IntroductionThe COVID lockdown has posted a great challenge to paediatric patients with type 1 diabetes (T1D) and their caregivers on the disease management. This systematic review and meta-analysis sought to compare the glycaemic control among paediatric patients with T1D (aged under 18 years) pre- during, and post-lockdown period.Methods and materialsWe did a systematic search of three databases (PubMed, Embase, and the WHO COVID‐19 Global literature) for the literature published between 1 Jan 2019 to 10 Sep 2022. Studies meeting the following inclusion criteria were eligible for this study: (1) a COVID-19 related study; (2) inclusion of children aged 18 years old or under with established T1D; (3) comparing the outcomes of interest during or after the COVID lockdown with that before the lockdown. Study endpoints included mean difference (MD) in HbA1c, blood glucose, time in range (TIR, 70-180 mg/dl), time above range (TAR, >180mg/dl), time below range (TBR,<70mg/dl) and glucose variability (coefficient of variation [CV]) between pre-lockdown and during lockdown and/or between pre- and post-lockdown period. The MD and its corresponding 95% CI of each endpoint were pooled using random-effect model considering the potential between-study heterogeneity in COVID restrictions and T1D management.ResultsInitial search identified 4488 records and 22 studies with 2106 paediatric patients with T1D were included in the final analysis. Compared with pre-lockdown period, blood glucose was significantly decreased by 0.11 mmol/L (95%CI: -0.18, -0.04) during lockdown period and by 0.42 mmol/L (95%CI: -0.73, -0.11) after lockdown. The improvement was also found for TIR, TAR, TBR, and CV during and post-lockdown (all p values<0.05) except for the post-lockdown TBR (p =0.35). No significant change in HbA1c was observed during and post- lockdown period when compared with the pre-lockdown value. There was moderate to high between-study heterogeneity for most of the analyses.ConclusionCompared with pre-lockdown period, there was significant improvement in T1D paediatric patients’ glucose metrics during and post-lockdown. The underlying reasons for this positive impact warrant further investigation to inform future paediatric diabetes management.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022359213.
Abstracts Context Weight management is recognized as critical in reducing cardio-metabolic risk factors for adults with diabetes, but the effects of weight change on cardiovascular disease in patients with diabetes are unknown. Objective To evaluate 18-month weight change and subsequent risk of macrovascular and microvascular complications in established individuals with type 2 diabetes. Design and Setting This study consisted of a cohort study and a meta-analysis. In the cohort study, weight change over 18 months was divided into: gain ≥5%, gain 1%–5%, stable (-1%–1%), loss 1%–5%, and loss ≥5%. Cox regression analyses were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI). We then used random-effect models to pool the results combing our study with other relevant studies. Results In the cohort study, 8920 participants with valid weight measurements were included. Compared with patients with stable weight, higher risks were seen in those with weight change for total vascular complications (gain ≥5%: HR=1.43, 95% CI: 1.10–1.85; gain 1–5%: HR=1.44, 95% CI: 1.02–2.03; loss ≥5%: HR=1.58, 95% CI: 1.20–2.08), macrovascular complications (gain ≥5%: HR=1.84, 95% CI: 1.16–2.91; loss 1–5%: HR=1.91, 95% CI: 1.06–3.43; loss ≥5%: HR=2.18, 95% CI: 1.36–3.49) and microvascular complications (loss ≥5%: HR=1.48, 95% CI: 1.06–2.06). Meta-analysis also showed similar results. Conclusions Weight gain and loss over 18 months among patients with type 2 diabetes, especially weight change ≥5%, may be a warning sign of adverse cardiovascular outcomes.
Background/objectives: Obesity and cardiovascular disease (CVD) often co-occur. However, the effects of excessive body weight and weight change on CVD in patients with hypertension is not clearly established. We examined the associations of BMI, weight change and the risk of CVD in patients with hypertension.Subjects/methods: Our Data were drawn from the medical records of primary-care institutions in China. A total of 25 810 patients with valid weight measurements attending primary healthcare centers were included. Body weight were grouped in BMI categories of underweight (<18.5kg/m 2 ), normal weight (18.5-22.9 kg/m 2 ), overweight (23.0-24.9 kg/m 2 ) and obesity (≥25.0 kg/m 2 ). Weight change over 12 months was divided into: gain >4%, gain 1%-4%, stable (-1%-1%), loss 1%-4%, and loss ≥4%. Cox regression analyses were used to estimate hazard ratio (HR) and 95% con dence interval (95% CI) between BMI, weight change and the risk of CVD.Result: After multivariable adjustment, patients with obesity were related to higher risks of CVD (HR=1.46, 95% CI: 1.22-1.75). Higher risks were seen in participants with loss ≥4%, gain 1-4% and gain >4% of body weight compared to stable weight (loss ≥4%: HR=1.26,
Background/objectives: Obesity and cardiovascular disease (CVD) often co-occur. However, the effects of excessive body weight and weight change on CVD in patients with hypertension is not clearly established. We examined the associations of BMI, weight change and the risk of CVD in patients with hypertension. Subjects/methods: Our Data were drawn from the medical records of primary-care institutions in China. A total of 25 810 patients with valid weight measurements attending primary healthcare centers were included. Body weight were grouped in BMI categories of underweight (<18.5kg/m2), normal weight (18.5–22.9 kg/m2), overweight (23.0–24.9 kg/m2) and obesity (≥25.0 kg/m2). Weight change over 12 months was divided into: gain >4%, gain 1%–4%, stable (–1%–1%), loss 1%–4%, and loss ≥4%. Cox regression analyses were used to estimate hazard ratio (HR) and 95% confidence interval (95% CI) between BMI, weight change and the risk of CVD. Result: After multivariable adjustment, patients with obesity were related to higher risks of CVD (HR=1.46, 95% CI: 1.22–1.75). Higher risks were seen in participants with loss ≥4%, gain 1–4% and gain >4% of body weight compared to stable weight (loss ≥4%: HR=1.26, 95% CI: 1.02–1.55; gain 1–4%: HR=1.31, 95% CI: 1.04–1.64; gain >4%: HR=1.34, 95% CI: 1.08–1.66). Conclusion: Obesity and weight change of loss ≥4%, gain 1–4% and gain >4% were related to higher risks of CVD. Close monitoring and appropriate interventions aimed at achieving an optimal weight are needed to prevent adverse outcomes for patients with hypertension.
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