BackgroundHypertension and obesity are known to contribute, directly or indirectly, to the development of long-term complications of type 2 diabetes mellitus (T2DM). Knowing the prevalence of these comorbidities is important for determining the size of the population that may benefit from strategies that reduce blood pressure and weight while controlling blood glucose.MethodsIn this systematic literature review, electronic searches of PubMed, Embase, and the Cochrane Library were conducted to identify observational studies of hypertension and/or obesity prevalence in patients with T2DM throughout the world. The searches were limited to studies reported in English from January 1, 2001 to February 16, 2012.ResultsFrom a total of 2,688 studies, 92 observational studies provided prevalence rates for hypertension and/or obesity specifically in adults with T2DM. Fifteen studies of specific subtypes of hypertension or subpopulations with T2DM were subsequently excluded, leaving 78 studies (in 77 articles) for inclusion in this article. Of these, 61studies reported hypertension prevalence, 44 reported obesity prevalence, and 12 reported the prevalence of hypertension with obesity. Most studies had a low risk of bias regarding diagnosis of T2DM (70/78), hypertension (59/69), or obesity (45/47). The continental regions with the most observational studies of hypertension or obesity prevalence were Europe (n = 30) and Asia (n = 26). Hypertension rates typically were high in all regions; most studies presented rates above 50%, and many presented rates above 75%. Obesity rates exceeded 30% in 38 of 44 studies and 50% in 14 of 44 studies, especially those assessing central obesity (based on waist circumference). Among obese adults, hypertension rates were at or above 70% in Asia and above 80% in Europe; rates were lower in North and South America but still above 30%.ConclusionAround the world, hypertension and obesity, separately or together, are common comorbidities in adults with T2DM.
3This meta-analysis compares health care resource use costs, adherence, and persistence between groups of patients taking antihypertensives as single-pill combinations (SPCs) vs free-equivalent components (FEC) based on a structured review of published studies. The search yielded 12 retrospective database studies included in analyses. The mean difference in combined total annual allcause and hypertension-related health care costs was $1357 (95% confidence interval [CI], $778-$1935) lower in favor of SPC than FEC groups. Adherence, measured as the mean difference in medication possession ratio, was estimated to be 8% higher for patients naive to prior antihypertensives and 14% higher for nonnaive SPC patients compared with corresponding FEC patients. Persistence in the SPC groups was twice as likely as the FEC groups (pooled risk ratio, 2.1; 95% CI, 1.1-4.1). Improved adherence and persistence may have contributed to the lower costs in the SPC groups via improved clinical outcomes. J Clin Hypertens (Greenwich). 2011;13:898-909. Ó2011 Wiley Periodicals, Inc.Hypertension is a chronic medical condition and recent estimates suggest that 76.4 million US adults 20 years or older have hypertension.1 Total costs (direct plus indirect) for hypertension in the United States were estimated at $73.4 billion in 2009. Pharmaceutical treatment of hypertension can be very successful, with the potential to reduce blood pressure (BP) to recommended levels in almost all patients (<140 ⁄ 90 mm Hg or <130 ⁄ 80 mm Hg for patients with diabetes or chronic kidney disease). However, recent data show that only 50% of patients with hypertension achieved BP control.2 Uncontrolled BP can result in significant morbidity and mortality, with increased risk of adverse cardiovascular (CV), cerebrovascular, and renal outcomes.3-5 Furthermore, uncontrolled BP can result in increased medication costs compared with costs for hypertension patients with appropriately controlled BP. 6Two of the main reasons for a lack of adequate BP control are lack of adherence (missing doses of an antihypertensive medication in the context of ongoing treatment) and lack of persistence (discontinuation of an antihypertensive medication). 7,8 Adherence to antihypertensive therapy is often very low, ranging from 15% to 35%.9 One major factor contributing to decreased adherence and persistence with antihypertensive medications is the complexity of treatment regimens. Many patients with hypertension require !2 medications to provide adequate BP control. Only one third of patients with hypertension require a single medication for BP control, one third require 2 medications, and the remaining one third require !3 medications. 10Strategies to improve adherence and persistence to prescribed antihypertensive medications are likely to improve BP control and thus can potentially have substantial medical and economic benefits. One such strategy is the use of fixed-dose single-pill combination (SPC) medications, which combine !2 active agents in a single pill. SPC medications simpl...
AIMTo systematically review the literature on epidemiology, disease burden, and treatment outcomes for Crohn’s disease (CD) patients with complex perianal fistulas.METHODSPubMed, Embase, and Cochrane were searched for relevant articles (published 2000-November 2016) and congress abstracts (published 2011-November 2016).RESULTSOf 535 records reviewed, 62 relevant sources were identified (mostly small observational studies). The cumulative incidence of complex perianal fistulas in CD from two referral-centre studies was 12%-14% (follow-up time, 12 years in one study; not reported in the second study). Complex perianal fistulas result in greatly diminished quality of life; up to 59% of patients are at risk of faecal incontinence. Treatments include combinations of medical and surgical interventions and expanded allogeneic adipose-derived stem cells. High proportions of patients experience lack of or inadequate response to treatment (failure and relapse rates, respectively: medical, 12%-73% and 0%-41%; surgical: 0%-100% and 11%-20%; combined medical/surgical: 0%-80% and 0%-50%; stem cells: 29%-47% and not reported). Few studies (1 of infliximab; 3 of surgical interventions) have been conducted in treatment-refractory patients, a population with high unmet needs. Limited data exist on the clinical value of anti-tumour necrosis factor-α dose escalation in patients with complex perianal fistulas in CD.CONCLUSIONComplex perianal fistulas in CD pose substantial clinical and humanistic burden. There is a need for effective treatments, especially for patients refractory to anti-tumour necrosis factor-α agents, as evidenced by high failure and relapse rates.
Summary What is known and objective The application of biologics to treat inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, is well established. Our aim was to characterize the most recent five years of data on rates of adherence, persistence, switching and dose escalations with biologics used to treat IBD in the United States. Methods We systematically reviewed electronic databases MEDLINE, MEDLINE In‐Process, EMBASE and Cochrane Library for 2012‐2017 as well as conference proceedings for 2016‐2017 published in English. Results and discussion Of 449 records identified, 41 met all screening criteria. Published studies varied greatly in methodology, data sources, population studied, follow‐up time and endpoint definitions, preventing meaningful comparisons across studies. Based on studies using a medication possession rate threshold of <80% or <86%, 38%‐77% of patients were found non‐adherent to biologics. Discontinuation within the first 3 months occurred in 0%‐25% of patients in six studies; 7%‐65% discontinued by 12 months in 13 studies. Among all patients who initiated an index biologic, the switch rate to another biologic ranged from 4.5% to 20% in 6 studies. Dose escalations were reported in only four studies; 8%‐35% of patients had their dose escalated within the first year of therapy. What is new and conclusion This study demonstrates variability in study design and methodology to assess adherence, persistence, switching and dose escalation with biologics among adults with IBD in the United States. Our findings suggest that real‐world biologic use may be suboptimal and indicate new therapies and/or additional patient support may be needed.
PurposeThe objective of this review was to evaluate existing patient-completed screening questionnaires and/or symptom-based predictive models with respect to their potential for use as screening tools for endometriosis in adult women. Validated instruments were of particular interest.MethodsWe conducted structured searches of PubMed and targeted searches of the gray literature to identify studies reporting on screening instruments used in endometriosis. Studies were screened according to inclusion and exclusion criteria that followed the PICOS (population, intervention, comparison, outcomes, study design) framework.ResultsA total of 16 studies were identified, of which 10 described measures for endometriosis in general, 2 described measures for endometriosis at specific sites, and 4 described measures for deep-infiltrating endometriosis. Only 1 study evaluated a questionnaire that was solely patient-completed. Most measures required physician, imaging, or laboratory assessments in addition to patient-completed questionnaires, and several measures relied on complex scoring. Validation for use as a screening tool in adult women with potential endometriosis was lacking in all studies, as most studies focused on diagnosis versus screening.ConclusionsThis literature review did not identify any fully validated, symptom-based, patient-reported questionnaires for endometriosis screening in adult women.
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