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Interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus

Twenty‐one studies assessing interventions to improve adherence to treatment recommendations, not to diet or exercise, in people with type 2 diabetes in different settings (outpatients, community, hospitals, primary care) were included. There were many outcomes evaluated in these studies and a variety of adherence measurement instruments was used. Nurse led interventions, home aids, diabetes education and pharmacy led interventions showed a very small effect on some outcomes including metabolic control. No data on mortality or morbidity, nor on quality of life could be found.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Pharmacotherapy for weight loss in adults with type 2 diabetes mellitus

Obesity is closely related to type 2 diabetes and weight reduction is an important part of the care delivered to obese persons with diabetes. This review of drugs for weight loss among adults with type 2 diabetes revealed weight loss of between 2.0 and 5.1 kg for fluoxetine, orlistat and sibutramine at follow‐up of up to 57 weeks. The long‐term effects remain uncertain. Adverse events were common in all three drugs: gastrointestinal side effects with orlistat; tremor, somnolence, and sweating with fluoxetine; and palpitations with sibutramine. There were few studies examining other drugs used for weight loss in populations with diabetes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Chinese herbal medicines for type 2 diabetes mellitus

We are still waiting for firm evidence on Chinese herbal medicines for treatment of non‐insulin‐dependent diabetes. Although the use of herbal medicines for treatment of diabetes has a long history especially in the East, current evidence cannot warrant to support the routine use in clinical practice. This systematic review evaluates the effects of various herbal preparations (including single herbs or mixtures of different herbs) for treating people with type 2 diabetes. The review shows that some herbal medicines lower blood sugar and relieving symptoms in patients with diabetes. However, the methodological quality of the clinical trials evaluating these herbs is generally poor. The analyses also indicate that trials with positive findings are more likely to be associated with exaggerated effects. However, the trials did not report significant adverse effects. In conclusion, herbal medicines should not be recommended for routine use in diabetic patients of type 2 diabetes until we get scientifically sound trials. Testing the herbs in larger, well‐designed trials is needed in order to establish the necessary evidence for their use.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus

Metformin, a medication used to lower glucose levels in patients with diabetes mellitus, has long been thought to increase the risk for a metabolic disorder known as lactic acidosis. This review summarised data from all known comparative and observational studies lasting at least one month, and found no cases of fatal or nonfatal lactic acidosis in 70,490 patient‐years of metformin use, or in 55,451 patient‐years for those not on metformin. Average lactate levels measured during metformin treatment were no different than for placebo or for other medications used to treat diabetes. In summary, there is no evidence at present that metformin is associated with an increased risk for lactic acidosis when prescribed under the study conditions.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Momordica charantia for type 2 diabetes mellitus

Mormordica charantia (bitter gourd or bitter melon) is a climbing perennial that is characterized by elongated, warty fruit‐like gourds or cucumbers and is native to the tropical belt. Although momordica charantia is commonly used in traditional medical practices, along with research suggesting its benefits for people with type 2 diabetes, the current evidence does not warrant using the plant in treating this disease. This review of trials found only four studies which had an overall low quality. Three trials showed no significant differences between momordica charantia and placebo or antidiabetic drugs (glibenclamide and metformin) in the blood sugar response. The duration of treatment ranged from four weeks to three months, and altogether 479 patients with type 2 diabetes mellitus participated. No trial investigated death from any cause, morbidity, health‐related quality of life or costs. Adverse effects were mostly moderate, including diarrhoea and abdominal pain. However, reporting of adverse effects was incomplete in the included studies. There are many varieties of preparations of momordica charantia, as well as variations in its use as a vegetable. Further studies are needed to assess the quality of the various momordica charantia preparations as well as to further evaluate its use in the diet of diabetic people.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Dietary advice for treatment of type 2 diabetes mellitus in adults

No high quality data on the efficacy of diet alone exists for treatment of type 2 diabetes mellitus. This systematic review assesses the effects of studies that examined dietary advice with or without the addition of exercise or behavioural approaches. Eighteen studies were included. No data were found on micro‐ or macrovascular diabetic complications, mortality or quality of life. It is difficult to draw reliable conclusions from the limited data that are presented in this review, however, the addition of exercise to dietary advice showed improvement of metabolic control after six‐ and twelve‐month follow‐up.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Long‐term non‐pharmacological weight loss interventions for adults with type 2 diabetes mellitus

Most persons with type 2 diabetes are overweight, and the health of these persons can be improved with weight loss. Weight loss is very difficult to achieve in the long‐term, however, particularly among persons with diabetes. This systematic review of diet, physical activity, and behavioral interventions for weight loss, revealed a decrease in weight of 1.7 kg at one year or more. These results were minimized by weight loss in the comparison group, however. No data were identified on quality of life or mortality.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Computer‐assisted versus oral‐and‐written family history taking for identifying people with elevated risk of type 2 diabetes mellitus

We know that diabetes runs in families. For this reason, healthcare professionals routinely take family histories to help them identify people who are at high risk of developing diabetes. Patient histories may be recorded manually by using oral‐and‐written methods or via a computer‐assisted history taking system. Computer‐assisted history taking systems can be used by healthcare professionals, or directly by patients, as in the case of, for example, pre‐consultation interviews. They can be used remotely, for example via the Internet, telephone  or on‐site. They draw on a range of technologies such as personal computers, personal digital assistants, mobile phones and electronic kiosks; data input can be mediated via, amongst others, keyboards, touch screens and voice‐recognition software. Although computer‐assisted history taking methods were first used in the 1960s we are still not certain about their effects on history taking in people with a high risk to develop diabetes. Therefore, we reviewed the literature to find studies that compare the effects of oral‐and‐written methods to those of computer‐assisted family history taking on the quality of collected data as well as on allowing us to identify people who are at risk of developing diabetes. In this occasion we found no randomised controlled trials that investigated the above. We therefore suggest that more primary research is required in this area to allow an informed decision to be made by physicians, patients and policymakers.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Meglitinide analogues for type 2 diabetes mellitus

In type 2 diabetes mellitus, impairment of insulin secretion is an important component of the disease. The meglitinide analogues ("meglitinides") are a class of oral antidiabetic agents that increase insulin secretion in the pancreas. The properties of this class of drug suggest that they have the potential to produce a rapid, short‐lived insulin output. Two analogues are currently available for clinical use: repaglinide and nateglinide. Altogether 15 studies were included in this review, eight of the studies used repaglinide as the study drug and five used nateglinide. Two compared the two meglitinides to one another. In total, 3781 people participated in the 15 studies which mainly lasted between 10 and 24 weeks (one study had a duration of 52 weeks).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Insulin monotherapy versus combinations of insulin with oral hypoglycaemic agents in patients with type 2 diabetes mellitus

Simple application of a single daily insulin injection in addition to oral hypoglycaemic agents may facilitate the initiation of insulin therapy in type 2 diabetes mellitus.This review examined 20 trials including 1,811 participants which compared insulin monotherapy with insulin in combination with oral hypoglycaemic agents (OHA) in insulin‐requiring patients with type 2 diabetes. The results suggest that a bedtime NPH insulin‐oral hypoglycaemic agent combination therapy regimen provides comparable glycaemic control to insulin monotherapy. Due to lack of studies it remains unclear whether insulin‐OHA combination regimens with metformin alone are superior to those with metformin plus a sulphonylurea. In most cases no significant differences in hypoglycaemic events were observed between insulin mono‐ and OHA combination therapy. No study assessed diabetes‐related morbidity or mortality.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Sweet potato for type 2 diabetes mellitus

Sweet potato (Ipomoea batatas) is a plant found in the tropical and subtropical belts and is one of the most nutritious tropical and subtropical vegetables. As well as being popular in cooking in countries in Asia‐Pacific, Africa and North America, sweet potato is also used in traditional medicine for the treatment of diabetes mellitus. We decided to investigate whether there is enough evidence from medical trials to show whether sweet potato works as a treatment for diabetes. This review of randomised controlled trials found only three studies (with a total of 140 participants) that evaluated the effects of sweet potato for type 2 diabetes mellitus compared with a fake medicine (placebo). All these trials were of very low quality. Two studies with 122 participants showed improved long‐term metabolic control of blood sugar levels as measured by glycosylated haemoglobin A1c (HbA1c) which was moderately lowered by 0.3% in participants who were given 4 g sweet potato tablets a day for three to five months. The duration of treatment ranged from six weeks to five months. No study investigated diabetic complications, death from any cause, health‐related quality of life, well‐being, functional outcomes or costs. Adverse effects were mostly mild, and included abdominal distension and pain. There are many varieties of sweet potatoes and sweet potato preparations. More trials are needed to assess the quality of the various sweet potato preparations as well as to evaluate further the use of different varieties of sweet potato in the diet of diabetic people.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Alpha‐glucosidase inhibitors for type 2 diabetes mellitus

Alpha‐glucosidase inhibitors may be used for patients with type 2 diabetes. They delay the absorbance of carbohydrates ('complex form of sugar') in the gut. In this review we present data from meta‐analyses that show (among other things) a decrease in glycated haemoglobin, fasting and post‐load blood glucose and post‐load insulin. But we found no evidence for an effect on mortality or morbidity. We found clues that with higher dosages the effect on glycated haemoglobin, in contrast to post‐load blood glucose, remains the same. This might be because a lower compliance due to increasing side‐effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Whole grain foods for the prevention of type 2 diabetes mellitus

Food products derived from cereal grains as wheat, rice, corn, rye, oat, and barley constitute a major part of the daily diet in many countries. In refined‐grain products, the bran and germ of the grain, which contain the major amount of nutrients and dietary fibre, have been removed and only the starchy inner part of the grain (ca. 80% of the whole grain) is used. Whole grain foods contain either intact, flaked or broken grain kernels, coarsely ground kernels or flour that is made from whole grains (whole‐meal flour). In this review the effect of whole grain foods and cereal fibre (as a marker of whole‐grain food intake) on the prevention of type 2 diabetes mellitus (T2DM) was assessed using all available prospective cohort studies and randomised controlled trials. Only one randomised controlled trial was found which was of low methodological quality. This study investigated in 12 overweight persons during six weeks the effect of the consumption of refined grain foods versus that of whole grain foods on insulin sensitivity (risk factor for the development of T2DM). Intake of whole grain foods resulted in a slight improvement of insulin sensitivity, increased bowel movements and no adverse effects. No information was given about patient satisfaction, health related quality of life, total mortality and morbidity. In addition eleven prospective cohort studies were found. One study was conducted in Finland and the rest in the United States of America of which seven were done in health care workers. Some of the studies were of limited quality. They consistently showed that a high intake of whole grain foods or cereal fibre is associated with a lower risk of the development of T2DM. However, evidence for a protective effect coming from prospective cohort studies only has to be considered as weak as with this design no cause and effect relationship can be established. Well‐designed randomised controlled trials are needed to be able to draw definite conclusions about the preventive effects of whole grain consumption on development of T2DM.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Dipeptidyl peptidase‐4 (DPP‐4) inhibitors for type 2 diabetes mellitus

Dipeptidyl peptidase‐4 (DPP‐4) inhibitors like sitagliptin and vildagliptin are promising new medicines for the treatment of type 2 diabetes mellitus. They are supposed to improve metabolic control (as measured by lowering blood glucose) without causing severe hypoglycaemia (low blood sugar levels leading to unconsciousness and other symptoms).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Exercise for type 2 diabetes mellitus

Exercise, dietary changes and medications are frequently used in the management of type 2 diabetes. However, it is difficult to determine the independent effect of exercise from some trials because exercise has been combined with dietary modifications or medications, or compared with a control which includes another form of intervention. The review authors aimed to determine the effect of exercise on blood sugar control in type 2 diabetes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Colesevelam for type 2 diabetes mellitus

Colesevelam was originally approved for the treatment of hyperlipidaemia (high blood lipids) in the 2000s but has been shown to improve blood sugar as well. Therefore, we investigated its role in the management of type 2 diabetes mellitus. A total of 1450 patients took part in six studies investigating colesevelam. These studies lasted 8 to 26 weeks. Only one small study compared colesevelam directly to placebo, the other five studies investigated a combination of colesevelam with other antidiabetic agents versus a combination of placebo with other antidiabetic agents. There were no two studies with the same intervention and comparison group. When added to other antidiabetic agents colesevelam showed improvements in the control of blood glucose and blood lipids. However, it is difficult to disentangle the effects of colesevelam from the other antidiabetic agents used because only one study compared colesevelam to placebo. The same is true for adverse effects: three studies reported on just a few non‐severe hypoglycaemic episodes, no other serious side effects were observed. No study investigated mortality; complications of type 2 diabetes such as eye disease, kidney disease, heart attack and stroke; health‐related quality of life; functional outcomes and costs of treatment. Therefore, long‐term data on the efficacy and safety of colesevelam are necessary.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Exercise or exercise and diet for preventing type 2 diabetes mellitus

Type 2 diabetes is mainly characterised by a reduced ability of the hormone insulin to stimulate glucose uptake in body fat and muscles (insulin resistance) combined with insufficient insulin secretion that leads to increased blood glucose levels. It has been shown that weight reduction and an increase in daily energy expenditure decreases insulin resistance. There are some factors that are associated with an increased risk of type 2 diabetes: these are obesity, previous gestational diabetes, hypertension, family history of type 2 diabetes, dyslipidaemia and some ethnical groups are more at risk. Persons with "prediabetes" are also at high risk: they have abnormal blood glucose levels but not in the range of diabetes. Prediabetes often precedes the development of type 2 diabetes. We searched for trials that intended to prevent the development diabetes type 2 in the above mentioned at risk groups. We assessed the effects of increased physical activity alone or in combination with dietary interventions on diabetes incidence and other outcomes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Pioglitazone for type 2 diabetes mellitus

Diseases of the heart and blood vessels account for approximately 70% of all mortality in people with diabetes. Compared to their non‐diabetic counterparts the relative risk of mortality caused by disorders of the heart and blood vessels is two to three for men and three to four for women with diabetes. Type 2 diabetes is mainly characterised by a reduced ability of the hormone insulin to stimulate glucose uptake in body fat and muscles (insulin resistance) and affects most people suffering from diabetes. Several medications are on the market to treat diabetes, amongst them pioglitazone as a member of the 'glitazones' reduced risk factors for diseases of the heart and blood vessels. Since the two biggest trials in people with type 2 diabetes showed that improved blood glucose alone is not enough to reduce the risk of the above mentioned diseases we looked for longer‐term studies investigating 24 weeks as a minimum of pioglitazone treatment on patient‐oriented outcomes. As patient‐oriented outcomes we defined mortality, complications of diabetes, side effects of the medication, health‐related quality of life, costs and metabolic control (lowering of blood glucose to near normal levels).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Rosiglitazone for type 2 diabetes mellitus

Diseases of the heart and blood vessels account for approximately 70% of all mortality in people with diabetes. Compared to their non‐diabetic counterparts the relative risk of mortality caused by disorders of the heart and blood vessels is two to three for men and three to four for women with diabetes. Type 2 diabetes is mainly characterised by a reduced ability of the hormone insulin to stimulate glucose uptake in body fat and muscles (insulin resistance) and affects most people suffering from diabetes. Several medications are on the market to treat diabetes, amongst them rosiglitazone as a member of the 'glitazones' reduced risk markers for diseases of the heart and blood vessels. Since the two biggest trials in people with type 2 diabetes showed that improved blood glucose alone is not enough to reduce the risk of the above mentioned diseases we looked for longer‐term studies investigating 24 weeks as a minimum of rosiglitazone treatment on patient‐oriented outcomes. As patient‐oriented outcomes we defined mortality, complications of diabetes, side effects of the medication, health‐related quality of life, costs and metabolic control (lowering of blood glucose to near normal levels).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Zinc supplementation for the prevention of type 2 diabetes mellitus

Some studies have shown that zinc improves glucose levels (glycaemic control) in people with diabetes. As a consequence of diabetes long‐term complications may develop, such as kidney, nerve and eye disease. Also, the risk of cardiovascular complications like heart attacks and strokes is raised. Type 1 diabetes is a form of diabetes where the body cannot produce insulin any more. The risk of developing type 2 diabetes increases with age, obesity and lack of physical activity and is characterised by an increasing inability of the body to make good use of insulin (insulin resistance). The mineral zinc plays a key role in the action of insulin and theoretically zinc supplementation used by people with insulin resistance could prevent the onset of diabetes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

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