The Influence of Yoga-Based Programs on Risk Profiles in Adults with Type 2 Diabetes Mellitus: A Systematic Review Group Visits for Hmong Adults with Type 2 Diabetes Mellitus: A Pre-Post Analysis Yoga Practice for the Management of Type II Diabetes Mellitus in Adults: A systematic review The effectiveness of group medical visits on diabetes mellitus type 2 (dm2) specific outcomes in adults: a systematic review Management of type 2 diabetes in Western Australian metropolitan general practice. Management of Depression in Patients With Cancer: A Clinical Practice Guideline. Impact of a self-care education programme on patients with type 2 diabetes in primary care in the Basque Country Overview of Systematic Reviews: Yoga as a Therapeutic Intervention for Adults with Acute and Chronic Health Conditions A monitoring and feedback tool embedded in a counselling protocol to increase physical activity of patients with COPD or type 2 diabetes in primary care: study protocol of a three-arm cluster randomised controlled trial Effectiveness of a stepped-care intervention to prevent major depression in patients with type 2 diabetes mellitus and/or coronary heart disease and subthreshold depression: A pragmatic cluster randomized controlled trial Community-based care for the management of type 2 diabetes: an evidence-based analysis. Effectiveness of PRECEDE model for health education on changes and level of control of HbA1c, blood pressure, lipids, and body mass index in patients with type 2 diabetes mellitus Yoga and Mindfulness as Therapeutic Interventions for Stroke Rehabilitation: A Systematic Review Rating the strength of scientific evidence: relevance for quality improvement programs. Lack of effects of pioglitazone on cardiac function in patients with type 2 diabetes and evidence of left ventricular diastolic dysfunction: a tissue doppler imaging study Yoga on Our Minds: A Systematic Review of Yoga for Neuropsychiatric Disorders Completion report: Effect of Comprehensive Yogic Breathing program on type 2 diabetes: A randomized control trial A Smart Web Aid for Preventing Diabetes in Rural China: Preliminary Findings and Lessons A simple clinical score for type 2 diabetes mellitus screening in the Canary Islands. Decrease in blood pressure, body mass index and glycemia after aerobic training in elderly women with type 2 diabetes. Effects of meal preparation training on body weight, glycemia, and blood pressure: results of a phase 2 trial in type 2 diabetes Dairy Products and Prevention of Type 2 Diabetes: Implications for Research and Practice Comprehensive yogic breathing program improves quality of life in patients with diabetes Effects of oral amino acid supplementation on myocardial function in patients with type 2 diabetes mellitus. Behavioural interventions for type 2 diabetes: an evidence-based analysis. Nicotine infusion acutely impairs insulin sensitivity in type 2 diabetic patients but not in healthy subjects. Impact of a 10 minute Seated Yoga Practice in the Management of Diabetes. Bias in Systematic Reviews? Functional polymorphisms of the leptin and leptin receptor genes are associated with longevity and with the risk of myocardial infarction and of type 2 diabetes mellitus. The effectiveness of yoga to prevent diabetes mellitus type 2 [Adherence to a medical nutrition therapy program in pregnant women with diabetes, measured by three methods, and its association with glycemic control]. Protocol for a systematic review of psychological interventions for cancer-related fatigue in post-treatment cancer survivors Catheter ablation of atrial fibrillation in patients with diabetes mellitus type 2: results from a randomized study comparing pulmonary vein isolation versus antiarrhythmic drug therapy. The Effectiveness of Exercise Interventions for the Management of Frailty: A Systematic Review Interventions to reduce the incidence of falls in older adult patients in acute care hospitals: a systematic review Effectiveness of workplace interventions in rehabilitating musculoskeletal disorders and preventing its consequences among workers with physical and sedentary employment: systematic review protocol Scoping review of systematic reviews of complementary medicine for musculoskeletal and mental health conditions
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 Hmong refugees with type 2 diabetes mellitus ( DM2 ) have poor glycemic control . For Hmong adults with DM2 , group visits were instituted at a community health center and evaluated for their influence on diabetes management . Pre- and postintervention measures of physical health , mental health , and behavior were collected on 39 participants ( 64 % participation rate ) . Baseline characteristics and clinical outcomes of 39 group visit participants were compared with 22 Hmong DM2 adults who refused to participate and 216 nonparticipating Hmong DM2 adults from a local diabetes registry . Baseline characteristics were similar among the three groups . Although participants received good medical services and their mental health improved ( p < 0.05 ) , clinical outcomes did not significantly improve . Although group visits are feasible for providing medical services for Hmong adults with DM2 , clinical outcomes remain outside of recommended targets . Addressing mental health in this population may be necessary before people can institute behavioral changes that improve diabetes management 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 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 The purpose of this study was : ( 1 ) to record GP opinions , practice s and outcomes for the care of Type 2 Diabetes Mellitus ( DM2 ) , ( 2 ) compare practice facilities and process of care with a criterion of recommended competent care and ( 3 ) determine if there were any differences between vocationally registered and non-vocationally registered GPs . A r and om sample of 204 metropolitan doctors from 124 practice s was selected and an audit performed on 467 of their patient records . GPs pursued good blood sugar control and advocated lifestyle changes before hypoglycaemic drugs . Over 80 % regard uncomplicated DM2 as a condition for general practice management . However , only 15 % conducted an annual diabetes check , 9 % had a diabetic register , 6 % a diabetic recall system and 8 % used a diabetic health care checklist for monitoring their patients . The most commonly recorded processes of medical audit in the previous 12 months were : blood pressure ( 94 % ) , duration of diabetes ( 72 % ) , blood glucose ( 70 % ) , diet ( 66 % ) , body weight ( 56 % ) , HBA1c ( 52 % ) and ophthalmoscopy ( 50 % ) . The least commonly recorded processes of care were body mass index ( 5 % ) , inspection of the feet ( 18 % ) , enquiries about vaginitis or impotence ( 23 % ) . The amount of exercise , alcohol and tobacco was recorded in only 34 % of records . Hypoglycaemic drugs were used appropriately but the most commonly used drugs for treating hypertension in DM2 patients were thiazide diuretics and beta-blockers .  Vocationally registered ( VR ) doctors had better records , higher process of care scores and more were willing to participate in the study than non-vocationally registered ( NVR ) doctors . However , there was no difference in metabolic control between patients from either group . The use of a Diabetic Health Care Checklist would improve diabetes care especially in the search for early complications and in the recording of HBA1c and other metabolic parameters . The drugs commonly used to control hypertension can have adverse effects on glucose and lipid metabolism and should be replaced with glucose and lipid neutral drugs PURPOSE This report up date s the Cancer Care Ontario Program in Evidence -Based Care guideline for the management of  depression in adult patients with cancer . This guideline covers pharmacologic , psychological , and collaborative care interventions , with a focus on integrating practical management tools to assist clinicians in delivering appropriate treatments for depression in patients with cancer . METHODS Recommendations were developed by synthesizing information from extant guidelines and review s and search ing for r and omized controlled trials from the date of data base inception ( 1964 for MEDLINE and 1974 for EMBASE ) to January 2015 . Quality assessment of guidelines and systematic review s were conducted by using the Appraisal of Guidelines for Research and Evaluation II ( AGREE II ) , Assessment of Multiple Systematic Review s ( AMSTAR ) , and Cochrane Risk of Bias tools . Final recommendations were developed through a st and ardized Program in Evidence -Based Care multidisciplinary expert and knowledge user review process . RESULTS Two high- quality relevant clinical practice guidelines , eight pharmacologic trials , nine psychological trials , and eight collaborative care intervention trials composed the evidence base upon which the recommendations were developed . Eight specific recommendations were made to establish a st and ard of care for the management of depression in patients with cancer . The recommendations and practical management tools were review ed as being well organized and helpful , although systemic barriers to implementation were identified . CONCLUSION This up date d guideline supports the previous general recommendation that patients with cancer who have depression may benefit from psychological and /or pharmacologic interventions , without evidence for the superiority of any specific treatment over another . New recommendations for a collaborative care model that incorporates a stepped care approach suggest that multidisciplinary mental health care restructuring may be required for optimal management of depression Background Type 2 diabetes mellitus ( DM2 ) is a disease with high prevalence and significant impact in terms of mortality and morbidity . The increased prevalence of the disease requires the implementation of new strategies to promote patient self-management . The Spanish Diabetes Self-Management Program ( SDSMP ) has proven to be effective in other setting s. The objective of this study is to assess its effectiveness in terms of care for DM2 patients in primary care setting s within the Basque Health Service – Osakidetza ( Spain ) . Method / Design This is a r and omised clinical trial in which patients diagnosed with DM2 , 18–79 years of age , from four health regions within the Basque Health Service will be r and omised into two groups : an intervention group , who will follow the SDSMP , and a control group , who will receive usual care in accordance with the clinical guidelines for DM2 and existing regulations in our region . The intervention consists of 2,5 hour-group sessions once a week for six weeks . The sessions cover target setting and problem solving techniques , promotion of physical exercise , basic knowledge of nutrition , proper use of medication , effective communication with relatives and health professionals , and basic knowledge about DM2 and its complications . This content is complemented by educational material : books , leaflets and CDs . The primary outcome measure will be the change in glycated haemoglobin ( HbA1c ) , and secondary outcome measures will include changes in levels of physical activity and intake of fruit and vegetables , cardiovascular risk , quality of life , self-efficacy , number of consultations and drug prescriptions . The results will be analysed 6 , 12 and 24 months after the intervention . Discussion If the intervention were to be effective , the programme should be spread to the entire diabetic population in the Basque Country and it could also be applied for other diseases . Trial registration Clinical Trials.gov identifier Objectives . Overview the quality , direction , and characteristics of yoga interventions for treatment of acute and chronic health conditions in adult population s. Methods . We search ed for systematic review s in 10 online data bases , bibliographic references , and h and - search es in  yoga-related  journals . Included review s satisfy Oxman criteria and specify yoga as a primary intervention in one or more r and omized controlled trials for treatment in adults . The AMSTAR tool and GRADE approach evaluated the method ological quality of review s and quality of evidence . Results . We identified 2202 titles , of which 41 full-text articles were assessed for eligibility and 26 systematic review s satisfied inclusion criteria . Thirteen systematic review s include quantitative data and six papers include meta- analysis . The quality of evidence is generally low . Sixteen different types of health conditions are included . Eleven review s show tendency towards positive effects of yoga intervention , 15 review s report unclear results , and no , review s report adverse effects of yoga . Yoga appears most effective for reducing symptoms in anxiety , depression , and pain . Conclusion . Although the quality of systematic review s is high , the quality of supporting evidence is low . Significant heterogeneity and variability in reporting interventions by type of yoga , setting s , and population characteristics limit the generalizability of results Background Physical activity is important for a healthy lifestyle . Although physical activity can delay complications and decrease the burden of the disease , the level of activity of patients with chronic obstructive pulmonary disease ( COPD ) or type 2 Diabetes Mellitus ( DM2 ) is often far from optimal . To stimulate physical activity , a monitoring and feedback tool , consisting of an accelerometer linked to a smart phone and webserver ( It ’s LiFe ! tool ) , and a counselling protocol for practice nurses in primary care was developed ( the Self-management Support Program ) . The main objective of this study is to measure the longitudinal effects of this counselling protocol and the added value of using the tool . Methods / Design This three-armed cluster r and omised controlled trial with 120 participants with COPD and 120 participants with DM2 ( aged 40–70 ) , compares the counselling protocol with and without the use of the tool ( group 1 and 2 ) with usual care ( group 3 ) . Recruitment takes place at GP practice s in the southern regions of the Netherl and s. R and omisation takes place at the practice level . The intended sample ( three arms of 8 practice s ) powers the study to detect a 10-minute difference of moderate and intense physical activity per day between groups 1 and 3 . Participants in the intervention groups have to visit the practice nurse 3–4 times for physical activity counselling , in a 4 - 6-month period . Specific activity goals tailored to the individual patient 's preferences and needs will be set . In addition , participants in group 1 will be instructed to use the tool in daily life . The primary outcome , physical activity , will be measured in all groups with a physical activity monitor ( PAM ) . Secondary outcomes are quality of life , general - and exercise - self-efficacy , and health status . Follow-up will take place after 6 and 9 months . Separately , a process evaluation will be conducted to explore reasons for trial non-participation , and the intervention ’s acceptability for participating patients and nurses . Discussion Results of this study will give insight into the effects of the It ’s LiFe ! monitoring and feedback tool combined with care from a practice nurse for people with COPD or DM2 on physical activity . Trial registration Clinical Trials.gov : Purpose Given the public health significance of poorly treatable co-morbid major depressive disorders ( MDD ) among patients with type 2 diabetes mellitus ( DM2 ) and coronary heart disease ( CHD ) , we need to investigate whether strategies to prevent the development of major depression could reduce its burden of disease . We therefore evaluated the effectiveness of a stepped-care program for subthreshold depression in comparison with usual care in patients with DM2 and /or CHD . Methods A cluster r and omized controlled trial , with 27 primary care centers serving as clusters . A total of 236 DM2 and /or CHD patients with subthreshold depression ( nine item Patient Health Question naire ( PHQ-9 ) score ≥ 6 , no current MDD according to DSM-IV criteria ) were allocated to the intervention group ( N = 96 ) or usual care group ( n = 140 ) . The stepped-care program was delivered by trained practice nurses during one year and consisted of four sequential treatment steps : watchful waiting , guided self-help , problem solving treatment and referral to the general practitioner . The primary outcome was the 12-month cumulative incidence of MDD as measured with the Mini International Neuropsychiatric Interview ( MINI ) . Secondary outcomes included severity of depression ( measured by PHQ-9 ) at 3 , 6 , 9 and 12 months . Results Of 236 patients ( mean age , 67,5 ( SD 10 ) years ; 54.7 % men ) , 210 ( 89 % ) completed the MINI at 12 months . The cumulative incidence of MDD was 9 of 89 ( 10.1 % ) participants in the intervention group and 12 of 121 ( 9.9 % ) participants in the usual care group . We found no statistically significant overall effect of the intervention ( OR = 1.21 ; 95 % confidence interval ( 0.12 to 12.41 ) ) and there were no statistically significant differences in the course or severity of depressive symptoms between the two groups . Conclusions This study suggest that Step-Dep was not more effective in preventing MDD than usual care in a primary care population with DM2 and /or CHD and subthreshold depression 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 Background Individual health education is considered to be essential in the overall care of patients with type 2 diabetes ( DM2 ) , although there is some uncertainty regarding its metabolic control benefits . There have been very few r and omized studies on the effects of individual education on normal care in DM2 patients with a control group , and none of these have assessed the long-term results . Therefore , this study aims to use this design to assess the effectiveness of the PRECEDE ( Predisposing , Reinforcing , Enabling , Causes in Educational Diagnosis , and Evaluation ) education model in the metabolic control and the reduction of cardiovascular risk factors , in patients with type 2 diabetes . Methods An open community effectiveness study was carried out in 8 urban community health centers in the North-East Madrid Urban Area ( Spain ) . Six hundred patients with DM2 were r and omized in two groups : PRECEDE or conventional model for health promotion education . The main outcome measures were glycated hemoglobin A1c , body mass index ( BMI ) , blood pressure , lipids and control criteria during the 2-year follow-up period . Results Glycated hemoglobin A1c and systolic blood pressure ( SBP ) levels decreased significantly in the PRECEDE group ( multivariate analysis of covariance , with baseline glycated hemoglobin A1c , SBP , and variables showing statistically significant differences between groups at baseline visits ) . The decrease levels in diastolic blood pressure ( DBP ) , triglycerides and LDL cholesterol were nonsignificant . PRECEDE increased compliance in all control criteria , except for LDL cholesterol . BMI did not change during the study in either of the two models analyzed . Conclusions PRECEDE health education model is a useful method in the overall treatment in patients with type 2 diabetes , which contributes to decrease glycated hemoglobin A1c and SBP levels and increase the compliance in all the control criteria , except for LDL cholesterol . Trial registration number Clinical Trials.gov Aim . This paper reports a systematic review and critical appraisal of the evidence on the effectiveness of behavioral therapies such as yoga and mindfulness practice s for stroke rehabilitation . Background . The experience of stroke can have a negative impact on both psychological and physical health and on quality of life . Yoga and relevant practice s are promising therapies that have been used with patients with a variety of conditions . In order to draw conclusions on effectiveness for stroke patients , the evidence requires systematic assessment . Methods . A comprehensive search of major biomedical and complementary medicine data bases was conducted . Relevant research was categorized by study type and appraised according to study design . Results . Five r and omized controlled clinical trials and four single case studies were found . Additionally , one qualitative research study was identified . Studies reported positive results , including improvements in cognition , mood , and balance and reductions in stress . Modifications to different yoga practice s make comparison between studies difficult , and a lack of controlled studies precludes any firm conclusions on efficacy . Conclusion . Yoga and mindfulness could be clinical ly valuable self-administered intervention options for stroke rehabilitation . Further research is needed to evaluate these specific practice s and their suitability in stroke rehabilitation OBJECTIVE To summarize an extensive review of systems for grading the quality of research articles and rating the strength of bodies of evidence , and to highlight for health professionals and decision-makers concerned with quality measurement and improvement the available " best practice s " tools by which these steps can be accomplished . DESIGN Drawing on an extensive review of checklists , question naires , and other tools in the field of evidence -based practice , this paper discusses clinical , management , and policy rationale s for rating strength of evidence in a quality improvement context , and documents best practice s methods for these tasks . RESULTS After review of 121 systems for grading the quality of articles , 19 systems , mostly STUDY DESIGN specific , met a priori scientific st and ards for grading systematic review s , r and omized controlled trials , observational studies , and diagnostic tests ; eight systems ( of 40 review ed ) met similar st and ards for rating the overall strength of evidence . All can be used as is or adapted for particular types of evidence reports or systematic review s. CONCLUSIONS Formally grading study quality and rating overall strength of evidence , using sound instruments and procedures , can produce reasonable levels of confidence about the science base for parts of quality improvement programs . With such information , health care professionals and administrators concerned with quality improvement can underst and better the level of science ( versus only clinical consensus or opinion ) that supports practice guidelines , review criteria , and assessment s that feed into quality assurance and improvement programs . New systems are appearing and research is needed to confirm the conceptual and practical underpinnings of these grading and rating systems , but the need for those developing systematic review s , practice guidelines , and quality or audit criteria to underst and and undertake these steps is becoming increasingly clear Background Thiazolidinediones , used for the treatment of patients with type 2 diabetes mellitus ( DM2 ) , are associated with an increased incidence of heart failure . We sought to investigate the effects of pioglitazone on novel echocardiographic indices of left ventricular ( LV ) diastolic function in DM2 patients with LV diastolic dysfunction ( LVDD ) . Methods Eighty-eight asymptomatic DM2 patients on metformin and /or sulfonylureas , aged 64.5 ± 7.7 years , without known cardiovascular disease , with normal LV systolic function and evidence of LVDD were r and omly assigned to pioglitazone 30 mg/day ( n = 42 ) or an increase in dose of other oral agents ( n = 39 ) for 6 months . All patients underwent transthoracic conventional and Tissue Doppler Imaging echocardiography at baseline and follow-up . The primary end-point was change in early diastolic velocity of the mitral annulus ( E ' ) . Results Improvement of glycaemic control was similar in the 2 groups . A significant difference ( p < 0.05 ) between the 2 groups was found in the treatment-induced changes in fasting insulin , the insulin resistance index HOMA , HDL cholesterol , triglycerides , diastolic blood pressure ( all in favor of pioglitazone ) and in body weight ( increase with pioglitazone ) . No significant changes were observed in any echocardiographic parameter in either group and did not differ between groups ( p = NS for all ) . E ' increased non-significantly and to a similar extent in both groups ( p = NS ) . Conclusions In asymptomatic DM2 patients with LVDD , the addition of pioglitazone to oral conventional treatment for 6 months does not induce any adverse or favorable changes in LV diastolic or systolic function despite improvements in glycaemic control , insulin sensitivity , lipid profile , and blood pressure Background : The dem and for clinical ly efficacious , safe , patient acceptable , and cost-effective forms of treatment for mental illness is growing . Several studies have demonstrated benefit from yoga in specific psychiatric symptoms and a general sense of well-being . Objective : To systematic ally examine the evidence for efficacy of yoga in the treatment of selected major psychiatric disorders . Methods : Electronic search es of The Cochrane Central Register of Controlled Trials and the st and ard bibliographic data bases , MEDLINE , EMBASE , and PsycINFO , were performed through April 2011 and an up date d in June 2011 using the keywords yoga AND psychiatry OR depression OR anxiety OR schizophrenia OR cognition OR memory OR attention AND r and omized controlled trial ( RCT ) . Studies with yoga as the independent variable and one of the above mentioned terms as the dependent variable were included and exclusion criteria were applied . Results : The search yielded a total of 124 trials , of which 16 met rigorous criteria for the final review . Grade B evidence supporting a potential acute benefit for yoga exists in depression ( four RCTs ) , as an adjunct to pharmacotherapy in schizophrenia ( three RCTs ) , in children with ADHD ( two RCTs ) , and Grade C evidence in sleep complaints ( three RCTs ) . RCTs in cognitive disorders and eating disorders yielded conflicting results . No studies looked at primary prevention , relapse prevention , or comparative effectiveness versus pharmacotherapy . Conclusion : There is emerging evidence from r and omized trials to support popular beliefs about yoga for depression , sleep disorders , and as an augmentation therapy . Limitations of literature include inability to do double-blind studies , multiplicity of comparisons within small studies , and lack of replication . Biomarker and neuroimaging studies , those comparing yoga with st and ard pharmaco- and psychotherapies , and studies of long-term efficacy are needed to fully translate the promise of yoga for enhancing mental health Background : Yoga has been shown to be beneficial in diabetes in many studies , though r and omized control trials are few . The aim of this r and omized control trial was to see the effect of Sudarshan Kriya and related practice s ( comprehensive yogic breathing program ) on quality of life , glycemic control , and cardiac autonomic functions in diabetes . Diabetes mellitus is a risk factor for sudden cardiac death . Cardiac autonomic neuropathy has been implicated in the causation of sudden cardiac death . Therefore , a maneuver to prevent progression of cardiac autonomic neuropathy holds significance . Material s and Methods : A total of 120 patients of diabetes on oral medication and diet and exercise advice were r and omized into two groups : ( 1 ) Continued to receive st and ard treatment for diabetes . ( 2 ) Patients administered comprehensive yogic breathing program and monitored to regularly practice yoga in addition to st and ard treatment of diabetes . At 6 months , quality of life and postpr and ial plasma glucose significantly improved in the group practicing yoga compared to baseline , but there was no significant improvement in the fasting plasma glucose and glycated hemoglobin . Results : On per protocol analysis , sympathetic cardiac autonomic functions significantly improved from baseline in the group practicing comprehensive yogic breathing . Conclusion : This r and omized control trial points towards the beneficial effect of yogic breathing program in preventing progression of cardiac neuropathy . This has important implication s as cardiac autonomic neuropathy has been considered as one of the factors for sudden cardiac deaths Background Increasing cases of diabetes , a general lack of routinely operational prevention , and a long history of separating disease prevention and treatment call for immediate engagement of frontier clinicians . This applies especially to village doctors who work in rural China where the majority of the nation ’s vast population lives . Objective This study aims to develop and test an online Smart Web Aid for Preventing Type 2 Diabetes ( SWAP-DM2 ) capable of addressing major barriers to applying proven interventions and integrating diabetes prevention into routine medical care . Methods Development of SWAP-DM2 used evolutionary prototyping . The design of the initial system was followed by refinement cycles featuring dynamic interaction between development of practical and effective st and ardized operation procedures ( SOPs ) for diabetes prevention and Web-based assistance for implementing the SOPs . The result ing SOPs incorporated proven diabetes prevention practice s in a synergetic way . SWAP-DM2 provided support to village doctors ranging from simple educational webpages and record maintenance to relatively sophisticated risk scoring and personalized counseling . Evaluation of SWAP-DM2 used data collected at baseline and 6-month follow-up assessment : ( 1 ) audio recordings of service encounters ; ( 2 ) structured exit surveys of patients ’ knowledge , self-efficacy , and satisfaction ; ( 3 ) measurement of fasting glucose , body mass index , and blood pressure ; and ( 4 ) qualitative interviews with doctors and patients . Data analysis included ( 1 ) descriptive statistics of patients who received SWAP-DM2–assisted prevention and those newly diagnosed with prediabetes and diabetes ; ( 2 ) comparison of the variables assessed between baseline and follow-up assessment ; and ( 3 ) narratives of qualitative data . Results The 17 participating village doctors identified 2219 patients with elevated diabetes risk . Of these , 84.85 % ( 1885/2219 ) consented to a fasting glucose test with 1022 new prediabetes and 113 new diabetes diagnoses made within 6 months . The prediabetic patients showed substantial improvement from baseline to 6-month follow-up in vegetable intake ( 17.0 % , 43/253 vs 88.7 % , 205/231 ) , calorie intake ( 1.6 % , 4/253 vs 71.4 % , 165/231 ) , leisure-time exercises ( 6.3 % , 16/253 vs 21.2 % , 49/231 ) , body weight ( mean 62.12 kg , SD 9.85 vs mean 58.33 kg , SD 9.18 ) , and body mass index ( mean 24.80 kg/m2 , SD 3.21 vs mean 23.36 kg/m2 , SD 2.95 ) . The prediabetic patients showed improvement in self-efficacy for modifying diet ( mean 5.31 , SD 2.81 vs mean 8.53 , SD 2.25 ) , increasing physical activities ( mean 4.52 , SD 3.35 vs mean 8.06 , SD 2.38 ) , engaging relatives ( mean 3.93 , SD 3.54 vs mean 6.93 , SD 2.67 ) , and knowledge about diabetes and risks of an imbalanced diet and inadequate physical activity . Most participating doctors and patients viewed SWAP-DM2 as useful and effective . Conclusions SWAP-DM2 is helpful to village doctors , acceptable to patients , and effective in modifying immediate determinants of diabetes at least in the short term , and may provide a useful solution to the general lack of participation in diabetes prevention by frontier clinicians in rural China . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 66772711 ; http://www.controlled-trials.com/IS RCT N66772711 ( Archived by WebCite at http://www.webcitation.org/6OMkAqyEy ) AIM To develop a straightforward risk score for type 2 diabetes ( DM2 ) screening to use in clinical practice . METHODS A sample of 6237 adult inhabitants of the Canary Isl and s ( Spain ) was r and omly divided into two subgroups : one yielded data used to develop the instrument , and the other yielded data used for validation testing . Performance of the instrument was compared in persons with clinical ly diagnosed DM2 and undiagnosed diabetes . The risk score , calculated by multivariate logistic regression , included the potential risk variables that yielded the highest odds ratio in the univariate analysis . A cut-off point for screening purpose s was established at a 99 % negative predictive value . RESULTS In men , variables included in the risk score were age , waist/height ratio , familial antecedents of diabetes , and systolic blood pressure ( ROC curve 0.837 , 95 % CI : 0.803 - 0.871 ) . In women , the risk score contained the same variables plus gestational diabetes history ( ROC curve 0.874 , 95 % CI : 0.847 - 0901 ) . Excluding systolic blood pressure from the score had no significant effect on the area under the curve . This instrument result ed valid only for people aged less than 55 years . CONCLUSIONS This simple risk score for DM2 would be easy to apply in clinical practice BACKGROUND The aging process is associated with the development of several diseases , which can be attenuated by the practice of physical activities . Aerobic training is an effective method to maintain and improve cardiovascular function . Additionally , it has a crucial role in the prevention and treatment of several chronic-degenerative diseases , especially diabetes mellitus . } OBJECTIVE To verify the effect of a 13-week aerobic training program on blood pressure ( BP ) , body mass index ( BMI ) and glycemia levels in elderly women with type-2 diabetes mellitus ( DM2 ) . METHODS Eleven sedentary elderly women with DM2 , aged 61.0 ± 9.1 years , were su bmi tted a 13-week aerobic training program , constituting group G2 . Eleven controlled elderly women ( aged 60.2 ± 6.8 years ) were not su bmi tted to the aerobic training , constituting the control group ( G1 ) . G1 attended educational lectures once a week , whereas G2 walked three times a week . RESULTS Both groups presented a significant decrease in glycemia and diastolic blood pressure levels . No significant decreases in BMI were observed after the aerobic training in either group . CONCLUSION The 13-week aerobic training program was enough to promote significant decrease in the diastolic blood pressure and glycemia levels ; therefore , this type of exercise training decreases the risk factors for cardiovascular and metabolic diseases Background Modest reductions in weight and small increases in step- related activity ( e.g. , walking ) can improve glycemic and blood pressure control in type 2 diabetes mellitus ( DM2 ) . We examined changes in these parameters following training in time- efficient preparation of balanced , low- energy meals combined with pedometer- based step count monitoring . Methods Seventy- two adults with DM2 were enrolled in a 24- week program ( i.e. , 15 three- hour group sessions ) . They prepared meals under a chef ’s supervision , and discussed eating behaviours/nutrition with a registered dietitian . They maintained a record of pedometer- assessed step counts . We evaluated changes from baseline to 24 weeks in terms of weight , step counts , hemoglobin A1c ( HbA1c , glycemic control ) , blood pressure , and eating control ability ( Weight Efficacy Lifestyle WEL Question naire ) . 53 participants ( 73.6 % ) completed assessment s. Results There were improvements in eating control ( 11.2 point WEL score change , 95 % CI 4.7 to 17.8 ) , step counts ( mean change 869 steps/day , 95 % CI 198 to 1,540 ) , weight ( mean change −2.2 % ; 95 % CI −3.6 to −0.8 ) , and HbA1c ( mean change −0.3 % HbA1c , 95 % CI −0.6 to −0.1 ) , as well as suggestion of systolic blood pressure reduction ( mean change −3.5 mm Hg , 95 % CI −7.8 to 0.9 ) . Findings were not attributable to medication changes . In linear regression models ( adjusted for age , sex , ethnicity , insulin use , season ) , a −2.5 % weight change was associated with a −0.3 % HbA1c change ( 95 % CI −0.4 to −0.2 ) and a −3.5 % systolic blood pressure change ( 95 % CI −5.5 to −1.4 ) . Conclusions In this ‘ proof of concept ’ study , persistence with the program led to improvements in eating and physical activity habits , glycemia reductions , and suggestion of blood pressure lowering effects . The strategy thus merits further study and development to exp and the range of options for vascular risk reduction in DM2 A growing body of scientific evidence has linked dairy intake to a reduced  type 2 diabetes ( T2D ) risk . Using an evidence -based approach , we review ed the most recent and strongest evidence on the relationship between dairy intake and the risk of T2D . Evidence indicates that dairy intake is significantly associated with a reduced T2D risk , and likely in a dose-response manner . The association between low-fat dairy and T2D risk reduction appears consistent . A beneficial impact is suggested for regular-fat dairy . The role of specific dairy products needs to be clarified . Potential underlying mechanisms include the role of dairy products in obesity and metabolic syndrome , as well as several dairy components , such as calcium , vitamin D , dairy fat , and specifically trans-palmitoleic acid . To conclude , there is strong , consistent , and accumulating evidence that dairy intake reduces the risk of T2D . More research is needed to better underst and the role of regular-fat and specific dairy products . Well- design ed r and omized controlled trials and mechanistic studies are needed to support these findings . Efforts to translate this evidence into clinical practice and public health guidance are needed Objective : To assess the effect of a comprehensive yogic breathing program on glycemic control and quality of life ( QOL ) in patients with diabetes . Material s and Methods : This is a prospect i ve r and omized controlled intervention trial . Patients having HbA1c between 6 and 9 % for at least 3 months with lifestyle modification and oral antidiabetic medication were included . They were followed-up and r and omized at 6 months into two groups : one group receiving st and ard treatment of diabetes and the other group receiving st and ard treatment of diabetes and taught and told to regularly practice the comprehensive yogic breathing program ( Sudarshan Kriya Yoga and Pranayam ) . Change in fasting and post-pr and ial blood sugars , glycated hemoglobin and QOL as assessed by the World Health Organization QOL WHOQOL BREF question naire were assessed . Results : There was a trend toward improvement in glycemic control in the group practicing the comprehensive yogic breathing program compared with the group following st and ard treatment alone , although this was not significant . There was significant improvement in physical , psychological and social domains and total QOL post-intervention in the group practicing the comprehensive yogic breathing program as compared with the group following st and ard treatment alone . Conclusion : There was significant improvement in the QOL and a non-significant trend toward improvement in glycemic control in the group practicing the comprehensive yogic breathing program compared with the group that was following st and ard treatment alone BACKGROUND Diabetes mellitus is associated with an increased rate of cardiac amino acid catabolism that could interfere with cardiac function . METHODS We assessed the effects of an oral amino acids mixture ( AAM ) on myocardial function in patients with type 2 diabetes mellitus ( DM2 ) . We studied 65 consecutive patients with DM2 who had normal resting left ventricular ejection fraction ( LVEF ) and did not have obstructive coronary artery disease ( CAD ) . After baseline evaluations , patients were r and omized to receive , in a single-blinded fashion , AAM ( 12 grams/day ) or placebo for 12 weeks , after which , treatment was crossed over for another similar period . At baseline and at the end of each treatment , 2-dimensional ecocardiography at rest and during isometric exercise ( h and grip ) was performed , as were biochemical assays . Twenty adults , matched for age , sex , and body mass index served as control subjects . RESULTS At baseline and during AAM or placebo treatment , resting left ventricular dimensions and LVEF in patients with DM2 did not differ from those of control subjects . In patients with DM2 , at baseline and during placebo treatment , peak h and grip LVEF decreased significantly in comparison with the resting value ( 63 % + /- 9 % vs 56 % + /- 9 % , P < .001 ; and 62 % + /- 6 % vs 55 % + /- 8 % , P < .001 ) . During AAM treatment , peak h and grip LVEF did not differ from resting value ( 66 % + /- 11 % vs 64 % + /- 9 % , P = not significant ) . Thus , exercise LVEF was higher during AAM treatment than both baseline and placebo treatment ( 66 % + /- 11 % vs 56 % + /- 9 % and vs 55 % + /- 8 % , P < .001 ) . In contrast to placebo treatment , after the AAM supply , a decreased glycated hemoglobin level was observed ( 7.0 % + /- 1.3 % vs 7.6 % + /- 1.8 % , P < .05 ) . CONCLUSIONS Myocardial dysfunction is easily inducible with isometric exercise in patients with DM2 who have normal resting LV function and do not have CAD . An increased amino acid supply prevents this phenomenon and improves metabolic control UNLABELLED In June 2008 , the Medical Advisory Secretariat began work on the Diabetes Strategy Evidence Project , an evidence -based review of the literature surrounding strategies for successful management and treatment of diabetes . This project came about when the Health System Strategy Division at the Ministry of Health and Long-Term Care subsequently asked the secretariat to provide an evidentiary platform for the Ministry 's newly released Diabetes Strategy .After an initial review of the strategy and consultation with experts , the secretariat identified five key areas in which evidence was needed . Evidence -based analyses have been prepared for each of these five areas : insulin pumps , behavioural interventions , bariatric surgery , home telemonitoring , and community based care . For each area , an economic analysis was completed where appropriate and is described in a separate report . To review these titles within the Diabetes Strategy Evidence series , please visit the Medical Advisory Secretariat Web site , http://www.health.gov.on.ca/english/providers/program/mas/mas_about.html,DIABETES STRATEGY EVIDENCE PLATFORM : Summary of Evidence -Based AnalysesContinuous Subcutaneous Insulin Infusion Pumps for Type 1 and Type 2 Adult Diabetics : An Evidence -Based Analysis Behavioural Interventions for Type 2 Diabetes : An Evidence -Based Analysis  BARIATRIC SURGERY FOR PEOPLE WITH DIABETES AND MORBID OBESITY : An Evidence -Based Summary Community-Based Care for the Management of Type 2 Diabetes : An Evidence -Based Analysis Home Telemonitoring for Type 2 Diabetes : An Evidence -Based Analysis Application of the Ontario Diabetes Economic Model ( ODEM ) to Determine the Cost-effectiveness and Budget Impact of Selected Type 2 Diabetes Interventions in Ontario OBJECTIVE The objective of this report is to determine whether behavioural interventions are effective in improving glycemic control in adults with type 2 diabetes . BACKGROUND Diabetes is a serious chronic condition affecting millions of people worldwide and is the sixth leading cause of death in Canada . In 2005 , an estimated 8.8 % of Ontario 's population had diabetes , representing more than 816,000 Ontarians . The direct health care cost of diabetes was $ 1.76 billion in the year 2000 and is projected to rise to a total cost of $ 3.14 billion by 2016 . Much of this cost arises from the serious long-term complications associated with the disease including : coronary heart disease , stroke , adult blindness , limb amputations and kidney disease . Type 2 diabetes accounts for 90 - 95 % of diabetes and while type 2 diabetes is more prevalent in people aged 40 years and older , prevalence in younger population s is increasing due to a rise in obesity and physical inactivity in children . Data from the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) has shown that tight glycemic control can significantly reduce the risk of developing serious complications in type 2 diabetics . Despite physicians ' and patients ' knowledge of the importance of glycemic control , Canadian data has shown that only 38 % of patients with diabetes have HbA1C levels in the optimal range of 7 % or less . This statistic highlights the complexities involved in the management of diabetes , which is characterized by extensive patient involvement in addition to the support provided by physicians . An enormous dem and is , therefore , placed on patients to self-manage the physical , emotional and psychological aspects of living with a chronic illness . Despite differences in individual needs to cope with diabetes , there is general agreement for the necessity of supportive programs for patient self-management . While traditional programs were didactic models with the goal of improving patients ' knowledge of their disease , current models focus on behavioural approaches aim ed at providing patients with the skills and strategies required to promote and change their behaviour . Several meta-analyses and systematic review s have demonstrated improved health outcomes with  self-management support programs in type 2 diabetics . They have all , however , either looked at a specific component of self-management support programs ( i.e. self-management education ) or have been conducted in specific population s. Most review s are also qualitative and do not clearly define the interventions of interest , making findings difficult to interpret . Moreover , heterogeneity in the interventions has led to conflicting evidence on the components of effective programs . There is thus much uncertainty regarding the optimal design and delivery of these programs by policymakers . EVIDENCE -BASED ANALYSIS OF EFFECTIVENESS : RESEARCH QUESTIONS Are behavioural interventions  effective in improving glycemic control in adults with type 2 diabetes?Is the effectiveness of the intervention impacted by intervention characteristics ( e.g. delivery of intervention , length of intervention , mode of instruction , interventionist etc . ) ? INCLUSION CRITERIA English Language Published between January 1996 to August 2008 Type 2 diabetic adult population ( > 18 years)R and omized controlled trials ( RCTs ) Systematic review s , or meta-analyses Describing a multi-faceted self-management support intervention as defined by the 2007 Self-Management Mapping Guide (1)Reporting outcomes of glycemic control ( HbA1c ) with extractable data Studies with a minimum of 6-month follow up EXCLUSION CRITERIA Studies with a control group other than usual care Studies with a sample size < 30 Studies without a clearly defined intervention OUTCOMES OF INTEREST PRIMARY OUTCOME glycemic control ( HbA1c ) SECONDARY OUTCOMES systolic blood pressure ( SBP ) control , lipid control , change in smoking status , weight change , quality of life , knowledge , self-efficacy , managing psychosocial aspects of diabetes , assessing dissatisfaction and readiness to change , and setting and achieving diabetes goals . SEARCH STRATEGY A search was performed in OVID MEDLINE , MEDLINE In-Process and Other Non-Indexed Citations , EMBASE , the Cumulative Index to Nursing & Allied Health Literature ( CINAHL ) , The Cochrane Library , and the International Agency for Health Technology Assessment ( INAHTA ) for studies published between January 1996 and August 2008 . Abstract s were review ed by a single author and studies meeting the inclusion criteria outlined above were obtained . Data on population characteristics , glycemic control outcomes , and study design were extracted . Reference lists were also checked for relevant studies . The quality of the evidence was assessed as being either high , moderate , low , or very low according to the GRADE methodology . SUMMARY OF FINDINGS The search identified 638 citations published between 1996 and August 2008 , of which 12 met the inclusion criteria and one was a meta- analysis ( Gary et al. 2003 ) . The remaining 11 studies were RCTs ( 9 were used in the meta- analysis ) and only one was defined as small ( total sample size N=47 ) . SUMMARY OF PARTICIPANT DEMOGRAPHICS ACROSS STUDIES : A total of 2,549 participants were included in the 11 identified studies . The mean age of participants reported was approximately 58 years and the mean duration of diabetes was approximately 6 years . Most studies reported gender with a mean percentage of females of approximately 67 % . Of the eleven studies , two focused only on women and four included only Hispanic individuals . All studies evaluated type 2 diabetes patients exclusively . STUDY CHARACTERISTICS : The studies were conducted between 2002 and 2008 . Approximately six of 11 studies were carried out within the USA , with the remaining studies conducted in the UK , Sweden , and Israel ( sample size ranged from 47 to 824 participants ) . The quality of the studies ranged from moderate to low with four of the studies being of moderate quality and the remaining seven of low quality ( based on the Consort Checklist ) . Differences in quality were mainly due to method ological issues such as inadequate description of r and omization , sample size calculation allocation concealment , blinding and uncertainty of the use of intention-to-treat ( ITT ) analysis . Patients were recruited from several setting s : six studies from primary or general medical practice s , three studies from the community ( e.g. via advertisements ) , and two from outpatient diabetes clinics . A usual care control group was reported in nine of 11 of the studies and two studies reported some type of minimal diabetes care in addition to usual care for the control group . INTERVENTION CHARACTERISTICS : All of the interventions examined in the studies were mapped to the 2007 Self-management Mapping Guide . The interventions most often focused on problem solving , goal setting and encouraging participants to engage in activities that protect and promote health ( e.g. modifying behaviour , change in diet , and increase physical activity ) . All of the studies examined comprehensive interventions targeted at least two self-care topics ( e.g. diet , physical activity , blood glucose monitoring , foot care , etc . ) . Despite the homogeneity in the aims of the interventions , there was substantial clinical heterogeneity in other intervention characteristics such as duration , intensity , setting , mode of delivery ( group vs. individual ) , interventionist , and outcomes of interest ( discussed below ) . DURATION , INTENSITY AND MODE OF DELIVERY : Intervention duration s ranged from 2 days to 1 year , with many falling into the range of 6 to 10 weeks . The rest of the interventions fell into categories of ≤ 2 weeks ( 2 studies ) , 6 months ( 2 studies ) , or 1 year ( 3 studies ) . Intensity of the interventions varied widely from 6 hours over 2 days , to 52 hours over 1 year ; however , the majority consisted of interventions of 6 to 15 hours . Both individual and group sessions were used to deliver interventions . Group counselling was used in five studies as a mode of instruction , three studies used both individual and group sessions , and one study used individual sessions as its sole mode of instruction . ( ABSTRACT OBJECTIVES The aim of this study was to examine if an acute nicotine infusion alters insulin sensitivity to a similar degree in type 2 diabetic patients as in healthy control subjects . DESIGN . Double-blind , cross-over , placebo-controlled , r and omized experimental study . Nicotine 0.3 microg kg-1 min(-1 ) or NaCl was infused ( 2 h ) during a euglycaemic hyperinsulinaemic clamp ( 4 h ) to assess insulin sensitivity . SETTING University research laboratory . SUBJECTS Six male and female type 2 diabetic patients [ DM2 ; age 54 + /- 10 ( mean + /- SD ) years ; body mass index ( BMI ) 25.6 + /- 2.9 kg m(-2 ) ] treated with diet or one oral hypoglycaemic agent and six age- and BMI -matched control subjects ( Ctr ) . MAIN OUTCOME MEASURE Insulin sensitivity ( rate of glucose infusion per kg fat free body mass and minute ) , nicotine and free fatty acid ( FFA ) levels , pulse rate and blood pressure . RESULTS The infusions produced similar nicotine levels in both groups . In the absence of nicotine , DM2 were more insulin resistant than Ctr ( 6.7 + /- 0.4 vs. 10.9 + /- 0.3 mg kg-1 LBM min(-1 ) , respectively ; P < 0.0001 ) . This insulin resistance was further aggravated by the nicotine infusion in DM2 but not in Ctr ( 4.6 + /- 0.3 vs. 10.9 + /- 0.3 mg kg(-1 ) LBM min(-1 ) ; P < 0.0001 ) . Only minor differences were seen in FFA levels , pulse rates and blood pressure . CONCLUSIONS At this low infusion rate , nicotine aggravated the insulin resistance in DM2 but not in Ctr . This finding may be because of the ( dysmetabolic ) diabetic state per se or to an increased sensitivity to environmental factors associated with a genetic predisposition for type 2 diabetes . These results show that diabetic subjects are particularly susceptible to the detrimental effects of nicotine OBJECTIVE We sought to prospect ively evaluate the impact of a 10 minute seated yoga program added to st and ard comprehensive diabetes care on glucose control and cardiovascular health in the severely ill , medically complex diabetic population . METHOD A total of 10 patients with type 2 diabetes , ages 49 - 77 , with duration of diabetes > 10 years and haemoglobin A1C > 9 % ( 75 mmol/mol ) were included in the study . Patients r and omized to a yoga intervention were taught a 10 minute seated yoga practice , were given an explanatory DVD and a fold-out pocket guide to encourage adherence at home , and were instructed to incorporate the practice as often as they could . The patients in the control arm were provided information and h and outs on the available yoga classes on campus . RESULTS At 3 month clinical follow up , the mean decrease in fasting capillary blood glucose ( CBG ) was 45 % among yoga participants ( -5.2 ± 4.1 mmol/L ) . Heart rate ( HR ) dropped by 18 % and Diastolic blood pressure ( BP ) dropped by 29 % in the intervention arm , ( -12.4 ± 6.69 and -26 ± 12.05 mmHg , respectively ) . There were no statistically significant changes in the haemoglobin A1C , systolic blood pressure , weight , or body mass index in either group . CONCLUSION Our small pilot study reinforces the current medical evidence supporting the use of yoga , combined with st and ard care , to improve health outcomes in diabetes At an orthodontic meeting in recent years , a colleague recounted to me that when a presenter had finished their presentation on a systematic review , the person beside leaned over and said to my colleague ‘ not another systematic review where it ’s not possible to draw any firm conclusions ’ . So an element of frustration was clear based on the screening of a large volume of evidence to arrive at such a low point for a conclusion . This , however , is now a familiar outcome for many orthodontic systematic review s. In this short editorial , I have attempted to give a brief outline of the proposed benefits of systematic review s but more importantly , to highlight , some issues we all need to bear in mind in their regard . The increasing focus on evidence -based healthcare , including orthodontics , has shunned the narrative review and spawned the systematic review . Aim ing to identify , evaluate and summarize the findings of all relevant studies on a specific topic , its exacting systematic approach should minimize bias and provide conclusions based on reliable findings . Meta-analyses of r and omized clinical trials with low risk of bias are considered the highest level of evidence available for evaluating the effects of an intervention . Systematic review s are also important tools in setting the research agenda via their recommendations for future research and authors can alert research ers to the most pertinent outcomes in clinical practice . But systematic review s like any other study type are not without their variability , both in dentistry in general and specifically in orthodontics . Large differences have also been observed in the quality of reporting of several characteristics between Cochrane and non-Cochrane systematic review s. A key question that must be asked when looking at all Cochrane review s is whether the review has been undertaken in a way to avoid bias and whether the data and results from the included studies are valid . Conclusions may be distorted if bias is introduced to the review process at any stage . For example , incomplete search ing for all relevant studies may lead to publication bias ; there is strong association between publication and studies reporting significant or positive findings in medicine and also within orthodontics . With regard to studies included within the review , these need to be assessed to ensure that they are undertaken and reported in a manner that is free of bias ( systematic error ) . Outcome reporting bias ( ORB ) may also be relevant , e.g. in a study identified as relevant to a review , where data exist on the outcome of interest but only selected findings have been given based on the results . Although systematic review s have emphasized ‘ assessment of method ological quality ’ of included studies , the Cochrane h and book recommends a focus on ‘ risk of bias assessment ’ instead . The justifications are four-fold : it targets whether the results of included studies should be credible ; despite being carried out to the highest st and ards , a study may have risk of bias due to , e.g. impracticality/impossibility of blinding of participants / study personnel ; some quality markers , e.g. a power calculation is unlikely to directly affect risk of bias ; it overcomes ambiguity between quality of reporting and quality of the underlying research INTRODUCTION Longevity is commonly associated with good health and with delayed onset of age-related diseases with usually benign course . Leptin ( LEP ) significantly affects metabolism and numerous functions of the organism . To find out if extreme longevity and its phenotype are associated with genetic variants of leptin and leptin receptor ( LEPR ) genes , we analysed the frequencies of the -2548 G/A and + 19 G/A LEP , as well as the K109R , Q223R , and K656N LEPR polymorphisms in centenarians and in control groups . MATERIAL AND METHODS The frequencies of the LEP and LEPR polymorphisms  were tested by restriction fragment length polymorphism in 128 centenarians , 414 young controls ( Y ) , 226 myocardial infa rct ion ( MI ) patients , and 190 type 2 diabetes mellitus ( DM2 ) patients . RESULTS The GG genotype of the -2548 G/A LEP polymorphism  was significantly more common in centenarians than in the Y , MI and DM2 groups ( p = 0.048 , p = 0.003 , p = 0.049 , respectively ) . In addition , the AA genotype of the K109R LEPR polymorphism was significantly less frequent in centenarians than in the Y , MI , and DM2 groups ( p = 0.026 , p = 0.013 , and p = 0.001 , respectively ) . CONCLUSIONS We suggest that the leptin pathway plays a role in the regulation of longevity , possibly by modulating the risk of development of MI and of DM2 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 INTRODUCTION The measurement of adherence to nutrition therapy is essential to evaluate if the outcomes are related to given recommendations . MATERIAL AND METHODS The aim of this study was to describe adherence to a Medical Nutrition Therapy Program in Mexican pregnant women with diabetes , using three different methods ; and evaluate its association with glycemic control . Adherence was measured with a question naire ( 0 - 100 % ) , women 's self-perception ( 0 - 100 % ) and energy intake adequacy by multiple pass 24 hour recall ( 85 - 115 % of recommendation ) . Women were r and omly assigned to two different dietary strategies .  Glycemic control was determined by capillary glucose self-monitoring . RESULTS Women analyzed in this study ( n=69 ) had an age range of 22 - 42 years ; 47.8 % had type 2 diabetes ( DM2 ) and 52.2 % had gestational diabetes ( GDM ) .  Energy intake adequacy was higher in women with GDM ( 41.9 % vs. 37.7 % , p = 0.001 ) . Average adherence measured with the question naire was 55 % ; no differences were found by type of diabetes . Self-perception was higher in women with DM2 ( 84 % ) when compared to women with GDM ( 70 % ) ( p = 0.039 ) . No differences were found in the three methods by study group . Optimal glycemic control was observed in 50 % of women ; no association was found with adherence measured with any of the three methods studied . CONCLUSIONS The observed differences in adherences suggest that it may be recommendable to combine different measurement methods and include social and psychological factors that affect behavioral change Background Fatigue is a common symptom in cancer patients that can persist beyond the curative treatment phase . Some evidence has been reported for interventions for fatigue during active treatment . However , to date , there is no systematic review on psychological interventions for fatigue after the completion of curative treatment for cancer . This is a protocol for a systematic review that aims to evaluate the effectiveness of psychological interventions for cancer-related fatigue in post-treatment cancer survivors . This systematic review protocol was registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) data base . Methods / design We will search the Cochrane Central Register of Controlled Trials ( CENTRAL ; The Cochrane Library ) , PubMed , MEDLINE , EMBASE , CINAHL , PsycINFO , and relevant sources of grey literature . R and omised controlled trials ( RCTs ) which have evaluated psychological interventions in adult cancer patients after the completion of treatment , with fatigue as an outcome measure , will be included . Two review authors will independently extract data from the selected studies and assess the method ological quality using the Cochrane Collaboration Risk of Bias Tool . Discussion Most existing evidence on cancer-related fatigue is from those in active cancer treatment . This systematic review and meta- analysis will build upon previous evaluations of psychological interventions in people during and after cancer treatment . With the growing need for stage-specific research in cancer , this review seeks to highlight a gap in current practice and to strengthen the evidence base of r and omised controlled trials in the area . Systematic review registration PROSPERO CRD42014015219 INTRODUCTION Atrial fibrillation ( AF ) and diabetes mellitus type 2 ( DM2 ) often coexist ; however , a small number of patients with DM2 undergoing catheter ablation ( CA ) of AF  have been included in previous studies . The aim of this study was to evaluate safety and efficacy of ablation therapy in DM2 patients with drug refractory AF . METHODS AND RESULTS From January 2005 to September 2006 , 70 patients with a diagnosis of DM2 and paroxysmal ( n = 29 ) or persistent ( n = 41 ) AF were r and omized to receive either pulmonary vein isolation or a new antiarrhythmic drug treatment ( ADT ) with a 1-year follow-up . The primary endpoint was the time to first AF recurrence . By Kaplan-Meier analysis , at the end of follow-up , 42.9 % of patients in the ADT group and 80 % of patients who received a single ablation procedure and were without medications were free of AF ( P = 0.001 ) . In the ablation group , a significant improvement in quality -of-life ( QoL ) scores as compared with ADT group was observed . Six patients in the ADT group ( 17.1 % ) developed significant adverse drug effects . Hospitalization rate during follow-up was higher in the ADT group ( P = 0.01 ) . The only complication attributable to ablation was one significant access-site hematoma . CONCLUSION In patients with DM2 , CA of AF provides significant clinical benefits over the ADT and appears to be a reasonable approach regarding feasibility , effectiveness , and low procedural risk This systematic review examines the effectiveness of current exercise interventions for the management of frailty . Eight electronic data bases were search ed for r and omized controlled trials that identified their participants as “ frail ” either in the title , abstract , and /or text and included exercise as an independent component of the intervention . Three of the 47 included studies utilized a vali date d definition of frailty to categorize participants . Emerging evidence suggests that exercise  has a positive impact on some physical determinants and on all functional ability outcomes reported in this systematic review . Exercise programs that optimize the health of frail older adults seem to be different from those recommended for healthy older adults . There was a paucity of evidence to characterize the most beneficial exercise program for this population . However , multicomponent training interventions , of long duration ( ≥5 months ) , performed three times per week , for 30–45 minutes per session , generally had superior outcomes than other exercise programs . In conclusion , structured exercise training seems to have a positive impact on frail older adults and may be used for the management of frailty Background Falls can have a considerable impact on a patients ' well being , they can result in serious physical and emotional injury , poor quality of life and increased length of hospital stay . Most of the current literature recommends a comprehensive approach to fall prevention that addresses a wide variety of risk factors and involves the use of risk assessment . Objective The objective of this review was to present the best available evidence for the effectiveness of interventions design ed to reduce the incidence of falls in older adult patients in acute care hospitals . Inclusion Criteria Types of Studies Only r and omised controlled trials ( RCTs ) assessing the effectiveness of risk assessment or other interventions that aim ed to minimise the number of falls were included . Types of Participants Participants were older adult in patients ( defined as aged 65 years or over ) in acute care hospitals . Types of Interventions This review focused on interventions design ed to assess the risk of falling or those used to minimise the risk of falling in older adult hospital patients . These interventions were compared to either st and ard practice , which included any method or technique already in place at the facility , or no intervention . Types of Outcome measures The primary outcome was the number of patient falls during hospitalisation . Search Strategy A search for published and unpublished literature from 1998 to 2008 published in the English language was conducted using all major electronic data bases . A three‐step search strategy was developed using MeSH terminology and keywords to ensure that all material relevant to the review was captured . Assessment of Quality The method ological quality of included studies was assessed by two review ers , who appraised each study independently , using st and ardised Joanna Briggs Institute ( JBI ) critical appraisal tools Data Collection and Analysis Data was extracted from the studies that were identified as meeting the criteria for method ological quality using the st and ard JBI data extraction tools . Due to the heterogeneity of population s and interventions , meta‐analyses were not possible and results are presented in narrative form . Results and Conclusions Seven studies were included in the review . The evidence on interventions for reducing the number of falls in older adults during their stay in an acute health care facility is sparse . There is some evidence to suggest that certain multifactorial interventions are more effective than others and that increasing patient education or targeting fall risk factors may be of benefit . Further high quality research is needed in order to ascertain effective fall prevention strategies in acute care facilities . Implication s for Practice There are some evidence to suggest that implementing the following interventions in acute hospitals may be effective in reducing the amount of falls of older adult in patients : ˙ a multidisciplinary multifactorial intervention program consisting of a falls risk alert card , an exercise program , an education program and the use of hip protectors after approximately 45 days ˙ a one‐on‐one patient education package entailing information on risk factors and preventative strategies for falls as well as goal setting ˙ a targeted falls risk factor reduction intervention that includes a falls risk factor screen , recommended interventions encompassing local advice and a summary of the evidence There is some evidence to suggest that implementing a multidisciplinary multifactorial intervention that consists of systematic assessment and treatment of fall risk factors , as well as active management of postoperative complications can reduce the amount of falls in patients with femoral neck fracture following surgery . Implication s for Research Better design ed RCTs that distinguish subgroups of population s ( for example people with or without cognitive impairment ) and that targets interventions at specific groups is required . Further research that focuses on individual intervention components that are part of larger multifactorial interventions are also warranted Background Musculoskeletal disorders ( MSDs ) are the leading cause of work disability and sickness absence worldwide . The prevalence of MSDs increases with age , consequently challenging sustainable employability among the growing ageing workforce . Knowledge of feasible and efficient workplace-based interventions to rehabilitate MSD or prevent its consequences is therefore warranted . This systematic review will evaluate the effectiveness of workplace-based interventions on MSDs and its consequences among adult workers with physical and sedentary work tasks , respectively . Methods We will search the following bibliographic data bases : PubMed ( including the data base ‘ MEDLINE ’ ) and Web of Science Core Collection ( including the data bases ‘ Science Citation Index Exp and ed ’ , ‘ Social Sciences Citation Index ’ and ‘ Arts & Humanities Citation Index ’ ) . Manual search es will also be performed . We will include r and omised controlled trials ( RCTs ) and non- RCTs reported in English in which ( 1 ) participants are adult workers with MSD , ( 2 ) interventions are aim ing at rehabilitating pain symptoms of MSD or preventing the consequences of MSD and ( 3 ) interventions are initiated and /or carried out at the workplace . The review will adhere to the ‘ Preferred Reporting Items for Systematic review s and Meta-Analyses ’ ( PRISMA ) guidelines for reporting systematic review s and the Institute for Work and Health ( IWH ) guidelines for workplace-based interventions . For the primary evaluation of the review , the quality assessment and evidence synthesis will conform to the IWH guidelines . Secondary evaluation will include a meta- analysis ( unless the included studies do not allow this due to heterogeneity ) and employ the risk of bias domains recommended by Cochrane along with the Grading of Recommendations , Assessment , Development and Evaluations ( GRADE ) approach on the studies with pain intensity as an outcome . Discussion This systematic review will provide knowledge on effective workplace-based interventions among physical and sedentary workers with MSD . RCTs are considered the most powerful experimental design in clinical trials , but solely including these may be too restrictive to underst and effective workplace-based interventions where r and omised and carefully controlled trials ( RCTs ) are not always possible . In order to maximize practical relevance , the selection process will , therefore , include both RCTs and non- RCTs and the quality assessment and evidence synthesis will conform to IWH guidelines focusing on developing practical guidelines for stakeholders . The result of this work will form the basis for industry-specific evidence -based recommendations on effective workplace-based interventions for rehabilitation of MSDs and its consequences that will later be operationalised into concrete and user-friendly practical tools for workplaces . Systematic review registration International Prospect i ve Register of Systematic Review s ( PROSPERO ) number CRD42018116752 Objective To identify potentially effective complementary approaches for musculoskeletal (MSK)–mental health ( MH ) comorbidity , by synthesis ing evidence on effectiveness , cost-effectiveness and safety from systematic review s ( SRs ) . Design Scoping review of SRs . Methods We search ed literature data bases , registries and reference lists , and contacted key authors and professional organisations to identify SRs of r and omised controlled trials for complementary medicine for MSK or MH . Inclusion criteria were : published after 2004 , study ing adults , in English and scoring > 50 % on Assessing the Method ological Quality of Systematic Review s ( AMSTAR ) ; quality appraisal checklist ) . SRs were synthesis ed to identify research priorities , based on moderate/good quality evidence , sample size and indication of cost-effectiveness and safety . Results We included 84 MSK SRs and 27 MH SRs . Only one focused on MSK – MH comorbidity . Meditative approaches and yoga may improve MH outcomes in MSK population s. Yoga and tai chi had moderate/good evidence for MSK and MH conditions . SRs reported moderate/good quality evidence ( any comparator ) in a moderate/large population for :  low back pain ( LBP )  ( yoga , acupuncture , spinal manipulation/mobilisation , osteopathy ) , osteoarthritis ( OA ) ( acupuncture , tai chi ) , neck pain  ( acupuncture , manipulation/manual therapy ) , myofascial trigger point pain ( acupuncture ) , depression ( mindfulness-based stress reduction ( MBSR ) , meditation , tai chi , relaxation ) , anxiety ( meditation/MBSR , moving meditation , yoga ) , sleep disorders ( meditative/mind – body movement ) and stress/distress ( mindfulness ) . The majority of these complementary approaches had some evidence of safety — only three had evidence of harm . There was some evidence of cost-effectiveness for spinal manipulation/mobilisation and acupuncture for LBP , and manual therapy/manipulation for neck pain , but few SRs review ed cost-effectiveness and many found no data . Conclusions Only one SR studied MSK – MH comorbidity . Research priorities for complementary medicine for both MSK and MH ( LBP , OA , depression , anxiety and sleep problems ) are yoga , mindfulness and tai chi . Despite the large number of SRs and the prevalence of comorbidity , more high- quality , large r and omised controlled trials in comorbid population s are needed
Collectively , findings suggest that yogic practice s may promote significant improvements in several indices of importance in DM2 management , including glycemic control , lipid levels , and body composition .
More limited data suggest that yoga may also lower oxidative stress and blood pressure ; enhance pulmonary and autonomic function , mood , sleep , and quality of life ; and reduce medication use in adults with DM2 .
A growing body of evidence suggests yogic practice s may benefit adults with type 2 diabetes ( DM2 ) .
In this systematic review , we evaluate available evidence from prospect i ve controlled trials regarding the effects of yoga-based programs on specific health outcomes pertinent to DM2 management .