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The Effectiveness of Glyburide Compa.ed to Insulin in the Ma.a.ement of Gesta.iona. Dia.etes Mellitus: a.Systema.ic Review

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Journa. of Dia.etes Mellitus 2015年第2期5卷 58-66页

作者： Jephtha. O. Odiba.mzwandile a. mabhala Depa.tment of Community Hea.th a.d Wellbeing University of Chester Riverside Campus Chester UK

Ba.kground: Insulin thera.y ha. been the ma.nsta. in ma.a.ing women with gesta.iona. dia.etes mellitus (GDM), but some disa.va.ta.es of insulin ha.e led to the use of glyburide, which is inexpensive in some countries, to ma.a.e GDM. However, there ha. been deba.e over its effectiveness, effica.y a.d sa.ety when compa.ed to insulin for ma.erna. glyca.mic control, a.d some a.verse neona.a. outcomes in GDM. Method: a.systema.ic review of eight ra.domised controlled tria. (RCT) studies wa. underta.en to compa.e glyburide a.d insulin. Studies involving 849 pa.ticipa.ts were included in the qua.tita.ive a.a.ysis. Results: There wa. no significa.t difference between glyburide a.d insulin in ma.erna. fa.ting (P = 0.09;SMD: 0.13;95% CI: ﹣0.02 to 0.28) a.d postpra.dia. (P = 0.45;SMD: 0.05;95% CI: ﹣0.09 to 0.19) glyca.mic control a.d glycosyla.ed ha.-moglobin (P = 0.35;SMD: 0.08;95% CI: ﹣0.08 to 0.24). When compa.ed with insulin, glyburide ha. a. increa.e risk ra.io (RR) for neona.a. hypoglyca.mia.(P = 0.0002;RR: 2.27;95% CI: 1.47 to 3.51) a.d la.ge for gesta.iona. a.e ba.ies (P = 0.03;RR: 1.60;95% CI: 1.06 to 2.41). Estima.ion of sta.da.d mea. difference shows tha. neona.a. birth weight wa. significa.tly higher in subjects receiving glyburide tha. in the insulin group (P = 0.002;SMD: 0.21;95% CI: 0.08 to 0.35). Conclusions: Glyburide wa. seen to be clinica.ly effective a.d a.sa.er a.terna.ive to insulin for ma.erna. glyca.mic control in GDM women. It is a.forda.le, convenient a.d requires no comprehensive educa.ive tra.ning a. the time of initia.ion of thera.y. However, its a.verse outcomes—neona.a. hypogly-ca.mia. high neona.a. birth weight a.d la.ge for gesta.iona. a.e ba.ies—ca.l for ca.eful monitoring of GDM pa.ients for a.y need for supplementa. insulin.

关键词： Gesta.iona. Dia.etes Mellitus Glyburide Insulin

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Eva.ua.ing the Use of Vita.in D Supplementa.ion to Improve Glyca.mic Outcome in Type 2 Dia.etes Mellitus Pa.ients: a.Systema.ic Review of Evidence

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Journa. of Dia.etes Mellitus 2017年第4期7卷 223-240页

作者： mzwandile a. mabhala a.etoyosi Ba.a.umi a.thony Ola.unju Eloho a.a.a.a.ma.t Yoha.nes Depa.tment of Public Hea.th a.d Wellbeing Faculty of Health and Social Care University of CHESTER Riverside Campus Chester UK Depa.tment of Surgery Mount Sinai Hospital Ambulatory Surgery Centre New York NY USA

Ba.kground: The evidence indica.es tha. vita.in D [25(OH)D] improves glyca.mic outcomes in type 2 Dia.etes mellitus pa.ients. The outcome mea.ures used to determine the a.cura.y of this hypothesis a.e: glycosyla.ed hemoglobin (Hba.c), fa.ting pla.ma.glucose (FPG) a.d homeosta.is model a.sessment-insulin resista.ce (HOMa.IR). Methods: We performed a.systema.ic review a.d meta.a.a.ysis which included a.l previous ra.domised controlled tria. (RCT) studies tha. a.sessed the effects of vita.in D on glucose meta.olism. We ca.ried out a. extensive electronic da.a.a.e sea.ch of published a.d unpublished RCTs, eva.ua.ing the a.socia.ion between vita.in D a.d glyca.mic outcomes in type 2 dia.etes mellitus pa.ients. We sea.ched Cochra.e Libra.y, PubMed, EMBa.E, CINa.L Plus with Full Text, MEDLINE, BioMed Centra., Turning Resea.ch Into Pra.tice (TRIP), Hea.th Technology a.sessment (HTa., a.d La.in a.erica. a.d Ca.ibbea. Hea.th Sciences (LILIa.S) between the yea.s 2005 a.d 2016. The full texts of releva.t studies were retrieved a.d a.snowba.ling technique wa. used to discover further studies missed from the initia. da.a.a.e sea.ch. This wa. done by ha.d-sea.ching for references within the retrieved a.ticles. Results: a.tota. of 17 studies were included in the review. The pooled effect of 15 studies tha. mea.ured Hba.c showed a. insignifica.t effect of vita.in D on Hba.c (Mea. difference (MD) = -0.06 mmol/l;95% CI = -0.26 to 0.14;I2 = 76%). a.pooled a.a.ysis of seven studies tha. mea.ured the effect of vita.in D on blood glucose a.so found no significa.t effect of vita.in D on T2DM (MD = -0.03 mmol/l;95% CI = -0.69 to 0.63;I2 = 76%). Three studies tha. a.a.ysed the effect of vita.in D on insulin sensitivity a.so observed no significa.t effect (MD = -1.51 mmol/l;95% CI = -3.61 to 0.60;I2 = 67%). Conclusion: In conclusion, a.though vita.in D ha. been extensively studied in rela.ion to some glyca.mic outcomes a.d some indica.ions tha. increa.ed pla.ma.vita.in D concentra.ions might

关键词： Vita.in D Tyep 2 Dia.etes Mellitus Glycea.ic Public Hea.th

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