frequency of hypoglycemic episodes improves the quality of life ( QoL ) of diabetic patients . However , there are appreciable acquisition cost differences between different insulins . Consequently , there is a need to assess their impact on QoL to provide future guidance to health authorities . Method A systematic review of multiple data bases including Medline , LILACS , Cochrane , and EMBASE data bases with several combinations of agreed terms involving r and omized controlled trials and cohorts , as well as manual search es and gray literature , was undertaken . The primary outcome measure was a change in QoL. The quality of the studies and the risk of bias was also assessed . Results Eight studies were eventually included in the systematic review out of 634 publications . Eight different QoL instruments were used ( two generic , two mixed , and four specific ) , in which the Diabetes Treatment Satisfaction Question naire ( DTSQ ) was the most used . The systematic review did not consistently show any significant difference overall in QoL scores , whether as part of subsets or combined into a single score , with the use of GLA versus neutral protamine Hagedorn ( NPH ) insulin . Only in patient satisfaction measured by DTSQ was a better result consistently seen with GLA versus NPH insulin , but not using the Well-being Inquiry for Diabetics ( WED ) scale . However , none of the cohort studies scored a maximum on the Newcastle – Ottawa scale for quality , and they generally were of moderate quality with bias in the studies . Conclusion There was no consistent difference in QoL or patient-reported outcomes when the findings from the eight studies were collated . In view of this , we believe the current price differential between GLA and NPH insulin in Brazil can not be justified by these findings OBJECTIVE The present study aim ed to compare the effects of a general dietary intervention and an intervention with low glycaemic load ( GL ) on glycaemic control , blood lipid metabolism and pregnancy outcomes in women with gestational diabetes mellitus . DESIGN Participants were r and omly assigned to two groups , receiving either an individualized general dietary intervention ( Control group ) or an intensive low-GL intervention ( Low-GL group ) every two weeks , from 24 - 26 weeks of gestation to delivery . SETTING The Center of Maternal Primary Care in Guangdong General Hospital , China . SUBJECTS Ninety-five women with gestational diabetes mellitus were enrolled from June 2008 to July 2009 . RESULTS After the intervention , both groups significantly decreased their dietary intakes of energy , fat and carbohydrate . The Low-GL group had significantly lower values for GL ( 122 v. 136 ) and glycaemic index ( 50 v. 54 ) but greater dietary fibre intake ( 33 v. 29 g/d ) than did the Control group ( all P<0·01 ) . Significantly greater decreases in fasting plasma glucose ( -0·33 v. -0·02 mmol/l , P<0·01 ) and 2 h postpr and ial glucose ( -2·98 v. -2·51 mmol/l , P<0·01 ) , significantly lower increases in total cholesterol ( 0·12 v. 0·23 mmol/l ) and TAG ( 0·41 v. 0·56 mmol/l ) and a significantly lower decrease in HDL cholesterol ( -0·01 v. -0·11 mmol/l ) were also observed in the Low-GL group compared with the Control group ( all P<0·05 ) . There were no significant differences in body weight gain , birth weight or other maternal-fetal perinatal outcomes between the two groups . CONCLUSIONS The low-GL targeted dietary intervention outperformed the general dietary intervention in glycaemic control and the improvement of blood lipid levels in women with gestational diabetes mellitus Low-glycaemic index diets reduce glycated Hb ( HbA1c ) in patients with type 2 diabetes , but require intensive dietary support . Using a liquid meal replacement with a low glycaemic response ( GR ) may be an alternative dietary approach . In the present study , we investigated whether breakfast replacement with a low-GR liquid meal would reduce postpr and ial glycaemia and /or improve long-term glycaemia . In the present r and omised , controlled , cross-over design , twenty patients with type 2 diabetes consumed either a breakfast replacement consisting of an isoenergetic amount of Glucerna SR or a free-choice breakfast for 3 months  . Postpr and ial AUC levels were measured using continuous glucose measurement at home . After the 3-month dietary period , meal profiles and oral glucose tolerance were assessed in the clinical setting . The low-GR liquid meal replacement reduced the AUC of postpr and ial glucose excursions at home compared with a free-choice control breakfast ( estimated marginal mean 141 ( 95 % CI 114 , 174 ) v. estimated marginal mean 259 ( 95 % CI 211 , 318 ) mmol × min/l ; P= 0·0002 ) . The low-GR liquid meal replacement also reduced glucose AUC levels in the clinical setting compared with an isoenergetic control breakfast ( low GR : median 97 ( interquartile range ( IQR ) 60 - 188 ) mmol × min/l ; control : median 253 ( IQR 162 - 386 ) mmol × min/l ; P < 0·001 ) . However , the 3-month low-GR liquid meal replacement did not affect fasting plasma glucose , HbA1c or lipid levels , and even slightly reduced oral glucose tolerance . In conclusion , the low-GR liquid meal replacement is a potential dietary approach to reduce postpr and ial glycaemia in patients with type 2 diabetes . However , clinical trials into the effects of replacing multiple meals on long-term glycaemia in poorly controlled patients are required before a low-GR liquid meal replacement can be adopted as a dietary approach to the treatment of type 2 diabetes Background The prevalence of diabetes mellitus is ubiquitous . Complications and costs of diabetes are rising and are depleting limited re sources . It is imperative for healthcare professionals and patients alike to confront this chronic condition by exploring new interventions . An innovative health care delivery model has emerged in the last 25 years in the form of the group medical visit . Group medical visits can range from of six to twenty patients scheduled together with time allotted for individual care as well as in the group setting . Objectives The review objective was to conduct a systematic review and meta‐ analysis to synthesize the best available evidence related to effectiveness of group medical visits on HbA1c , blood pressure and cholesterol measurements /levels for adult patients with type II diabetes in outpatient setting s. Search strategy A three‐step literature search for studies in English language from 1990 to 2010 was conducted utilising ( a ) a primary search of Medline , CINAHL , PsycINFO and Cochrane Central Register of Controlled Trials , ( b ) a secondary search of non‐indexed data bases , and ( c ) a search of the grey literature . In addition , a manual review of the reference lists of all identified reports and articles was performed to identify additional studies . Inclusion criteria All r and omised and quasi‐experimental studies of adult patients ( > 18 ) with type II diabetes mellitus seen in outpatient health setting s were considered if they met one or more of the following diagnostic outcome measurements : haemoglobin A1c , systolic and diastolic blood pressure , and low density lipoprotein cholesterol . Critical appraisal , data collection and analysis Each of the eligible articles was review ed by two independent review ers . Disagreements between the review ers were resolved through discussion , or with a third review er . Studies that met the inclusion criteria were assessed for method ological quality using the JBI st and ardized critical appraisal tools . Data extraction was undertaken using the st and ardised data extraction tool from JBI‐MAStARI . Main results The search strategy identified 2,040 articles in the published and unpublished literature . Of these , 11 r and omised controlled trials and 4 quasi‐experimental trials met the inclusion criteria and represented 2240 patients included in the final review . There are clear benefits of group medical visits for patients ' HbA1c levels which are consistent in the post‐intervention and change from baseline effect sizes . The most significant effect observed is with the change from baseline results . Some evidence suggests post‐intervention and change from baseline systolic blood pressure improvement at the nine to twelve month interval and change from baseline improvement at the 4 year timeframe . There is no evidence that group visits improve LDL cholesterol values of the group visit participants . Conclusions Group medical visits should be considered by clinicians as an effective non‐pharmacologic intervention that can have a positive impact on biologic markers such as haemoglobin A1c and systolic blood pressure . Implication s for practice The evidence suggests that the most powerful model of Group medical visits ( GMV ) is when a clinician prescriber is present during or immediately after GMV sessions for medication reconciliation or individual patient needs . Implication s for research Future research should include this GMV intervention in r and omised controlled trials across different health systems and socio‐economic and ethnic groups INTRODUCTION Gestational diabetes mellitus ( GDM ) increases risks for type 2 diabetes and cardiovascular diseases . Low glycaemic index ( GI ) diets improve cardio-metabolic outcomes in insulin-resistant individuals . We examined the feasibility of lowering GI through GI-based-education among Asian post-GDM women . METHODS A 3-month investigation was carried out on 60 Malaysian women with a mean age of 31.0 + /- 4.5 years and a history of GDM . Subjects were r and omised into two groups : LGIE and CHDR . The CHDR group received conventional healthy dietary recommendations only . The LGIE group received GI based-education in addition to conventional healthy dietary recommendations . At baseline and after 3-months , dietary intake of energy and macronutrient intakes including GI diet and glycaemic load was assessed using 3-day food records .  Diabetes-Diet and GI-concept scores and physical activity levels were assessed using a question naire . Adherence to dietary instructions was measured at the end of 3 months . RESULTS At the end of 3 months , the LGIE group had significant reductions in energy intake ( 241.7 + /- 522.4Kcal , P = 0.037 , ES=0.463 ) , total carbohydrate ( 48.7 + /- 83.5 g , P = 0.010 , ES = 0.583 ) , GI ( 3.9 + /- 7.1 , P = 0.017 , ES = 0.549 ) and GL ( 39.0 + /- 55.3 , P = 0.003 , ES = 0.705 ) and significant increases in protein ( 3.7 + /- 5.4 g , 0.003 , ES = 0.685 ) and diet fibre ( 4.6 + /- 7.3 g , P = 0.06 ) . The CHDR group had a significant reduction in fat only ( 5.7 + /- 9.4 g , P = 0.006 , ES = 0.606 ) . There was a 30 % increase in GI-concept scores in the LGIE group ( p < 0.001 ) . Changes in GI-concept scores correlated significantly to the reduction in dietary GI ( r = -0.642 , P = 0.045 ) . Dietary adherence was comparable in both groups . CONCLUSION GI-education improves GI-concept knowledge and helps lower dietary glycaemic index among women with a history of GDM This study sought to examine whether consumption of two low-calorie fruit/day for 3-months can effectively improve oxidative stress , anthropometry , blood pressure and glycaemic control in type 2 diabetes mellitus . Study involved 123 patients who were assigned to receive either st and ard care or with additional dietary therapy .  Dietary intervention result ed in significant reduction in malondialdehyde , plasma glucose , glycated haemoglobin and improvement in antioxidants like vitamin C and reduced glutathione when compared to controls . Mean plasma levels of vitamin C increased by 64 % ( p < 0.001 ) . There were no differences in waist circumference , waist-to-hip ratio , blood pressure , vitamin E and superoxide dismutase in the intervention group at follow-up . Diet rich in fruits can improve some antioxidants which are likely to reduce oxidative stress in type 2 diabetes . Regular consumption of fruits can lower the glycaemic status in these patients . The study supports the usefulness of plasma vitamin C as a biomarker for fruit intake Objectives To evaluate whether a course teaching flexible intensive insulin treatment combining dietary freedom and insulin adjustment can improve both glycaemic control and quality of life in type 1 diabetes . Design R and omised design with participants either attending training immediately ( immediate DAFNE ) or acting as waiting list controls and attending “ delayed DAFNE ” training 6 months later . Setting Secondary care diabetes clinics in three English health districts . Participants 169 adults with type 1 diabetes and moderate or poor glycaemic control . Main outcome measures Glycated haemoglobin ( HbA1c ) , severe hypoglycaemia , impact of diabetes on quality of life ( ADDQoL ) . Results At 6 months , HbA1c was significantly better in immediate DAFNE patients ( mean 8.4 % ) than in delayed DAFNE patients ( 9.4 % ) ( t=6.1 , P < 0.0001 ) . The impact of diabetes on dietary freedom was significantly improved in immediate DAFNE patients compared with delayed DAFNE patients ( t= − 5.4 , P < 0.0001 ) , as was the impact of diabetes on overall quality of life ( t=2.9 , P < 0.01 ) . General wellbeing and treatment satisfaction were also significantly improved , but severe hypoglycaemia , weight , and lipids remained unchanged . Improvements in “ present quality of life ” did not reach significance at 6 months but were significant by 1 year . Conclusion Skills training promoting dietary freedom improved quality of life and glycaemic control in people with type 1 diabetes without worsening severe hypoglycaemia or cardiovascular risk . This approach has the potential to enable more people to adopt intensive insulin treatment and is worthy of further investigation Abstract Objectives : To evaluate whether a course teaching flexible intensive insulin treatment combining dietary freedom and insulin adjustment can improve both glycaemic control and quality of life in type 1 diabetes . Design : R and omised design with participants either attending training immediately ( immediate DAFNE ) or acting as waiting list controls and attending “ delayed DAFNE ” training 6 months later . Setting : Secondary care diabetes clinics in three English health districts . Participants : 169 adults with type 1 diabetes and moderate or poor glycaemic control . Main outcome measures : Glycated haemoglobin ( HbA1c ) , severe hypoglycaemia , impact of diabetes on quality of life ( ADDQoL ) . Results : At 6 months , HbA1c was significantly better in immediate DAFNE patients ( mean 8.4 % ) than in delayed DAFNE patients ( 9.4 % ) ( t=6.1 , P<0.0001 ) . The impact of diabetes on dietary freedom was significantly improved in immediate DAFNE patients compared with delayed DAFNE patients ( t=−5.4 , P<0.0001 ) , as was the impact of diabetes on overall quality of life ( t=2.9 , P<0.01 ) . General wellbeing and treatment satisfaction were also significantly improved , but severe hypoglycaemia , weight , and lipids remained unchanged . Improvements in “ present quality of life ” did not reach significance at 6 months but were significant by 1 year . Conclusion : Skills training promoting dietary freedom improved quality of life and glycaemic control in people with type 1 diabetes without worsening severe hypoglycaemia or cardiovascular risk . This approach has the potential to enable more people to adopt intensive insulin treatment and is worthy of further investigation AIMS AND OBJECTIVES To examine the effect of a hospital-based clinic intervention on glycaemic control self-efficacy and glycaemic control behaviour of Chinese patients with type 2 diabetes mellitus ( DM ) . BACKGROUND Self-efficacy expectations are related to self-management of diabetes and , in conjunction with environmental support , are better predictors of behaviour than are knowledge and skills . Enhancing self-efficacy in patients with DM has been shown to have a positive effect on behavioural change and positively influence long-term glycaemic control . DESIGN A r and omised controlled trial study consisting of two-group pretest-post-test . METHODS One hundred and fifty-seven patients with type 2 DM were r and omly divided into two groups : ( 1 ) the experimental group ( 77 patients ) receiving one-month hospital-based clinic intervention and ( 2 ) the control group ( 80 patients ) receiving usual care . Data collection instruments used in this study were Diabetes Management Self-Efficacy Scale and Summary of Diabetes Self-Care Activities Measure . Outcomes were determined by changes in glycaemic control self-efficacy and glycaemic control behaviour of patients with type 2 DM . RESULTS The findings revealed that the experimental group showed statistically significant improvement in glycaemic control self-efficacy and glycaemic control behaviour immediately and four months after the intervention ( F = 26.888 , df = 1 , 155 , p < 0.05 and F = 18.619 , df = 1 , 155 , p < 0.05 , respectively ) . CONCLUSIONS One-month hospital-based clinic intervention could be useful in improving glycaemic control self-efficacy and glycaemic control behaviour . RELEVANCE TO CLINICAL PRACTICE Nurses can learn and use the sources of self-efficacy to enhance patients ' self-efficacy on their glycaemic control in clinical care . The health education is most important in nursing care and should be considered while organising the hospital-based clinic intervention Aims /hypothesisThe aim of this study was to assess the efficacy and safety of sitagliptin ( MK-0431 ) as monotherapy in patients with type 2 diabetes mellitus and inadequate glycaemic control ( HbA1c ≥7 % and ≤10 % ) on exercise and diet . Methods A total of 521 patients aged 27–76 years with a mean baseline HbA1c of 8.1 % were r and omised in a 1:2:2 ratio to treatment with placebo , sitagliptin 100 mg once daily , or sitagliptin  200 mg once daily , for 18 weeks . The efficacy analysis was based on an all- patients -treated population using an analysis of covariance , excluding data obtained after glycaemic rescue . Results After 18 weeks , HbA1c was significantly reduced with sitagliptin 100 mg and 200 mg compared with placebo ( placebo-subtracted HbA1c reduction : −0.60 % and −0.48 % , respectively ) . Sitagliptin also significantly decreased fasting plasma glucose relative to placebo . Patients with higher baseline HbA1c ( ≥9 % ) experienced greater placebo-subtracted HbA1c reductions with sitagliptin ( −1.20 % for 100 mg and −1.04 % for 200 mg ) than those with HbA1c < 8 % ( −0.44 % and −0.33 % , respectively ) or ≥8 % to 8.9 % ( −0.61 % and −0.39 % , respectively ) . Homeostasis model assessment beta cell function index and fasting proinsulin : insulin ratio , markers of insulin secretion and beta cell function , were significantly improved with sitagliptin . The incidence of hypoglycaemia and gastrointestinal adverse experiences was not significantly different between sitagliptin and placebo . Sitagliptin had a neutral effect on body weight . Conclusions /interpretationSitagliptin significantly improved glycaemic control and was well tolerated in patients with type 2 diabetes mellitus who had inadequate glycaemic control on exercise and diet The aim of the study was to examine the association of dietary carbohydrates and glycaemic load with the  risk of type 2 diabetes among an urban adult Asian Indian population . Adult subjects aged > 20 years ( n 1843 ) were r and omly selected from the Chennai Urban Rural Epidemiology Study , in Chennai city in southern India .  Dietary carbohydrates , glycaemic load and food groups were assessed using FFQ . Oral glucose tolerance tests were performed using 75 g glucose in all subjects . Diagnosis of diabetes  was based on WHO Consulting Group criteria . OR for newly detected diabetes were calculated for carbohydrates , glycaemic load and specific food groups comparing subjects in the highest with those in the lowest quartiles , after adjustment for potential confounders such as age , sex , BMI , family history of diabetes , physical activity , current smoking , alcohol consumption and relevant dietary factors . We identified 156 ( 8.5 % ) newly diagnosed cases of type 2 diabetes .  Refined grain intake  was positively associated with the risk of type 2 diabetes ( OR 5.31 ( 95 % CI 2.98 , 9.45 ) ; P < 0.001 ) . In the multivariate model , after adjustment for potential confounders , total carbohydrate ( OR 4.98 ( 95 % CI 2.69 , 9.19 ) , P < 0.001 ) , glycaemic load ( OR 4.25 ( 95 % CI 2.33 , 7.77 ) ; P < 0.001 ) and glycaemic index ( OR 2.51 ( 95 % CI 1.42 , 4.43 ) ; P = 0.006 ) were associated with type 2 diabetes . Dietary fibre intake was inversely associated with diabetes ( OR 0.31 ( 95 % CI 0.15 , 0.62 ) ; P < 0.001 ) . In urban south Indians , total dietary carbohydrate and glycaemic load are associated with increased , and dietary fibre with decreased , risk of type 2 diabetes 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 BACKGROUND Development of this guideline was undertaken by the Exercise for People with Cancer Guideline Development Group , a group organized by Cancer Care Ontario 's Program in Evidence -Based Care ( pebc ) . The purpose of the guideline was to provide guidance for clinicians with respect to exercise for patients living with cancer , focusing on the benefits of specific types of exercise , recommendations about screening requirements for new referrals , and safety concerns . METHODS Consistent with the pebc 's st and ardized approach , a systematic search was conducted for existing guidelines , and systematic literature search es were performed in medline and embase for both systematic review s and primary literature . Content and methodology experts performed an internal review , which was followed by an external review by targeted experts and intended users . RESULTS The search identified three guidelines , eighteen systematic review s , and twenty-nine r and omized controlled trials with relevance to the topic . The present guideline provides recommendations for the duration , frequency , and intensity of exercise appropriate for people living with cancer . It also provides recommendations for pre-exercise assessment , safety concerns , and delivery models . CONCLUSIONS There is sufficient evidence to show that exercise provides benefits in quality of life and muscular and aerobic fitness for people with cancer both during and after treatment , and that it does not cause harm . The present guideline is intended to support the Canadian Society for Exercise Physiology 's Canadian physical activity guidelines . The recommendations are intended for clinicians and institutions treating cancer patients in Ontario , and for policymakers and program planners involved in the delivery of exercise programs for cancer patients Background and Objective Many patients with type 2 diabetes mellitus ( T2DM ) on insulin therapy  have inadequate glycaemic control . In such cases , Dutch guidelines recommend unlimited up-titration of insulin , yet in practice many patients never reach their glycaemic target . Clinical evidence shows that dapagliflozin — a highly selective sodium – glucose cotransporter 2 inhibitor — meets a need for these patients , i.e. by reducing glycated haemoglobin levels and bodyweight . We estimated the cost effectiveness and cost utility of adding dapagliflozin to insulin compared with not adding dapagliflozin in patients with T2DM who have inadequate glycaemic control while on insulin . Methods The cost effectiveness of dapagliflozin was estimated using the Cardiff Diabetes Model , using direct comparative efficacy data from a r and omized placebo-controlled trial ( Clinical Trials.gov identifier NCT00673231 ) . In this trial , up-titration of insulin was allowed in case of severe glycaemic imbalance . Risk factor progression and the occurrence of future vascular events were estimated using the United Kingdom Prospect i ve Diabetes Study 68 risk equations . Costs and utilities were derived from the literature . The analysis was conducted from the societal perspective , simulating the remaining lifetime of the patients . Results The overall incidence of macro- and microvascular complications was lower , and life expectancy was greater ( 19.43 versus 19.35 life-years [ LYs ] ) in patients receiving dapagliflozin than in those not receiving dapagliflozin . Patients in the dapagliflozin arm obtained an incremental benefit of 0.42 quality -adjusted life-years ( QALYs ) . The lifetime incremental cost per patient in the dapagliflozin arm was € 2,293 , result ing in an incremental cost-effectiveness ratio of € 27,779 per LY gained and an incremental cost – utility ratio of € 5,502 per QALY gained . Sensitivity and scenario analyses showed that the results were insensitive to variations in modelling assumptions and input variables . Conclusion Dapagliflozin in combination with insulin was estimated to be a cost-effective treatment option for patients with T2DM whose insulin treatment regimen does not provide adequate glycaemic control in a Dutch healthcare setting Background : Type 2 diabetes mellitus ( T2DM ) is becoming a leading problem worldwide . Emerging reports reveal alarming evidence of increasing prevalence of T2DM that has reached p and emic levels . Despite the significant incidence , there are limited reliable data re sources and comprehensive systematic review and meta- analysis on the effects of yoga on people who are a prediabetic or high risk for developing T2DM . Objective : The objective of this protocol is to conduct a full-scale systematic review and meta-analyses on the effects of yoga on people who are prediabetes or high risk of developing T2DM . Methods : The articles enrolled in the study will be retrieved from the online data bases between 2002 and the date the search es are executed . The search es will be repeated just before the final analyses and further relevant studies for inclusion . We will conduct a bibliographic search in data bases : Medline / PubMed , Scopus , Cochrane Library , EBSCO , and IndMED using keywords including prediabetes state , high risk for diabetes , metabolic syndrome , and yoga . A defined search strategy will be implemented along with selection criteria to obtain full-text articles of relevant studies . This study protocol was prepared according to the Preferred Reporting Items for Systematic Review s and Meta- Analysis for Protocol s 2015 guidelines . There will be no language restrictions . Ethics and dissemination : The proposed study will be based on published studies and publicly available anonymized data without directly involving human participants and therefore requires neither formal human ethical review nor approval by a human research ethics committee . We published an outline of the protocol in the International Prospect i ve Register of Systematic Review s ( PROSPERO ) in 2018 . We plan to disseminate the findings of this systematic review and meta- analysis through publication in a peer- review ed journal and presentation at relevant conference proceedings . In addition , we believe the results of the systematic review will have implication s for policy and practice . We will prepare policymaker summary using a vali date d format , disseminate through social media and email discussion groups . Review registration number : PROSPERO registration number CRD Aims To evaluate the efficacy and safety of two dosage strengths of a single‐tablet metformin – glibenclamide ( glyburide ) combination , compared with the respective monotherapies , in patients with Type 2 diabetes mellitus ( DM ) inadequately controlled by metformin monotherapy Introduction The prevalence of gestational diabetes mellitus ( GDM ) is rising in the UK . Good glycaemic control improves maternal and neonatal outcomes . Frequent clinical review of patients with GDM by healthcare professionals is required owing to the rapidly changing physiology of pregnancy and its unpredictable course . Novel technologies that allow home blood glucose ( BG ) monitoring with results transmitted in real time to a healthcare professional have the potential to deliver good- quality healthcare to women more conveniently and at a lower cost to the patient and the healthcare provider compared to the conventional face-to-face or telephone-based consultation . We have developed an integrated GDm-health management system and aim to test the impact of using this system on maternal glycaemic control , costs , patient satisfaction and maternal and neonatal outcomes compared to st and ard clinic care in a single large publicly funded ( National Health Service ( NHS ) ) maternity unit . Methods and analysis Women with confirmed gestational diabetes in a current pregnancy are individually r and omised to either the GDm-health system and half the normal clinic visits or normal clinic care . Primary outcome is mean BG in each group from recruitment to delivery calculated , with adjustments made for number of BG measurements , proportion of prepr and ial and postpr and ial readings and length of time in study , and compared between the groups . The secondary objective will be to compare the two groups for compliance to the allocated BG monitoring regime , maternal and neonatal outcomes , glycaemic control using glycated haemoglobin ( HbA1c ) and other BG metrics , and patient attitudes to care assessed using a question naire and re source use . Ethics and dissemination Thresholds for treatment , dietary advice and clinical management are the same in both groups . The results of the study will be published in a peer- review ed journal and disseminated electronically and in print . Trial registration number NCT01916694 ; Pre- results Introduction Type 2 diabetes ( T2D ) is a major health concern among population s of South Asian ethnicity . Although dietary and physical activity interventions may reduce the risk of T2D , the effectiveness has been moderate among South Asians . This might ( in part ) be because this subgroup follows strategies that were originally developed for interventions among other population s. Therefore , this review aims to assess the evidence for the current dietary and physical activity strategies recommended in T2D prevention intervention studies and guidelines for South Asians . Methods and analysis Included will be all studies and guidelines on dietary and /or physical activity strategies to prevent T2D in adult South Asians . Two review ers will search online data bases from their start until the present date for published and unpublished experimental/quasiexperimental studies , with at least an abstract in English . References of identified articles and key review s will be screened for additional studies . Guidelines will be identified by search es in online data bases and websites of public organisations . Finally , expert consultations will be held to supplement any missing information . Trial quality will be assessed with the Quality Assessment Tool for Quantitative Studies Data , and guidelines with the Appraisal of Guidelines for Research & Evaluation II . Data on the strategies recommended , targeting and evidence on effectiveness will be extracted by two review ers and presented in tabular and narrative forms . Recommendations will be compared with the National Institute for Health and Care Excellence guidelines [ PH35 ] . Overall findings on  dietary and physical activity recommendations , as well as findings for specific subgroups ( eg , by sex ) , will be discussed . Ethics and dissemination Ethics assessment is not required . Start date : 1 January 2016 , finishing and reporting date 31 July 2016 . Results will be published in a peer- review ed scientific journal , the project report of EuroDHYAN ( www.eurodhyan.eu ) and in a PhD dissertation . Trial registration number The protocol is registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) registration number CRD42015027067 Many biomarkers are associated with type 2 diabetes ( T2D ) risk in epidemiological observations . The aim of this study was to identify and summarize current evidence for causal effects of biomarkers on T2D . A systematic literature search in PubMed and EMBASE ( until April 2015 ) was done to identify Mendelian r and omization studies that examined potential causal effects of biomarkers on T2D . To replicate the findings of identified studies , data from two large-scale , genome-wide association studies ( GWAS ) were used : DIAbetes  Genetics Replication And Meta- analysis  ( DIAGRAMv3 ) for T2D and the Meta-Analyses of Glucose and Insulin-related traits Consortium ( MAGIC ) for glycaemic traits . GWAS summary statistics were extracted for the same genetic variants ( or proxy variants ) , which were used in the original Mendelian r and omization studies . Of the 21 biomarkers ( from 28 studies ) , ten have been reported to be causally associated with T2D in Mendelian r and omization . Most biomarkers were investigated in a single cohort study or population . Of the ten biomarkers that were identified , nominally significant associations with T2D or glycaemic traits were reached for those genetic variants related to bilirubin , pro-B-type natriuretic peptide , delta-6 desaturase and dimethylglycine based on the summary data from DIAGRAMv3 or MAGIC . Several Mendelian r and omization studies investigated the nature of associations of biomarkers with T2D . However , there were only a few biomarkers that may have causal effects on T2D . Further research is needed to broadly evaluate the causal effects of multiple biomarkers on T2D and glycaemic traits using data from large-scale cohorts or GWAS including many different genetic variants To determine whether a group behavior modification approach might be preferable to individual counseling in the nutritional therapy of non-insulin-dependent diabetes mellitus , 40 adults younger than 65 yr of age with diabetes mellitus who were not receiving insulin were r and omized to either a program of individualized dietary review and recommendations or a program of group meetings aim ed at controlling the signals leading to overeating and noncompliance with a diabetic dietary regimen . Statistically significant ( P < 0.05 ) decreases in body weight , sum skin-fold thickness , fasting serum glucose , and serum triglycerides but not LDL-C or HDL-C were observed . The individual counseling group had a greater amount of weight loss than the behavior modification group . There were no significant ( P < 0.05 ) differences between the two groups with respect to the biochemical outcome variables . Patient characteristics assessed at entry — namely anxiety , internal versus external locus of control and perceived disease severity , and compliance with advice — were significantly associated with weight loss in the behavior modification group while only the latter index was of value in the individual counseling group . Thus , our use of these programs does not identify a clear advantage of either approach in the nutritional therapy of non-insulin-dependent diabetic patients AIM To determine the glycaemic index values to a range of foods that are unique to New Zeal and , and those that are grown and /or manufactured locally . METHODS We determined the glycaemic index of 28 carbohydrate foods in both healthy subjects and those with type 2 diabetes . Venous blood sample s were collected over two to three hours , and the incremental area under the blood glucose curve was used to calculate glycaemic index values . RESULTS AND CONCLUSIONS This study has identified the glycaemic index values for a range of New Zeal and foods which will be clinical ly useful in the nutritional management of individuals with diabetes mellitus . People with diabetes are recommended to choose foods with a low glycaemic index which is associated with optimal blood glucose control and lipid levels 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 AIMS Our main aim was to analyse gender differences in the association of adherence and poor glycaemic control ( PGC ) in a cohort of patients with type 2 diabetes mellitus in Germany . METHODS Baseline data of the DIANA- study , a prospect i ve cohort study of type 2 diabetes mellitus patients in South-West Germany , were analysed . Information on medication adherence and factors related to PGC was obtained by self-administered question naire . PGC was defined as HbA(1c)≥7.5 % . Bivariate and multivariate analyses using log-binomial regression were employed to assess overall and gender-specific associations of non-adherence and PGC . RESULTS 624 men and 518 women were included in the analyses . In total , 147 men ( 24 % ) and 114 women ( 23 % ) reported non-adherence to medication . In men , PGC was found in 37 % of the participants reporting non-adherence and in 19 % reporting adherence ( adjusted prevalence ratio (PR)=1.90 , 95%-CI : 1.46 - 2.49 ) . In women , PGC was found in 19 % of the participants reporting non-adherence and in 18 % reporting adherence ( adjusted PR=0.97 , 95%-CI : 0.65 - 1.46 ) . CONCLUSIONS Our results show gender-specific differences in the association of adherence and PGC . This underlines the need for efforts to improve glycaemic control in patients with type 2 diabetes mellitus with a particular focus on men Aims In the UK , lifestyle intervention is first-line management in Type 2 diabetes . It is unclear what type of diet is most efficacious for improving glycaemic control . This study investigated the effects of an oat-enriched diet on glycaemic control , postpr and ial glycaemia , inflammation and oxidative stress compared with st and ard dietary advice . Methods In a r and omized crossover design , 27 volunteers with Type 2 diabetes , managed on diet and lifestyle only , were observed for two consecutive 8-week periods following either the oat-enriched diet or re-enforced st and ard dietary advice . Volunteers attended at baseline ( habitual intake ) and 8 and 16 weeks . Measurements included basic clinical measurements and fasted and postpr and ial ( 3-h ) glucose and insulin in response to a healthy test meal . Markers of inflammation and oxidative stress , including high-sensitivity C-reactive protein , interleukin 6 , interleukin 18 , tumour necrosis factor-alpha , adiponectin , thiobarbituric acid reactive substances , oxygen radical antioxidant capacity , oxidized LDL and urinary isoprostanes , were also measured at fasting and in the postpr and ial period . Results There were no diet-related effects on glycaemic control or glycaemic or insulinaemic responses to the test meal . Total cholesterol ( 5.1 ± 1.0 vs. 4.9 ± 0.8 mmol/l , P = 0.019 ) concentrations declined following the oat-enriched diet compared with st and ard dietary advice . There was a postpr and ial decline in adiponectin concentration ( P = 0.009 ) , but no effect of dietary intervention . None of the measures of oxidative stress or inflammation were altered by the oat-enriched diet compared with st and ard dietary advice . Conclusion The oat-enriched diet had a modest impact on lipid lowering , but did not impact on oxidative stress or inflammation in these volunteers with Type 2 diabetes AIM the purpose of the present study was to assess the effect of non-surgical periodontal therapy on glycaemic control of type 2 diabetes patients with moderate-to-severe periodontitis . MATERIAL S AND METHODS this was a r and omized , controlled clinical trial of patients with type 2 diabetes . A total of 60 patients with moderate-to-severe periodontal disease were assigned to either a periodontal treatment arm , consisting of scaling and root planing ( intervention group [ IG ] ) , or a delayed treatment arm that received periodontal care after 6 months ( control group [ CG ] ) . Periodontal parameters and glycosylated haemoglobin ( A1C ) were evaluated at 1 , 3 and 6 months . RESULTS all periodontal parameters improved significantly in the IG . A1C levels decreased statistically significantly more in the IG versus the CG ( 0.72%versus 0.13 % ; p<0.01 ) independently of other confounders . CONCLUSIONS this study provides evidence that periodontal treatment contributes to improved glycaemic control in type 2 diabetes mellitus patients . Larger controlled trials are needed to confirm if this finding is generalizable to other population s of patients with type 2 diabetes 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 the efficacy of specialized multidisciplinary community care for the management of type 2 diabetes compared to usual care . CLINICAL NEED TARGET POPULATION AND CONDITION Diabetes ( i.e. diabetes mellitus ) is a highly prevalent chronic metabolic disorder that interferes with the body 's ability to produce or effectively use insulin . The majority ( 90 % ) of diabetes patients have type 2 diabetes . ( 1 ) Based on the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) , intensive blood glucose and blood pressure control significantly reduce the risk of microvascular and macrovascular complications in type 2 diabetics . While many studies have documented that patients often do not meet the glycemic control targets specified by national and international guidelines , factors associated with glycemic control are less well studied , one of which is the provider(s ) of care . Multidisciplinary approaches to care may be particularly important for diabetes management . According guidelines from the Canadian Diabetes Association ( CDA ) , the diabetes health care team should be multi- and interdisciplinary . Presently in Ontario , the core diabetes health care team consists of at least a family physician and /or diabetes specialist , and diabetes educators ( registered nurse and registered dietician ) . Increasing the role played by allied health care professionals in diabetes care and their collaboration with physicians may represent a more cost-effective option for diabetes management . Several systematic review s and meta-analyses have examined multidisciplinary care programs , but these have either been limited to a specific component of multidisciplinary care ( e.g. intensified education programs ) , or were conducted as part of a broader disease management program , of which not all were multidisciplinary in nature . Most review s also do not clearly define the intervention(s ) of interest , making the evaluation of such multidisciplinary community programs challenging . EVIDENCE -BASED ANALYSIS METHODS RESEARCH QUESTIONS What is the evidence of efficacy of specialized multidisciplinary community care provided by at least a registered nurse , registered dietician and physician ( primary care and /or specialist ) for the management of type 2 diabetes compared to usual care ? [ Henceforth referred to as Model 1]What is the evidence of efficacy of specialized multidisciplinary community care provided by at least a pharmacist and a primary care physician for the management of type 2 diabetes compared to usual care ? [ Henceforth referred to as Model 2 ] INCLUSION CRITERIA English language full-reportsPublished between January 1 , 2000 and September 28 , 2008R and omized controlled trials ( RCTs ) , systematic review s and meta-analysesType 2 diabetic adult population ( ≥18 years of age)Total sample size ≥30Describe specialized multidisciplinary community care defined as ambulatory-based care provided by at least two health care disciplines ( of which at least one must be a specialist in diabetes ) with integrated communication between the care providers . Compared to usual care ( defined as health care provision by non-specialist(s ) in diabetes , such as primary care providers ; may include referral to other health care professionals/services as necessary)≥6 months follow-up EXCLUSION CRITERIA Studies where discrete results on diabetes can not be abstract edPredominantly home-based interventions Inpatient-based interventions OUTCOMES OF INTEREST The primary outcomes for this review were glycosylated hemoglobin ( rHbA1c ) levels and systolic blood pressure ( SBP ) . SEARCH STRATEGY A literature search was performed on September 28 , 2008 using 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 1 , 2000 and September 28 , 2008 . Abstract s were review ed by a single review er and , for those studies meeting the eligibility criteria , full-text articles were obtained . Reference lists were also examined for any additional relevant studies not identified through the search . Articles with unknown eligibility were review ed with a second clinical epidemiologist , then a group of epidemiologists until consensus was established . The quality of evidence was assessed as high , moderate , low or very low according to GRADE methodology . Given the high clinical heterogeneity of the articles that met the inclusion criteria , specific models of specialized multidisciplinary community care were examined based on models of care that are currently being supported in Ontario , models of care that were commonly reported in the literature , as well as suggestions from an Expert Advisory Panel Meeting held on January 21 , 2009 . SUMMARY OF FINDINGS The initial search yielded 2,116 unique citations , from which 22 RCTs trials and nine systematic review s published were identified as meeting the eligibility criteria . Of these , five studies focused on care provided by at least a nurse , dietician , and physician ( primary care and /or specialist ) model of care ( Model 1 ; see Table ES 1 ) , while three studies focused on care provided by at least a pharmacist and primary care physician ( Model 2 ; see Table ES 2 ) . Based on moderate quality evidence , specialized multidisciplinary community care Model 2 has demonstrated a statistically and clinical ly significant reduction in HbA1c of 1.0 % compared with usual care . The effects of this model on SBP , however , are uncertain compared with usual care , based on very-low quality evidence . Specialized multidisciplinary community care Model 2 has demonstrated a statistically and clinical ly significant reduction in both HbA1c of 1.05 % ( based on high quality evidence ) and SBP of 7.13 mm Hg ( based on moderate quality evidence ) compared to usual care . For both models , the evidence does not suggest a preferred setting of care delivery ( i.e. , primary care vs. hospital outpatient clinic vs. community clinic ) . Table ES1 : Summary of Results of Meta-Analyses of the Effects of Multidisciplinary Care Model 1 Outcome Estimate of effect(95 % CI)Heterogeneity I(2)(p-value ) GRADE Glycosylated Hemoglobin ( HbA1c [%])-1.00 [ -1.27 , -0.73]4 % (p=0.37)Moderate- quality Subgroup : Moderate-to-High Quality -0.91 [ -1.19 , -0.62]0 % (p=0.74)Systolic Blood Pressure ( mm Hg)-2.04 [ -13.80 , 9.72]89 % (p=0.002)Very-low quality * Mean change from baseline to follow-up between intervention and control groupsTable ES2 : Summary of Results of Meta-Analyses of the Effects of Multidisciplinary Care Model 2 Outcome Estimate of effect(95 % CI)Heterogeneity I(2)(p-value ) GRADE Glycosylated Hemoglobin ( HbA1c [%])-1.05 [ -1.57 , -0.52]0 % (p=0.75)High- quality Systolic Blood Pressure ( mm Hg)-7.13 [ -11.78 , -2.48]46 % (p=0.17)Moderate quality * Mean change from baseline to follow-up between intervention and control groups 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 Objectives To determine the incidence and characteristics of r and omised controlled trials that report using the modified intention to treat approach  , and how the approach is described . Design Systematic review . Data sources PubMed , Embase , Cochrane central register of controlled trials , ISI Web of Knowledge , Ovid , HighWire Press , Science-Direct , Ingenta , Medscape , BioMed Central , Springer , and Wiley , from inception to December 2006 . Main outcome measures Incidence of trials in which use of modified intention to treat was reported , and how the approach was described ( classified according to the type and number of deviations from the intention to treat approach ) . Results 475 r and omised controlled trials reported use of a  modified intention to treat analysis .  Of these , 76 ( 16 % ) were published in five highly cited general medical journals . The incidence of all trials that reported use of  modified intention to treat  published in journals indexed in Medline increased from 0.006 % in 1982 - 6 to 0.5 % in 2002 - 6 ( P<0.001 for linear trend ) . When the description of the modified intention to treat was examined in each trial , 192 ( 40 % ) reported one type of deviation from the intention to treat approach , 261 ( 55 % ) reported two or more types , and 22 ( 5 % ) did not describe any type . In 266 ( 56 % ) of the trials the deviation was related to the treatment received , in 196 ( 41 % ) to a post baseline assessment , in 118 ( 25 % ) to a baseline assessment , in 108 ( 23 % ) to a target condition , and in 23 ( 5 % ) to follow-up . Post-r and omisation exclusions occurred in 380 ( 80 % ) trials . The results reported by 270 of the 352 ( 77 % ) superiority trials favoured the drug under investigation . All of the 123 trials using equivalence or non-inferiority methods to investigate interventions reported results that favoured their assumptions . Conclusions R and omised controlled trials that report using a modified intention to treat are increasingly being published in the medical literature . The descriptions of such an approach were ambiguous , and may cover any type of descriptions for exclusion , such as missing data and deviation from protocol . Explicit statements about post-r and omisation exclusions should replace the ambiguous terminology of modified intention to treat Aims /hypothesis . To determine risk factors related to the incidence and progression of diabetic retinopathy over 6 years from diagnosis of Type II ( non-insulin-dependent ) diabetes mellitus . Methods . This report describes 1919 patients from within the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) , with retinal photographs taken at diagnosis and 6 years later and with complete data available . Photographs were central ly grade d for lesions of diabetic retinopathy using the modified Early Treatment of Diabetic Retinopathy Study Final scale . Risk factors were assessed after 3 months diet from the time of diagnosis of diabetes . Patients were seen every 3 months in a hospital setting . Biochemical measurements  were done by a central laboratory . End points of vitreous haemorrhage and photocagulation were confirmed by independent adjudication of systematic ally collected clinical data . The main outcome measures were incidence and progression of retinopathy defined as a two-step Early Treatment of Diabetic Retinopathy Study ( ETDRS ) final scale change . Results . Of the 1919 patients , 1216 ( 63 % ) had no retinopathy at diagnosis . By 6 years , 22 % of these had developed retinopathy , that is microaneurysms in both eyes or worse . In the 703 ( 37 % ) patients with retinopathy at diagnosis , 29 % progressed by two scale steps or more . Development of retinopathy ( incidence ) was strongly associated with baseline glycaemia , glycaemic exposure over 6 years , higher blood pressure and with not smoking . In those who already had retinopathy , progression was associated with older age , male sex , hyperglycaemia ( as evidence d by a higher HbA1 c ) and with not smoking . Conclusion /interpretation . The findings re-emphasise the need for good glycaemic control and assiduous treatment of hypertension if diabetic retinopathy is to be minimised . [ Diabetologia ( 2001 ) 44 : 156–163 Background Diabetic retinopathy ( DR ) is a common microvascular complication of diabetes mellitus , and more than 75 % of patients who have had diabetes for more than 20 years will have some degree of DR . This disease is highly destructive to self-esteem and puts a high burden on public health and pension systems due to the effects that it has on people of working age . The current mainstay of treatment is laser photocoagulation , which causes impairment of vision and discomfort to patients . Thus , finding a systemic drug that could act on all microcirculation and prevent direct manipulation of the eyes would be highly desirable . Objective To assess the efficacy and safety of the drugs in the statin and /or fibrate groups for the prevention and treatment of DR . Methods In this systematic review , we will select r and omized controlled trials of fibrates or statins used for the treatment or prevention of DR . Our search strategy will include free text terms and controlled vocabulary ( eg , MeSH , Emtree ) for , “ diabetic retinopathy ” , “ statins ” , “ fibrates ” , “ hypolipidemic agents ” , and for drugs from both groups . Data bases that will be used include Medical Literature Analysis and Retrieval System/ PubMed , Embase , Cochrane Central Register of Controlled Trials , Latin American and Caribbean Center on Health Sciences Information , Clinical trials.gov , World Health Organization International Clinical Trials Registry Platform , and OpenGrey , and we will not have language or date limits . Two review authors will independently select eligible studies and assess the risk of bias using the Cochrane Collaboration ’s tool . We will report structured summaries of the included studies and , if possible , conduct meta-analyses . Results This is a protocol for a systematic review , therefore results are not available . We registered a short version of this protocol before progressing in the review and we are currently in the process of selecting the studies for inclusion . Conclusions Intensive glucose control and lowering blood pressure and lipids are mechanisms that protect macrocirculation in diabetic patients . Both macrovascular and microvascular events in diabetic patients appear to have a common pathway , starting with endothelial injury . Thus , prevention and treatment of microvascular events may benefit from the same interventions . In the review for which we have written this protocol , we will assess whether the use of lipid-lowering oral drugs of the statin and /or fibrate groups may prevent and /or retard progression of DR , with the added benefit of preserving visual acuity . Trial Registration PROSPERO 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 Introduction : Diabetes is a chronic disease associated with high morbidity and mortality , which represents a major public health concern . Interventions that can enhance patient care and reduce clinic visits will not only relieve some of this burden , they will also improve patient QOL and wellbeing . Aims : This review assesses the evidence for the use of insulin glargine in type 1 and type 2 diabetes mellitus . Evidence review : Once-daily insulin glargine has a prolonged , peakless activity profile , making it a c and i date as a long-acting ( basal ) insulin . In combination with bolus insulin to cover pr and ial glucose surges , it facilitates a more physiologic approach to patient management . Evidence from large , r and omized , controlled clinical trials in patients with type 1 diabetes has confirmed its effectiveness and tolerability relative to neutral protamine hagedorn ( NPH ) insulin , with a tendency toward causing less hypoglycemia . In patients with type 2 diabetes requiring insulin therapy , once-daily insulin glargine has proven to be clinical ly superior to NPH insulin in terms of providing at least as effective glycemic control , but with significantly fewer episodes of nocturnal hypoglycemia . A variety of economic analyses have confirmed the cost effectiveness of insulin glargine in type 1 and type 2 diabetes and in particular it was shown to be significantly superior to NPH insulin . Clinical value : Insulin glargine has established itself as a first-line choice in patients with type 1 diabetes , including children ( > 6 years ) and adolescents , and is a recommended treatment option . In patients with type 2 diabetes it is clearly associated with less hypoglycemia than NPH insulin , and this may help overcome one of the major barriers to starting insulin therapy in this class of patient . Thus , insulin glargine is a valuable addition to the therapeutic armamentarium available to physicians and it has the potential to significantly improve the quality of life of patients with diabetes AIMS Weight loss improves glycaemic control in type 2 diabetes mellitus ( T2DM ) . However , as achieving and maintaining weight loss is difficult , alternative strategies are needed . Our primary aim was to investigate the effects of intermittent energy restriction ( IER ) compared to continuous energy restriction ( CER ) on glycated haemoglobin A1c ( HbA1c ) . Secondary aims were to assess effects on weight loss , body composition , medication changes and subjective measures of appetite . Using a 2-day IER method , we expected equal improvements to HbA1c and weight in both groups . METHOD Sixty-three overweight or obese participants ( BMI 35.2±5kg/m2 ) with T2DM ( HbA1c 7.4±1.3 % ) ( 57mmol/mol ) were r and omised to a 2-day severe energy restriction ( 1670 - 2500kJ/day ) with 5days of habitual eating , compared to a moderate CER diet ( 5000 - 6500kJ/day ) for 12weeks . RESULTS At 12weeks HbA1c ( -0.7±0.9 % P<0.001 ) and percent body weight reduction ( -5.9±4 % P<0.001 ) was similar in both groups with no group by time interaction . Similar reductions were also seen for medication dosages , all measures of body composition and subjective reports of appetite . CONCLUSIONS In this pilot trial , 2days of IER compared with CER result ed in similar improvements in glycaemic control and weight reduction offering a suitable alternative treatment strategy Accessibility , availability and frequent public contact place community pharmacists in an ideal position to provide medically necessary , intensive health education and preventive health services to diabetes patients , thus reducing physician burden . We assessed the cost-effectiveness of reducing glycaemic episodes in patients with type 2 diabetes mellitus through a pharmacist-led Diabetes Management Education Program ( DMEP ) compared to st and ard care . We recruited eight metropolitan community pharmacies in Perth , Western Australia for the study . We paired them based on geographical location and the socioeconomic status of the population served , and then r and omly selected one pharmacy in each pair to be in the intervention group , with the other assigned to the control group . We conducted an incremental cost-effectiveness analysis to compare the costs and effectiveness of DMEP with st and ard pharmacy care . Cost per patient of implementing DMEP was AU$394 ( US$ 356 ) for the 6-month intervention period . Significantly greater reductions in number of hyperglycaemic and hypoglycaemic episodes occurred in the intervention relative to the control group [ OR 0.34 ( 95 % CI 0.22 , 0.52 ) , p = 0.001 ; OR 0.54 ( 95 % CI 0.34 , 0.86 ) , p = 0.009 ] , respectively , with a net reduction of 1.86 days with glycaemic episodes per patient per month . The cost-effectiveness of DMEP relative to st and ard pharmacy care was AU$43 ( US$ 39 ) per day of glycaemic symptoms avoided . Patients with type 2 diabetes in three surveys were willing to pay an average of 1.9 times that amount to avoid a hypoglycaemic day . We conclude that DMEP decreased days with glycaemic symptoms at a reasonable cost . If a larger-scale replication study confirms these findings , widespread adoption of this approach would improve diabetes health without burdening general practitioners AIMS Patient education is a very important part of diabetes care . However , until now , little data has been presented about the long-term effectiveness of structured intensive diabetes education programmes ( SIDEP ) for people with Type 2 diabetes mellitus . METHODS People with Type 2 diabetes ( n = 547 ) hospitalized from December 1999 to December 2000 were r and omly assigned to two groups . Two hundred and nineteen patients undertook an inpatient SIDEP and the remaining patients received conventional glycaemic control without intensive education . After discharge , all patients were monitored regularly . Laboratory data were obtained , and adherence to self-care behaviour was determined on a five-point scale by question naires completed annually . RESULTS Of the patients who completed the SIDEP , 160 ( 73.1 % ) were followed up for more than 4 years . The mean HbA(1c ) ( 7.9 + /- 1.2 vs. 8.7 + /- 1.6 % ; P < 0.05 ) and the frequency of hospitalization related to diabetes per patient per year ( 0.3 + /- 0.6 vs. 0.8 + /- 0.9 ; P < 0.05 ) was significantly lower in the SIDEP group than in the control group . The SIDEP group adhered more closely to self-care behaviour than the control group over 4 years ( P < 0.05 ) . People with Type 2 diabetes mellitus of longer duration and those treated with insulin had poorer HbA(1c ) at follow-up . CONCLUSIONS A well- design ed , intensive patient education programme is necessary for people with diabetes . However , regular and sustained reinforcement with encouragement is also required to maintain optimal glycaemic control , especially in insulin-treated patients To show that albiglutide , a glucagon‐like peptide‐1 receptor agonist , is an effective and generally safe treatment to improve glycaemic control in patients with type 2 diabetes mellitus whose hyperglycaemia is inadequately controlled with pioglitazone ( with or without metformin ) AIMS Diabetes therapies that provide durable glycaemic control for people with type 2 diabetes mellitus ( T2DM ) are needed . We present efficacy results of albiglutide , a glucagon-like peptide-1 receptor agonist , in people with T2DM over a 3-year period . METHODS Five of the 8 HARMONY phase 3 trials , comparing albiglutide with other therapies or placebo across a spectrum of clinical care , lasted for a preplanned 3years . Participants with uncontrolled hyperglycaemia who met predetermined criteria could receive rescue medication . The ability to remain on study medication without needing additional rescue was an efficacy measure . Glycaemic measures and body weight were analysed in 2 population s : those who remained rescue-free and all participants . RESULTS Participants ( n=3132 ) were r and omised to albiglutide or comparator . A greater proportion of participants who received albiglutide remained rescue-free ( 55 - 71 % ) compared with placebo ( 35 - 51 % ; p<0.001 to p=0.002 ) . The proportion of rescue-free participants with albiglutide did not differ from glimepiride or insulin glargine , was higher than with sitagliptin ( p=0.013 ) , and lower than with pioglitazone ( p=0.045 ) . At 3years , albiglutide was associated with clinical ly significant reductions in hyperglycaemia ( eg , rescue-free participants : HbA1c -0.52 % [ SE0.11 ] to -0.98 % [ 0.12 ] ; -5.7mmol/mol [ 1.2 ] to -10.7mmol/mol [ 1.3 ] and all participants : HbA1c -0.29 % [ 0.11 ] to-0.92 % [ 0.13 ] ; -3.2mmol/mol [ 1.2 ] to -10.1mmol/mol [ 1.4 ] ) . Albiglutide was also associated with modest reductions in body weight vs pioglitazone , glimepiride , and insulin glargine , which were associated with weight gain . CONCLUSION These 3-year efficacy data support long-term use of albiglutide in the management of people with T2DM . Clinical Trials.gov NCT00849056 , NCT00849017 , NCT00838903 , NCT00838916 , NCT00839527 Background Despite the number of medications for type 2 diabetes , many people with the condition do not achieve good glycaemic control . Some existing glucose-lowering agents have adverse effects such as weight gain or hypoglycaemia . Type 2 diabetes tends to be a progressive disease , and most patients require treatment with combinations of glucose-lowering agents . The sodium glucose co-transporter 2 ( SGLT2 ) receptor inhibitors are a new class of glucose-lowering agents . Objective To assess the clinical effectiveness and safety of the SGLT2 receptor inhibitors in dual or triple therapy in type 2 diabetes . Data sources MEDLINE , Embase , Cochrane Library ( all sections ) ; Science Citation Index ; trial registries ; conference abstract s ; drug regulatory authorities ; bibliographies of retrieved papers . Inclusion criteria R and omised controlled trials of SGLT2 receptor inhibitors compared with placebo or active comparator in type 2 diabetes in dual or combination therapy . Methods Systematic review . Quality assessment used the Cochrane risk of bias score . Results Seven trials , published in full , assessed dapagliflozin and one assessed canagliflozin . Trial quality appeared good . Dapagliflozin 10 mg reduced HbA1c by −0.54 % ( weighted mean differences ( WMD ) , 95 % CI −0.67 to −0.40 ) compared to placebo , but there was no difference compared to glipizide . Canagliflozin  reduced HbA1c slightly more than sitagliptin ( up to −0.21 % vs sitagliptin ) . Both dapagliflozin and canagliflozin  led to weight loss  ( dapagliflozin WMD −1.81 kg ( 95 % CI −2.04 to −1.57 ) , canagliflozin up to −2.3 kg compared to placebo ) . Limitations Long-term trial extensions suggested that effects were maintained over time . Data on canagliflozin are currently available from only one paper . Costs of the drugs are not known so cost-effectiveness can not be assessed . More data on safety are needed , with the Food and Drug Administration having concerns about breast and bladder cancers . Conclusions Dapagliflozin appears effective in reducing HbA1c and weight in type 2 diabetes , although more safety data are needed BACKGROUND Dipeptidyl peptidase-4 inhibitors improve glycaemic control in patients with type 2 diabetes mellitus when used as monotherapy or in combination with other anti-diabetic drugs ( metformin , sulphonylurea , or thiazolidinedione ) . This 18-week , phase 3b , multicentre , double-blind , noninferiority trial compared the efficacy and safety of two dipeptidyl peptidase-4 inhibitors , saxagliptin and sitagliptin , in patients whose glycaemia was inadequately controlled with metformin . METHODS Adult type 2 diabetes mellitus patients ( N = 801 ) with glycated haemoglobin ( HbA(1c ) ) 6.5 - 10 % on stable metformin doses ( 1500 - 3000 mg/day ) were r and omized 1 : 1 to add-on 5 mg saxagliptin or 100 mg sitagliptin once daily for 18 weeks . The primary efficacy analysis was a comparison of the change from baseline HbA(1c ) at week 18 in per- protocol patients . Noninferiority was concluded if the upper limit of the two-sided 95 % confidence interval of the HbA(1c ) difference between treatments was < 0.3 % . RESULTS The adjusted mean changes in HbA(1c ) following the addition of saxagliptin or sitagliptin to stable metformin therapy were - 0.52 and - 0.62 % , respectively . The between-group difference was 0.09 % ( 95 % confidence interval , - 0.01 to 0.20 % ) , demonstrating noninferiority . Both treatments were generally well tolerated ; incidence and types of adverse events were comparable between groups . Hypoglycaemic events , mostly mild , were reported in approximately 3 % of patients in each treatment group . Body weight declined by a mean of 0.4 kg in both groups . CONCLUSIONS Saxagliptin added to metformin therapy was effective in improving glycaemic control in patients with type 2 diabetes mellitus inadequately controlled by metformin alone ; saxagliptin plus metformin was noninferior to sitagliptin plus metformin , and was generally well tolerated The prevalence of obesity and diabetes continues to rise in the US . Glucagon-like peptide-1 receptor agonist ( GLP-1RA ) is an effective treatment option for type 2 diabetes mellitus ( T2DM ) that promotes weight loss . Common and effective treatment options added to metformin therapy ( basal insulin , sulfonylureas , and pioglitazone ) contribute to weight gain , which makes the addition of GLP-1RAs advantageous . Exenatide was the first agent in this class and has recently been approved for use in combination with insulin glargine by the US Food and Drug Administration and the European Medicines Agency . Until recently , there was a lack of data examining basal insulin combined with these agents . The main purpose of this article is to review the prospect i ve interventional data on the safety and efficacy of GLP-1RAs ( exenatide , liraglutide , albiglutide , lixisenatide ) combined with basal insulin therapy in nonpregnant adults with T2DM . Data bases search ed were PubMed , Cochrane Central Register of Controlled Trials and the Data base of Systematic Review s ( inception to January 2012 ) . Abstract s presented at relevant diabetes and endocrine meetings from 2009 to 2011 were also review ed , as were reference lists of identified publications . A total of five studies met the criteria and were included in the review . Data from these studies demonstrated that this combination therapy offers advantages for the treatment of diabetes , such as additional lowering of A1c without major risk for hypoglycemia , lower basal insulin requirements , decreased postpr and ial glucose levels ( with or without fasting plasma glucose decreases ) , and weight loss , or at the very least , less weight gain . However , the gastrointestinal side effects and high cost of these agents may limit their use . This review demonstrates that adding a GLP-1RA to an existing basal insulin regimen is a reasonable treatment strategy in nonpregnant adult patients with T2DM The link diet-cognitive function/dementia has been largely investigated in observational studies ; however , there was a lack of evidence from r and omized clinical trials ( RCTs ) on the prevention of late-life cognitive disorders though dietary intervention in cognitively healthy older adults . In the present article , we systematic ally review ed RCTs published in the last four years ( 2014 - 2017 ) exploring nutritional intervention efficacy in preventing the onset of late-life cognitive disorders and dementia in cognitively healthy subjects aged 60 years and older using different levels of investigation ( i.e. , dietary pattern changes/medical food/nutraceutical supplementation/multidomain approach and dietary macro- and micronutrient approaches ) as well as possible underlying mechanisms of nutritional prevention . From the 35 included RCTs , there was moderate evidence that intervention through dietary pattern changes , medical food/nutraceutical supplementation , and multidomain approach improved specific cognitive domains or cognitive-related blood biomarkers . There was high evidence that protein supplementation improved specific cognitive domains or functional status in prefrail older adults without effect on cognitive function . For fatty acid supplementation , mainly long-chain polyunsaturated fatty acids , there was emerging evidence suggesting an impact of this approach in improving specific cognitive domains , magnetic resonance imaging ( MRI ) findings , and /or cognitive-related biomarkers also in selected subgroups of older subjects , although some results were conflicting . There was convincing evidence of an impact of non-flavonoid polyphenol and flavonoid supplementations in improving specific cognitive domains and /or MRI findings . Finally , there was only low evidence suggesting efficacy of intervention with homocysteine-related and antioxidant vitamins in improving cognitive functions , dementia incidence , or cognitive-related biomarkers in cognitively healthy older subjects Background Hyperglycemia in pregnancy is associated with poor perinatal outcome . Even if pregnant women with diabetes are monitored according to current guidelines , they do much worse than their normoglycaemic counterparts , marked by increased risks of pre-eclampsia , macrosomia , and caesarean section amongst others . Continuous Glucose Monitoring ( CGM ) is a new method providing detailed information on daily fluctuations , used to optimize glucose control . Whether this tool improves pregnancy outcome remains unclear . In the present protocol , we aim to assess the effect of CGM use in diabetic pregnancies on pregnancy outcome . Methods / design The GlucoMOMS trial is a multicenter open label r and omized clinical trial with a decision and cost-effectiveness study alongside . Pregnant women aged 18 and over with either diabetes mellitus type 1 or 2 on insulin therapy or with gestational diabetes requiring insulin therapy before 30 weeks of gestation will be asked to participate . Consenting women will be r and omly allocated to either usual care or complementary CGM . All women will determine their glycaemic control by self-monitoring of blood glucose levels and HbA1c . In addition , women allocated to CGM will use it for 5–7 days every six weeks . Based on their CGM profiles they receive dietary advice and insulin therapy adjustments if necessary . The primary outcome measure is rate of macrosomia , defined as a birth weight above the 90th centile . Secondary outcome measures will be birth weight , composite neonatal morbidity , maternal outcome and costs . The analyses will be according to the intention to treat principle . Discussion With this trial we aim at clarifying whether the CGM improves pregnancy outcome when used during diabetic pregnancies . Trial registration Nederl and s Trial Register : BACKGROUND An expert panel convened by the American Dental Association Council on Scientific Affairs and the Center for Evidence -Based Dentistry conducted a systematic review and formulated evidence -based clinical recommendations for the arrest or reversal of  noncavitated and cavitated dental caries  using nonrestorative treatments  in children and adults . TYPES OF STUDIES REVIEW ED The authors conducted a systematic search of the literature in MEDLINE and Embase via Ovid , Cochrane CENTRAL , and Cochrane data base of systematic review s to identify r and omized controlled trials reporting on nonrestorative treatments  for noncavitated and cavitated carious lesions . The authors used the Grading of Recommendations Assessment , Development and Evaluation approach to assess the certainty in the evidence and move from the evidence to the decisions . RESULTS The expert panel formulated 11 clinical recommendations , each specific to lesion type , tooth surface , and dentition . Of the most effective interventions , the panel provided recommendations for the use of 38 % silver diamine fluoride , sealants , 5 % sodium fluoride varnish , 1.23 % acidulated phosphate fluoride gel , and 5,000 parts per million fluoride ( 1.1 % sodium fluoride ) toothpaste or gel , among others . The panel also provided a recommendation against the use of 10 % casein phosphopeptide-amorphous calcium phosphate . CONCLUSIONS AND PRACTICAL IMPLICATION S Although the recommended interventions are often used for caries prevention , or in conjunction with restorative treatment options , these approaches have shown to be effective in arresting or reversing carious lesions . Clinicians are encouraged to prioritize use of these interventions based on effectiveness , safety , and feasibility One of the main focuses of lifestyle modification for the prevention of osteoporosis and osteoporotic fractures  in Japan is improvement in dietary calcium intake . However , virtually no r and omized controlled trial to assess the preventive effects of administration of calcium on the risk of fractures has been conducted in Japan . In this study , we review ed all the scientific papers currently available from medical literature data bases to propose evidence -based recommendations on the preventive procedures for osteoporosis . The result of the present systematic review gives the evidence showing that calcium supplementation or optimal dietary calcium intake increases bone density in childhood and adolescence and reduces the risk of fracture due to osteoporosis in the elderly people regardless of the gender . The evidence also supports the current health policy guiding the elderly to increase their dietary calcium intake in daily life Background Besides the classical role of vitamin D on calcium and bone homeostasis , vitamin D deficiency has recently been identified as a contributing factor in the onset of insulin resistance in type 2 diabetes mellitus . However , it is uncertain whether vitamin D deficiency and poor glycaemic control are causally interrelated or that they constitute two independent features of type 2 diabetes mellitus . There are limited clinical trials carried out which measured the effect of vitamin D supplementation on glycaemic control . The objective of this study is to investigate the effect of vitamin D supplementation on glycaemic control and quality of life in patients with type 2 diabetes mellitus . Methods / design In a r and omised double-blind placebo-controlled trial conducted in five general practice s in the Netherl and s three hundred patients with type 2 diabetes mellitus treated with lifestyle advises or metformin or sulphonylurea-derivatives are r and omised to receive either placebo or 50,000 IU Vitamin D3 at monthly intervals . The primary outcome measure is the change in glycated haemoglobin level between baseline and six months . Secondary outcome measures include blood pressure , anthropometric parameters , lipid profile , insulin resistance , quality of life , advanced glycation end products and safety profiles . Quality of life will be measured by The Short Form ( SF-36 ) Health Survey question naire . Advanced glycation end products are measured by an AGE-reader . Discussion This trial will be the first study exploring the effect of vitamin D supplementation on both glycaemic control and quality of life in patients with type 2 diabetes mellitus . Our findings will contribute to the knowledge of the relationship between vitamin D status and insulin resistance in patients with type 2 diabetes mellitus . Trial registration The Netherl and s trial register : AIMS To compare the efficacy and safety of lixisenatide ( LIXI ) , a once-daily pr and ial glucagon-like peptide-1 ( GLP-1 ) receptor agonist , as add-on to basal insulin ( Basal+LIXI ) versus once-daily rapid-acting insulin ( Basal+RAI ) in patients with type 2 diabetes mellitus ( T2DM ) . METHODS Data were extracted from five r and omized controlled trials assessing the efficacy and safety of basal insulin+insulin glulisine ( n=3 ) or basal insulin+LIXI ( n=2 ) . Patients in the Basal+LIXI cohort were matched to patients in the Basal+RAI cohort using propensity score matching . RESULTS In the matched population , Basal+LIXI was twice as likely to reach composite outcomes of glycated haemoglobin ( HbA1c ) < 7 % and no symptomatic hypoglycaemia compared with the Basal+RAI group ( odds ratio [ OR ] : 1.90 ; 95 % confidence interval [ CI ] : 1.01 , 3.55 ; P=0.0455 ) , as well as HbA1c < 7 % and no severe hypoglycaemia ( OR : 1.97 ; 95 CI : 1.06 , 3.66 ; P=0.0311 ) . Furthermore , Basal+LIXI was more than twice as likely to reach HbA1c < 7 % , no weight gain and no symptomatic hypoglycaemia ( OR : 2.58 ; 95 % CI : 1.23 , 5.40 ; P=0.0119 ) . CONCLUSIONS Both basal+LIXI and Basal+RAI  improved glycaemic control in patients with T2DM with inadequate glycaemic control on basal insulin . Basal+LIXI offers an effective therapeutic option to advance basal insulin therapy , improving glucose control without weight gain and with less risk of hypoglycaemia than pr and ial insulin Objective : To assess the carotenoid status in young type I diabetic patients and its relationship to the glycaemic control of the disease . Design : A follow-up study . Setting : Hospital Universitario Puerta de Hierro , Health Area VI of Madrid (Spain).Subjects : Forty-seven type I diabetic patients , followed for 2.5 years . Interventions : Coinciding with physical examination and laboratory tests , serum levels of carotenoids were analysed by HPLC , and dietary intake of carotenoids was evaluated by a semiquantitative food frequency question naire and 3-day prospect i ve dietary records . Results : In type I diabetic patients , average intake , serum levels and correlations between diet and serum levels of carotenoids were comparable to those in reference non-diabetic groups . Between-subjects seasonal variations were observed for β-cryptoxanthin intake and serum levels ( higher in winter ) and serum lycopene ( higher in summer ) . Significant within-subjects seasonal changes were shown for dietary and serum β-cryptoxanthin and serum β-carotene . Serum carotenoids were unrelated to glycaemic control markers . Subjects with clinical ly acceptable glycaemic control showed lower lycopene intake than those with unacceptable control . Intake of carotenoids did not explain variance in insulin dose , fasting glycaemia , fructosamine or HbA1c . With the exception of lycopene , serum carotenoids were predicted by dietary intake , but in no case by fasting glycaemia , HbA1c or fructosamine . Conclusion : In type I diabetic patients , serum carotenoid concentrations and their variance are determined by dietary intake patterns , and are unrelated to the glycaemic control of the disease , as assessed by biochemical markers Background Patients with type 2 diabetes mellitus ( T2D ) have an increased risk of cardiovascular disease and mortality compared to the background population . Observational studies report an association between reduced blood glucose and reduced risk of both micro- and macrovascular complications in patients with T2D . Our previous systematic review of intensive glycaemic control versus conventional glycaemic control was based on 20 r and omised clinical trials that r and omised 29 , 986 participants with T2D . We now report our up date d review . Objectives To assess the effects of targeted intensive glycaemic control compared with conventional glycaemic control in patients with T2D . Search methods Trials were obtained from search es of The Cochrane Library , MEDLINE , EMBASE , Science Citation Index Exp and ed , LILACS , and CINAHL ( all until December 2012 ) . Selection criteria We included r and omised clinical trials that prespecified targets of intensive glycaemic control versus conventional glycaemic control targets in adults with T2D . Data collection and analysis Two authors independently assessed the risk of bias and extracted data . Dichotomous outcomes were assessed by risk ratios ( RR ) and 95 % confidence intervals ( CI ) . Health-related quality of life and costs of intervention were assessed with st and ardized mean differences ( SMD ) and 95 % Cl . Main results Twenty-eight trials with 34,912 T2D participants r and omised 18,717 participants to intensive glycaemic control  versus 16,195 participants to  conventional glycaemic control . Only two trials had low risk of bias on all risk of bias domains assessed . The duration of the intervention ranged from three days to 12.5 years . The number of participants in the included trials ranged from 20 to 11,140 . There were no statistically significant differences between targeting intensive versus conventional glycaemic control for all-cause mortality ( RR 1.00 , 95 % CI 0.92 to 1.08 ; 34,325 participants , 24 trials ) or cardiovascular mortality ( RR 1.06 , 95 % CI 0.94 to 1.21 ; 34,177 participants , 22 trials ) . Trial sequential analysis showed that a 10 % relative risk reduction could be refuted for all-cause mortality . Targeting intensive glycaemic control did not show a statistically significant effect on the risks of macrovascular complications as a composite outcome in the r and om-effects model , but decreased the risks in the fixed-effect model ( r and om RR 0.91 , 95 % CI 0.82 to 1.02 ; and fixed RR 0.93 , 95 % CI 0.87 to 0.99 ; P = 0.02 ; 32,846 participants , 14 trials ) . Targeting intensive versus conventional glycaemic control seemed to reduce the risks of non-fatal myocardial infa rct ion ( RR 0.87 , 95 % CI 0.77 to 0.98 ; P = 0.02 ; 30,417 participants , 14 trials ) , amputation of a lower extremity ( RR 0.65 , 95 % CI 0.45 to 0.94 ; P = 0.02 ; 11,200 participants , 11 trials ) , as well as the risk of developing a composite outcome of microvascular diseases ( RR 0.88 , 95 % CI 0.82 to 0.95 ; P = 0.0008 ; 25,927 participants , 6 trials ) , nephropathy ( RR 0.75 , 95 % CI 0.59 to 0.95 ; P = 0.02 ; 28,096 participants , 11 trials ) , retinopathy ( RR 0.79 , 95 % CI 0.68 to 0.92 ; P = 0.002 ; 10,300 participants , 9 trials ) , and the risk of retinal photocoagulation ( RR 0.77 , 95 % CI 0.61 to 0.97 ; P = 0.03 ; 11,212 participants , 8 trials ) . No statistically significant effect of targeting intensive glucose control could be shown on non-fatal stroke , cardiac revascularization , or peripheral revascularization . Trial sequential analyses did not confirm a reduction of the risk of non-fatal myocardial infa rct ion but confirmed a 10 % relative risk reduction in favour of intensive glycaemic control on the composite outcome of microvascular diseases . For the remaining microvascular outcomes , trial sequential analyses could not establish firm evidence for a 10 % relative risk reduction . Targeting intensive glycaemic control significantly increased the risk of mild hypoglycaemia , but substantial heterogeneity was present ; severe hypoglycaemia ( RR 2.18 , 95 % CI 1.53 to 3.11 ; 28,794 participants , 12 trials ) ; and serious adverse events ( RR 1.06 , 95 % CI 1.02 to 1.10 ; P = 0.007 ; 24,280 participants , 11 trials ) . Trial sequential analysis for a 10 % relative risk increase showed firm evidence for mild hypoglycaemia and serious adverse events and a 30 % relative risk increase for severe hypoglycaemia when targeting intensive versus conventional glycaemic control . Overall health-related quality of life , as well as the mental and the physical components of health-related quality of life did not show any statistical significant differences . Authors ' conclusions Although we have been able to exp and the number of participants by 16 % in this up date , we still find paucity of data on outcomes and the bias risk of the trials was mostly considered high . Targeting intensive glycaemic control compared with conventional glycaemic control did not show significant differences for all-cause mortality and cardiovascular mortality . Targeting intensive glycaemic control seemed to reduce the risk of microvascular complications , if we disregard the risks of bias , but increases the risk of hypoglycaemia and serious adverse events 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 OBJECTIVES To review the literature on comorbid depression and diabetes ( DM/D ) and present a conceptual framework for integrating depression management with diabetes care in a managed care environment . STUDY DESIGN Literature review . RESULTS Depression affects diabetes management by 1 ) directly affecting patients ' health-related quality of life , 2 ) reducing physical activity levels , 3 ) limiting adherence to self-care regimens , and 4 ) impairing patients ' ability to communicate effectively with clinicians . Small r and omized trials suggest that both antidepressant medication and cognitive behavioral therapies ( CBTs ) or related approaches may improve not only DM/D patients ' depressive symptoms , but their physical health as well . CONCLUSIONS An effective DM/D management strategy should include the following elements : 1 ) systematic identification of DM/D patients and quality -of-care review s , 2 ) proactive patient monitoring between outpatient encounters , 3 ) intensive efforts to coordinate treatment across providers , 4 ) increased access to CBT or related therapies addressing patients ' depressive symptoms and diabetes self care , and 5 ) an emphasis on promoting physical activity to address both depressive symptoms and physiologic dysregulation . The conceptual framework developed for the care of DM/D patients offers general insights into the management of patients with multiple chronic medical AIMS Individuals with Type 2 diabetes are at high risk for coronary heart disease , and may benefit from aggressive lifestyle modification . We evaluated the prevalence of Type 2 diabetes , in a Greek adult population , in relation to physical activity and dietary habits . METHODS From May 2001 to December 2002 , we r and omly enrolled 1514 men and 1528 women , with no evidence of cardiovascular or any other chronic disease . The sampling was stratified by the age and gender distribution of the general population in the greater area of Athens ( census 2001 ) . Diabetes was defined according to the established American Diabetes Association criteria .  Dietary habits  were assessed through a vali date d food frequency question naire and a diet score  was developed , in which higher values suggest greater adherence to the Mediterranean diet . Weekly energy expenditure  was assessed by considering frequency , duration and intensity of sports-related physical activity during a usual week . RESULTS After age adjustment for the Greek adult population ( 2001 census ) , the projected prevalence of Type 2 diabetes was 7.6 % in men and 5.9 % in women . A significant proportion of diabetic subjects ( 24 % of men and 30 % of women ) were unaware of their condition . Moreover , a 10-unit increase in the diet score was associated with 21 % lower odds of diabetes ( P < 0.05 ) , while individuals taking light physical activity were at 35 % lower odds ratio of diabetes compared with sedentary individuals ( P < 0.05 ) . CONCLUSIONS Diabetes mellitus is common in our population , with approximately 1 in 5 individuals with Type 2 diabetes being unaware of their condition . The lifestyle approach described here may contribute significantly to the reduction in the prevalence of diabetes , at a population level Background The aim of these review s is to inform the design and content of interventions to reduce obesity in young children . The behaviors that are associated with obesity/overweight have been studied extensively ; however , the factors associated with these behaviors in young children ( 0 to 6 years ) have not been systematic ally review ed . Over the past few years the focus of obesity prevention has shifted to preschool children because of the high prevalence of obesity at school entry and recognition that habits formed in early life could track into adulthood . In order to develop effective interventions and change behavior , it is important to underst and the factors that are associated with those behaviors . For example , we need to underst and whether it would be more important to target the family , childcare setting s or the wider environment and identify the most effective way of changing these energy balance related behaviors . Methods / Design Quantitative ( intervention and observational ) and qualitative literature on determinants/correlates of fruit and vegetable intake , sugar sweetened beverage and other unhealthy diet intake , and physical activity and sedentary behaviors in young children will be systematic ally identified , mapped and review ed . A common search strategy ( no language or period restrictions ) will be used to identify papers from eight electronic data bases and this will be supplemented by h and - search ing . Next , studies in developed countries that examine the factors associated with these behaviors in children aged 0 to 6 years ( at baseline ) will be screened and mapped descriptively followed by in-depth data extraction , quality assessment and synthesis . Data from quantitative studies will be summarized using either forest plots or harvest plots and narrative synthesis , and qualitative studies using thematic analysis . Qualitative evidence will be integrated with the quantitative evidence , using a parallel synthesis approach , to provide a deeper underst and ing of effective strategies to influence these energy balance related behaviors . Discussion In addition to updating and mapping current research , these review s will be the first to comprehensively synthesize and integrate both the quantitative and qualitative evidence pertaining to determinants/correlates/barriers/facilitators of obesity related behaviors in this young age group ( 0 to 6 years ) with the aim of informing future interventions . Systematic review registration International Prospect i ve Register for Systematic Review s ( PROSPERO ) Registration number : Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made Aims : With the increase in the number of systematic review s available , a logical next step to provide decision makers in healthcare with the evidence they require has been the conduct of review s of existing systematic review s. Syntheses of existing systematic review s are referred to by many different names , one of which is an umbrella review . An umbrella review allows the findings of review s relevant to a review question to be compared and contrasted . An umbrella review 's most characteristic feature is that this type of evidence synthesis only considers for inclusion the highest level of evidence , namely other systematic review s and meta-analyses . A methodology working group was formed by the Joanna Briggs Institute to develop method ological guidance for the conduct of an umbrella review , including diverse types of evidence , both quantitative and qualitative . The aim of this study is to describe the development and guidance for the conduct of an umbrella review . Methods : Discussion and testing of the elements of methods for the conduct of an umbrella review were held over a 6-month period by members of a methodology working group . The working group comprised six participants who corresponded via teleconference , e-mail and face-to-face meeting during this development period . In October 2013 , the methodology was presented in a workshop at the Joanna Briggs Institute Convention . Workshop participants , review authors and method ologists provided further testing , critique and feedback on the proposed methodology . Results : This study describes the methodology and methods developed for the conduct of an umbrella review that includes published systematic review s and meta-analyses as the analytical unit of the review . Details are provided regarding the essential elements of an umbrella review , including presentation of the review question in a Population , Intervention , Comparator , Outcome format , nuances of the inclusion criteria and search strategy . A critical appraisal tool with 10 questions to help assess risk of bias in systematic review s and meta-analyses was also developed and tested . Relevant details to extract from included review s and how to best present the findings of both quantitative and qualitative systematic review s in a reader friendly format are provided . Conclusions : Umbrella review s provide a ready means for decision makers in healthcare to gain a clear underst and ing of a broad topic area . The umbrella review methodology described here is the first to consider review s that report other than quantitative evidence derived from r and omized controlled trials . The methodology includes an easy to use and informative summary of evidence table to readily provide decision makers with the available , highest level of evidence relevant to the question posed AIM The aim of this study is to assess the efficacy and safety of vildagliptin 50 mg bid as add-on therapy to insulin in type 2 diabetes mellitus ( T2DM ) . METHODS This is a multicentre , double-blind , placebo-controlled , parallel group , clinical trial in T2DM patients inadequately controlled by stable insulin therapy , with or without metformin .  Patients received treatment with vildagliptin 50 mg bid or placebo for 24 weeks . RESULTS In all , 449 patients were r and omized to vildagliptin  ( n = 228 ) or placebo ( n = 221 ) . After 24 weeks , the difference in adjusted mean change in haemoglobin A1c ( HbA1c )  between vildagliptin and placebo was -0.7 ± 0.1 % ( p < 0.001 ) in the overall study population , -0.6 ± 0.1 % ( p < 0.001 ) in the subgroup also receiving metformin and -0.8 ± 0.2 % ( p < 0.001 ) in the subgroup without metformin . Vildagliptin therapy was well tolerated and had a similarly low incidence of hypoglycaemia compared with placebo ( 8.4 vs. 7.2 % , p = 0.66 ) in spite of improved glycaemic control , and was not associated with weight gain . ( + 0.1 vs. -0.4 kg ) . CONCLUSIONS Vildagliptin 50 mg bid added to insulin significantly reduced HbA1c in patients with T2DM inadequately controlled by insulin , with or without metformin . Vildagliptin was well tolerated , with a safety profile similar to placebo . These results were achieved without weight gain or an increase in hypoglycaemia incidence or severity in spite of improved glycaemic control Background : The benefits of self-monitoring blood glucose levels are unclear in patients with type 2 diabetes mellitus who do not use insulin , but there are considerable costs . We sought to determine the cost effectiveness of self-monitoring for patients with type 2 diabetes not using insulin . Methods : We performed an incremental cost-effectiveness analysis of the self-monitoring of blood glucose in adults with type 2 diabetes not taking insulin . We used the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) model to forecast diabetes-related complications , corresponding quality -adjusted life years and costs . Clinical data were obtained from a systematic review comparing self-monitoring with no self-monitoring .  Costs and utility decrements were derived from published sources . We performed sensitivity analyses to examine the robustness of the results . Results : Based on a clinical ly modest reduction in hemoglobin A1C of 0.25 % ( 95 % confidence interval 0.15–0.36 ) estimated from the systematic review , the UKPDS model predicted that self-monitoring performed 7 or more times per week reduced the lifetime incidence of diabetes-related complications compared with no self-monitoring , albeit at a higher cost ( incremental cost per quality -adjusted life year $ 113 643 ) . The results were largely unchanged in the sensitivity analysis , although the incremental cost per quality -adjusted life year fell within widely cited cost-effectiveness thresholds when testing frequency or the price per test strip was substantially reduced from the current levels . Interpretation : For most patients with type 2 diabetes not using insulin , use of blood glucose test strips for frequent self-monitoring ( ≥ 7 times per week ) is unlikely to represent efficient use of finite health care re sources , although periodic testing ( e.g. , 1 or 2 times per week ) may be cost-effective . Reduced test strip price would likely also improve cost-effectiveness AIM Short-term efficacy of glimepiride , metformin and pioglitazone in newly diagnosed type 2 diabetes was compared with a group treated with diet and exercise . Effects on insulin secretion and sensitivity were also assessed . METHODS New type 2 diabetic subjects , aged 30 - 60 years with BMI < 30 kg/m2 were selected . Subjects having glycosylated haemoglobin ( HbA1c ) of < 8.5 % were advised diet and exercise ( control group ) . Others having HbA1c > or = 8.5 to 11.0 % were r and omized to receive glimepiride ( group 2 ) , metformin ( group 3 ) and pioglitazone ( group 4 ) . At the final review between 12 - 14 weeks , changes in plasma glucose , HbA1c , lipid profile , HOMA insulin resistance ( HOMA-IR ) , beta cell function ( HOMA-BF ) and insulinogenic index ( delta I/G ) were measured . Comparisons were made using appropriate statistical analyses . RESULTS Seventy-seven of the 97 subjects r and omized equally into four groups , were available for review . Glycaemic parameters improved in all groups . Mean cholesterol decreased significantly in groups treated with metformin and pioglitazone . HDL-cholesterol increased with pioglitazone .  Insulin resistance decreased significantly with metformin and pioglitazone , beta cell fuhction also showed improvement CONCLUSIONS Glycaemic control was seen in all study groups , the improvement was better in drug treated groups than in the control group . Glimepiride improved insulin secretion including the early phase secretion and reduced plasma triglycerides .  Metformin and pioglitazone had beneficial effects on lipid levels , improved insulin sensitivity and improved insulin secretion also Aims /hypothesisThe aim of this study was to measure the efficacy of motivational interviewing ( MI ) compared with usual care on changes in glycaemic control and competence of diabetes self-management in patients with diabetes mellitus . Methods Patients were eligible if they had type 1 or 2 diabetes mellitus , were over 18 years of age and had participated in a 4 day group education programme offered at a diabetes clinic at a university hospital in Denmark . Exclusion criteria included pregnancy , severe debilitating disease and cognitive deficit . Out of 469 patients who attended the group education programme , 349 patients were r and omised to either a usual care control group or an intervention group , which received up to five individual counselling sessions in 1 year based on MI , in addition to usual care . A r and omised parallel design was used and open-label allocation was done by r and om permuted blocks , with allocation concealment by sequentially numbered , sealed , opaque envelopes . The primary outcome was glycated haemoglobin ( HbA1c ) . Analysis regarding measurements of glycated haemoglobin ( HbA1c ) and competence of self-management ( using the Problem Areas in Diabetes Scale [ PAID ] and Perceived Competence for Diabetes Scale [ PCDS ] ) was based on 298 participants followed for a 24 month period . Data were collected at the Department of Endocrinology at Odense University Hospital . Our hypotheses were that MI could : ( 1 ) reduce HbA1c levels ; ( 2 ) increase self-efficacy ; and ( 3 ) increase diabetes self-care , compared with usual care . Results Out of the 176 included in the control group and 173 in the intervention group , 153 and 145 were analysed in the groups , respectively . When using the baseline value as covariate there were no significant differences in change score between the two study groups with regard to mean level of HbA1c ( 0.131 , p = 0.221 ) , PAID scores ( −1.793 , p = 0.191 ) or PCDS scores ( 0.017 , p = 0.903 ) at the 24 month follow-up , using a mixed effects regression model . The patients in the intervention group showed significantly higher levels of perceived competence in dealing with diabetes compared with the control group ( mean change score = −0.387 , p = 0.002 ) following 1 year of intervention . Conclusion /interpretationWe were unable to demonstrate any benefit , over or above usual care , of MI in patients with diabetes who have just completed a diabetes education programme , and who have well-regulated diabetes . Trial registration Clinical Trials NCT00555854 . Funding The National Board of Health , Funen County , Danish Association of Diabetes , Odense University Hospital , University of Southern Denmark and TRYG Fonden BACKGROUND The appropriate dietary intervention for overweight persons with type 2 diabetes mellitus ( DM2 ) is unclear . Trials comparing the effectiveness of diets are frequently limited by short follow-up times and high dropout rates . AIM The effects of a low carbohydrate Mediterranean ( LCM ) , a traditional Mediterranean ( TM ) , and the 2003 American Diabetic Association ( ADA ) diet were compared , on health parameters during a 12-month period . METHODS In this 12-month trial , 259 overweight diabetic patients ( mean age 55 years , mean body mass index 31.4 kg/m(2 ) ) were r and omly assigned to one of the three diets . The primary end-points were reduction of fasting plasma glucose , HbA1c and triglyceride ( TG ) levels . RESULTS 194 patients out of 259 ( 74.9 % ) completed follow-up . After 12 months , the mean weight loss for all patients was 8.3 kg : 7.7 kg for ADA , 7.4 kg for TM and 10.1 kg for LCM diets . The reduction in HbA1c was significantly greater in the LCM diet than in the ADA diet ( -2.0 and -1.6 % , respectively , p < 0.022 ) . HDL cholesterol increased ( 0.1 mmol/l + /- 0.02 ) only on the LCM ( p < 0.002 ) . The reduction in serum TG was greater in the LCM ( -1.3 mmol/l ) and TM ( -1.5 mmol/l ) than in the ADA ( -0.7 mmol/l ) , p = 0.001 . CONCLUSIONS An intensive 12-month dietary intervention in a community-based setting was effective in improving most modifiable cardiovascular risk factors in all the dietary groups . Only the LCM improved HDL levels and was superior to both the ADA and TM in improving glycaemic control RATIONALE , AIMS AND OBJECTIVES Self-management of type 2 diabetes through diet , exercise and for many medications , are vital in achieving and maintaining glycaemic control in type 2 diabetes . A number of interventions have been design ed to improve self-management , but the outcomes of these are rarely explored from a qualitative angle and even fewer through a process evaluation . METHOD A process evaluation was conducted using a qualitative design with participants r and omized to an intervention . Seventy-three people living with type 2 diabetes and hyperglycaemia for a minimum of 1 year , r and omized to one of two interventions ( n = 34 to an education intervention and n = 39 to an education and acceptance and commitment therapy intervention )  completed stage one of the process evaluation , immediately following the intervention through written feedback guided by open-ended questions . A purposive sample of 27 participants completed semi-structured interviews at 3 and 6 months post intervention . Interview data were transcribed and data analysed using a thematic analysis . RESULTS The majority of participants described an increase in knowledge around diabetes self-management and an increased sense of personal responsibility . Participants also described changes in self-management activities and reflected on the challenges in instigating and maintaining change to improve diabetes management . CONCLUSION The complexities of implementing change in daily life to improve glycaemic control indicate the need for ongoing support post intervention , which may increase and maintain the effectiveness of the intervention Aims /hypothesisThe role of diet in the prevention of diabetes remains uncertain . The aim of this study was to investigate two different dietary aspects , i.e. adherence to the Mediterranean diet and glycaemic load ( GL ) , in relation to diabetes occurrence . Methods We analysed data from the Greek cohort of the population -based European Prospect i ve Investigation into Cancer and Nutrition ( EPIC ) . From a total of 22,295 participants , actively followed for a median of 11.34 years , 2,330 cases of incident type 2 diabetes were recorded . All participants completed a vali date d , interviewer-administered semi-quantitative food frequency question naire at enrolment . From this information , we calculated a ten point Mediterranean diet score ( MDS ) , reflecting adherence to the traditional Mediterranean diet , as well as the dietary GL . We estimated HRs and the corresponding 95 % CIs of diabetes using Cox proportional hazards regression models adjusted for potential confounders . Results A higher MDS was inversely associated with diabetes risk ( HR 0.88 [ 95 % CI 0.78 , 0.99 ] for MDS ≥6 vs MDS ≤3 ) . GL was positively associated with diabetes ( HR 1.21 [ 95 % CI 1.05 , 1.40 ] for the highest vs the lowest GL quartile ) . A significant protection of about 20 % was found for a diet with a high MDS and a low GL . Conclusions /interpretationA low GL diet that also adequately adheres to the principles of the traditional Mediterranean diet may reduce the incidence of type 2 diabetes Diabetes is the leading cause of major complications , such as end-stage renal disease and lower extremity amputations , and is a significant contributor to ischemic heart disease , stroke , peripheral vascular disease , and vision loss ( 1 ) . There has been increasing acceptance of the importance of individualizing glycemic management and assessment of risk for adverse events , especially hypoglycemia ( 26 ) . This is of great importance for all patients , especially older adults ( aged 65 years ) with comorbid conditions . In 2013 , 12.0 million older adults in the United States had diabetes , comprising 40 % of the 30.2 million persons with the disease ( 7 ) . Older adults account for an estimated 60 % to 70 % of the U.S. Department of Veterans Affairs ( VA ) and U.S. Department of Defense ( DoD ) diabetic population ( largely retirees ) ( VA/DoD. Unpublished data ) . These considerations make safe and effective diabetes management a policy priority for health care providers ( physicians , nurses , dietitians , and pharmacists ) and policymakers in both the VA and the DoD. The 2017 VA/DoD Clinical Practice Guideline ( CPG ) for the Management of Type 2 Diabetes Mellitus in Primary Care offers health care providers an evidence -based framework to evaluate , treat , and manage persons with type 2 diabetes  mellitus in the context of their individual needs and preferences ( 8) . The current article is a summary of key CPG recommendations , which was developed with multiple stakeholders to ensure representation by a broad spectrum of clinicians . It provides practice recommendations for the care of patients with diabetes , with an emphasis on shared decision making . Guideline Development and Review Process These recommendations were developed using methods established by the VA/DoD Evidence -Based Practice Work Group ( EBPWG ) ( 9 ) , which are aligned with st and ards for trustworthy guidelines ( 10 ) . The EBPWG and the U.S. Army Medical Comm and selected guideline panel cochairs ( 1 each from the VA and the DoD ) . The cochairs then selected a multidisciplinary panel of practicing clinician stakeholders , including primary care physicians ( family and internal medicine ) , endocrinologists , medical nutritionists , pharmacists , diabetes educators , and nurse practitioners . At the start of the CPG development process and at other key points throughout , all members were required to su bmi t disclosure statements for potential conflicts of interest in the previous 24 months . Verbal affirmations of no conflicts were used during meetings throughout the development process . The project team was also subject to r and om Web-based surveillance ( for example , ProPublica ) . The VA/DoD contracted with The Lewin Group , a third party with expertise in clinical practice guideline development , to facilitate meetings . The guideline panel , in collaboration with the ECRI Institute , developed 9 key questions using the PICOTS ( population , intervention , comparator , outcomes , timing of outcomes measurement , and setting ) format . A systematic search of the peer- review ed literature from January 2009 through March 2016 was conducted to find evidence relevant to the key questions that focused on r and omized trials , systematic review s , and meta-analyses of fair or better quality . One key question was up date d through 14 June 2016 . The search methods and results are detailed in the full guideline ( 8) . The guideline panel rated recommendations by using the GRADE ( Grading of Recommendations Assessment , Development and Evaluation ) method ( 11 ) . The guideline panel focused on developing new and up date d recommendations using the evidence review for the key questions . The panel also considered , without a complete review of the relevant evidence , the current applicability of recommendations that were included in the 2010 CPG . As part of the development process , a patient focus group was also convened to better underst and the perspectives of patients receiving diabetes treatment in the VA and the DoD. Five patients were included , consistent with the requirements of the federal Paperwork Reduction Act . All patients had type 2 diabetes and were veterans receiving care in the VA . The focus group explored knowledge of treatment options , views on the delivery of care , patients ' needs and preferences , and the effect of diabetes on their lives . Important concepts that emerged from the focus group were shared with the panel and informed guideline development . It was acknowledged that this convenience sample may not be representative of all VA and DoD patients receiving treatment for type 2 diabetes . The draft guideline was sent to more than 15 expert review ers inside and outside the federal sector . Comments were review ed and , where appropriate , were incorporated into the final guideline based on panel consensus . The VA/DoD EBPWG approved the final document on 3 April 2017 and released it on 17 April 2017 . Recommendations are presented in the Table , and an algorithm for establishing a personalized glycemic goal and treatment plan is presented in the Figure . Key recommendations are review ed in this article . Table . Summary of Recommendations From the 2017 VA/DoD CPG on the Management of Type 2 Diabetes Mellitus Figure . Algorithmic approach to evaluating glycemic control risk factors , setting a personalized glycemic control target range , providing self-management ( including lifestyle and nutrition ) education , and initiating or reevaluating medication therapy . Recommendations Provide Patient-Centered Care and Incorporate Shared Decision Making The CPG strongly encourages clinicians to incorporate shared decision making and partner with their patients . Shared decision making is the process by which the patient and family , in conjunction with the care provider , reach an agreement about a plan of care and treatment . Key principles include readiness of the patient and family , tools with underst and able information about the benefits and harms of all options , and strategies to identify and incorporate patient preferences . Patients can not effectively participate in care and shared decision making unless they underst and diabetes and how they can be involved in planning and carrying out the jointly developed care plan . Shared decision making reinforces a trusted therapeutic relationship and increases patient satisfaction and treatment buy-in with regard to the methods used to reach a particular goal or treatment plan ( 1214 ) . It should be used not only for patients with stable glycemic control but also to assist those who are not able or willing to make lifestyle changes and decisions that affect their diabetes at any time during the course of treatment . At a minimum , shared decision making should be included at the time of diagnosis , during difficulties with management , and at times of transition or development of complications ( 14 ) . Benefits include greater knowledge of medications ( 13 ) and underst and ing of risks ( 14 ) . In addition , patient-centered care and shared decision making together may decrease patient anxiety , increase trust in clinicians ( 15 ) , and improve treatment adherence ( 16 ) . Family involvement should be considered if appropriate , especially in older adults ( 17 ) . Patient information should be culturally appropriate ; underst and able and actionable by people with limited literacy skills ; and accessible to those with physical , sensory , or learning needs ( 18 ) . As part of the patient-centered care approach to diabetes management , clinicians should explore with the patient the outcomes of previous opportunities for shared decision making , their ability to self-manage , prior efforts to change health behaviors , past treatment experiences ( including reasons for discontinuing treatment ) , and relevant clinical outcomes . In actively sharing decisions , they should involve the patient in prioritizing problems to be addressed and setting specific goals regardless of the setting or level of care . Assess Patient Characteristics and Nonglycemic Factors When Interpreting Results of Hemoglobin A1c , Fructosamine , and Other Glycemic Biomarker Testing Many factors affect measurement of hemoglobin A1c ( HbA1c ) besides the level of glycemia ( 19 ) . Because HbA1c level depends on the duration of erythrocyte exposure to glucose , conditions that alter erythrocyte life span affect the measured level of HbA1c ( 20 , 21 ) . Iron deficiency anemia , which prolongs erythrocyte life span and exposes the cell to glucose for a longer period , is associated with falsely elevated HbA1c levels ( 22 ) . In contrast , conditions that shorten erythrocyte life span ( such as hemolytic anemia ) may result in falsely low HbA1c levels . Various other conditions , such as chronic kidney disease , may alter HbA1c measurement . Hemoglobin variants can result in falsely elevated or falsely lowered HbA1c levels , depending on the assay used ( 2325 ) . In addition , oral hypoglycemic agents ( metformin or sulfonylureas ) may alter the relationship between blood glucose and HbA1c levels , although the clinical significance is unclear ( 26 ) . There are also racial/ethnic differences in HbA1c levels for a given level of glycemia . A previous study found that African Americans with prediabetes ( 27 ) had HbA1c values that were 0.4 % higher than among white persons ; those who were within 3 years of diagnosis ( 28 ) also had higher HbA1c values than white persons for any measure of glycemia . This difference can not be explained by measured differences in glycemia , clinical factors known to affect HbA1c measurement , or sociodemographic factors ( 27 , 28 ) . Therefore , it is recommended that a new diagnosis of diabetes be based on a confirmatory fasting blood glucose level of at least 7.0 mmol/L ( 126 mg/dL ) if the initial HbA1c value is 6.5 % to 6.9 % . How and where the HbA1c level is measured can also affect results because of intralaboratory variation ( variation in test accuracy and precision ) and interlaboratory variation ( variation related to use of different test methods ) . A single HbA1c measurement , even from a AIM The purpose of this study was to examine the effect of the diabetes outpatient intensive management programme ( DOIMP ) on glycaemic control over a 12 week follow-up period for type 2 diabetic patients in Korea . BACKGROUND Diabetic complications can be prevented if the glycaemic status of diabetes patients is maintained within a nearly normal range . Patient education is critical in controlling blood glucose levels of patients with diabetes within the optimal range . METHODS DOIMP was composed of multidisciplinary education , complication monitoring and telephone counselling .  Twenty-five patients in the intervention group participated in the DOIMP and 24 patients in the control group were briefed on the conventional description of diabetes mellitus by diabetes education nurses . RESULTS Patients in the intervention group had a mean decrease of 2.3 % , which those in the control group having a mean decrease 0.4 % in glycosylated haemoglobin ( HbA(1)c ) . There was no difference between the two groups in the change in fasting blood glucose ( FBG ) and two-hour postpr and ial blood glucose ( 2-h PBG ) . The proportion of the patients with HbA(1)c < 7 % was higher in the intervention group than in the control group at the post-test compare with the pretest . CONCLUSION DOIMP can reduce HbA(1)c in type 2 diabetes patients . RELEVANCE TO CLINICAL PRACTICE These findings indicated that DOIMP could be effective in glycaemic control in type 2 diabetes patients Abstract Women with gestational diabetes mellitus ( GDM ) have a greater risk of developing type 2 diabetes mellitus ( DM ) and heart disease than pregnant women without GDM . Advice given during the GDM pregnancy provides an opportunity to develop protective dietary patterns for the long-term management of this risk . Dietary guidelines for the prevention and management of type 2 DM support the inclusion of unsaturated fats , but food advice needs to target this outcome . The aim of this study was to compare the  dietary intakes  of women with GDM given general low-fat advice ( control group )  to women with GDM given the same advice with additional targets for food sources of unsaturated fats ( intervention group ) . After approximately 6 weeks , the intervention group reported more ideal dietary fatty acid intakes than the control group , with polyunsaturated : saturated fat ratios of 1:1 and 0.4:1 , respectively ( P < .001 ) , assessed using repeated measures analysis of variance . These results confirm the need to include food sources of unsaturated fats in advice strategies to assure optimal protective eating habits in this at-risk group Abstract s on this page have been chosen and edited by Dr Trevor Watts Abstract Periodontal treatment improved periodontal health but did not affect glycaemic control Background Despite broad agreement on the necessity to improve quality of diabetic care through implementation of clinical guidelines , in Italy many people with diabetes still lack adequate care in general practice . In addition there is little evidence to support the choice of implementation strategies , especially in the Lazio region ( central Italy ) , where comparative studies among general practitioners ( GPs ) are uncommon . The primary objective of the study is to assess the effectiveness of different strategies for the implementation of an  evidence -based guideline for the management of  non-complicated type 2 diabetes mellitus ( DM ) among GPs of the Lazio region . Methods / Design Three-arm cluster-r and omised trial ( C- RCT ) . 252 GPs were r and omised either to arm 1 ( comprising a training module and administration of the guideline ) , or to arm 2 ( administration of guideline without training ) , or to arm 3 ( control arm ) , continuing current practice . Arm 1 participants attended a two-day course with CME credits . Data collection will be performed using current information systems . Patients ' health data was also collected to describe diabetic population s cared for by GP participants . Process outcomes will be measured at the patient level and at the cluster level one year after the intervention . We will assess GPs ' adherence to guideline recommendations for diabetes management relative to : 1 ) pharmacological management of diabetes ; 2 ) pharmacological management of cardiovascular risk factors ( hypertension and dislypidaemia ) ; 3 ) measurement of glycosilated haemoglobin as the principal indicator of glycaemic control ; 4 ) micro- and macrovascular complications assessment tests . Outcomes will be expressed as proportions of patients cared for by GPs who will have prescriptions of drugs , requests for tests and for outpatient appointment visits . To estimate the efficiency of re source use associated with the intervention a cost-effectiveness analysis will be carried out . The design of the study is based on three Cochrane and one Health Technology Assessment systematic review s of guideline dissemination and implementation strategies OBJECTIVE A lower glycaemic index ( GI ) diet is associated with a reduction in glycosylated Hb ( HbA(1c ) ) in people with diabetes . Yet , little research has been conducted to determine the effects of specific goals regarding consumption of low GI ( LGI ) foods on diabetes outcomes . The present study evaluated a behavioural intervention on  dietary intake , weight status and HbA(1c ) , which included a goal to consume either six or eight servings of LGI foods daily . DESIGN A parallel two-group design was used . Following the 5-week intervention , participants were r and omly assigned to the group of six ( n 15 ) or eight ( n 20 ) servings of LGI foods daily and followed up for 8 weeks . Dietary intake was assessed using the mean of 4 d food records . SETTING A metropolitan community in the USA . SUBJECTS Individuals aged 40 - 65 years with type 2 diabetes of ≥1 year and HbA(1c ) ≥ 7·0 % were eligible . RESULTS There was no significant difference between goal difficulty groups with regard to GI servings at the end of the study . However , mean consumption of LGI foods increased by 2·05 ( SE 0·47 ) and 1·65 ( SE 0·40 ) servings per 4184 kJ in the six ( P < 0·001 ) and eight ( P < 0·001 ) LGI serving groups , respectively . For all participants combined , there were significant decreases in mean HbA(1c ) ( -0·58 ( SE 0·21 ) % ; P = 0·01 ) , weight ( -2·30 ( SE 0·78 ) kg ; P = 0·01 ) , BMI ( -0·80 ( SE 0·29 ) kg/m(2 ) ; P = 0·01 ) and waist circumference ( -2·36 ( SE 0·81 ) cm ; P = 0·01 ) . CONCLUSIONS An intervention including a specific goal to consume six to eight servings of LGI foods daily can improve diabetes outcomes . Clinicians should help patients set specific targets for dietary change and identify ways of achieving those goals OBJECTIVE To provide up date d guidelines for health care providers on the management of menopause in asymptomatic healthy women as well as in women presenting with vasomotor or urogenital symptoms and on considerations related to cardiovascular disease , breast cancer , urogynaecology , and sexuality . OUTCOMES Lifestyle interventions , prescription medications , and complementary and alternative therapies are presented according to their efficacy in the treatment of menopausal symptoms . Counselling and therapeutic strategies for sexuality concerns in the peri- and postmenopausal years are review ed . Approaches to the identification and evaluation of women at high risk of osteoporosis , along with options for prevention and treatment , are presented in the companion osteoporosis guideline . EVIDENCE Published literature was retrieved through search es of PubMed and The Cochrane Library in August and September 2012 with the use of appropriate controlled vocabulary ( e.g. , hormone therapy , menopause , cardiovascular diseases , and sexual function ) and key words ( e.g. , hormone therapy , perimenopause , heart disease , and sexuality ) . Results were restricted to clinical practice guidelines , systematic review s , r and omized control trials/controlled clinical trials , and observational studies . Results were limited to publication date s of 2009 onwards and to material in English or French . Search es were up date d on a regular basis and incorporated in the guideline until January 5 , 2013 . Grey ( unpublished ) literature was identified through search ing the websites of health technology assessment and health technology assessment -related agencies , national and international medical specialty societies , and clinical practice guideline collection Background DA-1229 is a novel , potent and selective dipeptidyl peptidase-4 ( DPP-IV ) inhibitor that is orally bioavailable . We aim ed to evaluate the optimal dose , efficacy and safety of DA-1229 , in Korean subjects with type 2 diabetes mellitus suboptimally controlled with diet and exercise . Methods We enrolled 158 patients ( mean age , 53 years and a mean BMI , 25.6 kg/m2 ) . The mean baseline fasting plasma glucose level , HbA1c and duration of diabetes were 8.28 mmol/L , 7.6 % ( 60 mmol/mol ) and 3.9 years , respectively . After 2 or 6 weeks of an exercise and diet program followed by 2 weeks of a placebo period , the subjects were r and omized into one of four groups for a 12-week active treatment period : placebo , 2.5 , 5 or 10 mg of DA-1229 . Results All three doses of DA-1229 significantly reduced HbA1c from baseline compared to the placebo group ( −0.09 in the placebo group vs. −0.56 , −0.66 and −0.61 % in 2.5 , 5 and 10-mg groups , respectively ) but without any significant differences between the doses . Insulin secretory function , as assessed by homeostasis model assessment β-cell , the insulinogenic index , 2-h oral glucose tolerance test ( OGTT ) C-peptide and post-OGTT C-peptide area under the curve (AUC)0–2h , significantly improved with DA-1229 treatment . The incidence of adverse events was similar between the treatment groups and DA-1229 did not affect body weight or induce hypoglycaemic events . Conclusions DA-1229 monotherapy ( 5 mg for 12 weeks ) improved HbA1c , fasting plasma glucose level , OGTT results and β-cell function . This drug was well tolerated in Korean subjects with type 2 diabetes mellitus . © 2014 The Authors . Diabetes/Metabolism Research and Review s published by John Wiley & Sons , Ltd. DA-1229 is a novel , potent and selective DPP-IV inhibitor that is orally bioavailable . In a pharmacodynamic study , more than 80 % of DPP-IV was inhibited by a single dose of 5 mg or higher of DA-1229 , and this level of inhibition was maintained for at least 24 h after a single dose of 10 mg or higher of DA-1229 . This phase II clinical trial was design ed to evaluate the efficacy and safety of oral DA-1229 and to determine the optimal dose to use for a phase III clinical study in Korean subjects with type 2 diabetes AIM The aim of our study was to describe investigate and association between improved glycaemic control on quality of life ( QoL ) during 1 year of treatment in a sample of 94 Type 2 diabetic patients referred for insulin therapy to an outpatient department ( OPD ) . Treatment was aim ed at achieving acceptable glycaemic control by means of maximizing oral therapy , if necessary switching over to insulin therapy , and information and education provided by a diabetes specialist nurse and dietitian . METHODS QoL was measured using a disease-specific ( Diabetes Health Profile ( DHP ) ) and a generic question naire ( R AND -36 ) . After 1 year the medical examination and QoL measurements were repeated . The association between 1-year changes in QoL and achievement of good metabolic control ( final glycosylated haemoglobin ( HbA1c ) < or = 8 % ) , switch to insulin therapy , and presence of hyperglycaemic complaints at baseline was analysed after adjustment for appropriate confounders . RESULTS After 1 year , mean HbA1c was reduced from 10.4 % to 7.8 % . Also QoL improved in the total group . Patients who achieved good glycaemic control after 1 year ( 61 % ) improved in a similar manner as the others . Patients switched over to insulin ( 65 % ) improved in a similar manner as the others , but at the final examination they experienced more problems with social functioning and pain . Patients with hyperglycaemic complaints at baseline ( 49 % ) improved more in QoL than those without , especially in physical functioning , vitality and health change , but at the final examination still scored lower on a majority of the DHP and R AND -36 dimensions . CONCLUSION Symptoms of hyperglycaemia predict the strength of an association between improvements of glycaemic control and
According to the network meta- analysis the Mediterranean diet is the most effective and efficacious dietary approach to improve glycaemic control in type 2 diabetes patients
The aim of the present study is to assess the comparative efficacy of different dietary approaches on glycaemic control in patients with type 2 diabetes mellitus using a systematic review of the literature .