Dipeptidyl peptidase- 4 inhibitors and risk of heart failure in type 2 diabetes: systematic review and meta- analysis of randomised and observational studies. Abstract. Objectives To examine the association between dipeptidyl peptidase- 4 (DPP- 4) inhibitors and the risk of heart failure or hospital admission for heart failure in patients with type 2 diabetes. Design Systematic review and meta- analysis of randomised and observational studies. Data sources Medline, Embase, Cochrane Central Register of Controlled Trials, and Clinical. Trials. gov searched up to 2. June 2. 01. 5, and communication with experts. Eligibility criteria Randomised controlled trials, non- randomised controlled trials, cohort studies, and case- control studies that compared DPP- 4 inhibitors against placebo, lifestyle modification, or active antidiabetic drugs in adults with type 2 diabetes, and explicitly reported the outcome of heart failure or hospital admission for heart failure. Data collection and analysis Teams of paired reviewers independently screened for eligible studies, assessed risk of bias, and extracted data using standardised, pilot tested forms. Data from trials and observational studies were pooled separately; quality of evidence was assessed by the GRADE approach. Results Eligible studies included 4. Pooling of 3. 8 trials reporting heart failure provided low quality evidence for a possible similar risk of heart failure between DPP- 4 inhibitor use versus control (4. The observational studies provided effect estimates generally consistent with trial findings, but with very low quality evidence. Pooling of the five trials reporting admission for heart failure provided moderate quality evidence for an increased risk in patients treated with DPP- 4 inhibitors versus control (6. The pooling of adjusted estimates from observational studies similarly suggested (with very low quality evidence) a possible increased risk of admission for heart failure (adjusted odds ratio 1. DPP- 4 inhibitors (exclusively sitagliptin) versus no use. Conclusions The relative effect of DPP- 4 inhibitors on the risk of heart failure in patients with type 2 diabetes is uncertain, given the relatively short follow- up and low quality of evidence. Both randomised controlled trials and observational studies, however, suggest that these drugs may increase the risk of hospital admission for heart failure in those patients with existing cardiovascular diseases or multiple risk factors for vascular diseases, compared with no use. Introduction. Of over 3. Dipeptidyl peptidase- 4 (DPP- 4) inhibitors are a relatively new class of incretin based agents for treating type 2 diabetes. Evidence from randomised controlled trials has established that DPP- 4 inhibitors reduce levels of glycated haemoglobin (Hb. A1c),2. 3 do not affect body weight,2 pose a low risk of hypoglycaemia,4 and do not increase the risk of cardiovascular events. The American Diabetes Association and European Association for the Study of Diabetes have recommended this drug class as second line agents for type 2 diabetes management. A recent major trial. SAVOR- TIMI 5. 3) reported an increased risk of admission to hospital for heart failure (hazard ratio 1. DPP- 4 inhibitor saxagliptin. Although unexpected, the finding raised concern among professionals and health authorities. In 2. 01. 4, the US Food and Drug Administration (FDA) requested the clinical trial data from the manufacturer to investigate the potential association between use of saxagliptin and heart failure. The FDA then recommended that “Patients should not stop taking saxagliptin and should speak with their health care professionals about any questions or concerns. Posted By : Pinecone Computing; November 22, 2016; No Comments » Discover How Women At ANY Age Are Using This Effects on Blood Pressure of Reduced Dietary Sodium and the Dietary Approaches to Stop Hypertension (DASH) Diet. Sacks, M.D., Laura P. Health care professionals should continue to follow the prescribing recommendations in the drug labels.”1. Subsequently, the EXAMINE trial. TECOS trial. 12 testing sitagliptin, reported no significant effect on hospital admission for heart failure. Evidence from observational studies has been inconsistent,1. DPP- 4 inhibitors on heart failure remains controversial. Research Dipeptidyl peptidase-4 inhibitors and risk of heart failure in type 2 diabetes: systematic review and meta-analysis of randomised and observational studies. Dieting is the practice of eating food in a regulated and supervised fashion to decrease, maintain, or increase body weight. In other words, it is conscious control. Metabolic Research Center Review: Overview. The Metabolic Research Center is a chain of weight loss facilities across the United States. The majority of their. What is the Mediterranean Diet? The Mediterranean diet is not a . It is a mix of the traditional eating habits of people living in Spain, Italy. A systematic review of trials and observational studies offers an opportunity to consider the total body of evidence and potentially resolve the concern. We therefore undertook a systematic review to assess the extent to which DPP- 4 inhibitors affect the risk of heart failure or hospital admission for heart failure in patients with type 2 diabetes. Methods. We followed the standards set by the meta- analysis of observational studies in epidemiology (MOOSE)1. PRISMA)1. 9 for the reporting of our study. Eligibility criteria. We included randomised controlled trials, non- randomised controlled trials, cohort studies, and case- control studies that compared DPP- 4 inhibitors against placebo, lifestyle modification, or active antidiabetic drugs in adults with type 2 diabetes. We required follow- up for at least 1. We classified study designs according to recommendations by the Cochrane Non- Randomised Studies Methods Group. Trials, particularly phase III studies, reported heart failure either as a normal adverse event or a serious adverse event. For serious adverse events, admission for heart failure may have been included. We defined heart failure reported in such trials as an unspecified outcome. Literature search. We searched Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to 2. June 2. 01. 5. We combined both Me. SH and free text terms for identifying relevant articles. An information expert (DP) developed our search strategies (web appendix 1). We also searched Clinical. Trials. gov to identify additional eligible studies. Section 8. 01 of the US Food and Drug Administration Amendments Act (FDAAA 8. In doing so, important information regarding heart failure can be collected. We used generic names of each drug to identify relevant studies, and limited our search to studies labelled as “completed” or “terminated,” in which summary results were available. We also contacted content experts and industry representatives, and searched for conference abstracts on the American Diabetes Association and European Association for the Study of Diabetes, for additional information. Study process. Teams of two paired reviewers, trained in health research methods, independently screened titles, abstracts, and full texts for eligibility; assessed risk of bias; and collected data from each eligible study, using standardised, pilot tested forms, together with detailed instructions. Reviewers resolved disagreement through discussion or, if required, by adjudication by a third reviewer (XS). Risk of bias assessment. We used the Cochrane Collaboration’s tool. The items included random sequence generation, allocation concealment, blinding of participants, caregivers, and assessors of outcomes (that is, heart failure or hospital admission for heart failure), and adjudication of the outcomes. By assessing the risk of bias associated with blinding of patients, caregivers, and outcome assessors, we modified the instrument by removing the “unclear” option, an approach that we have previously shown to be reliable and valid. We used the Newcastle- Ottawa quality assessment scale. We removed the items “representativeness of the exposed cohort” and “was follow- up long enough for outcomes to occur” for cohort studies and the item “representativeness of the cases” for case- control studies because these items relate to applicability of results. We, however, added two items: the ascertainment of type 2 diabetes and the ascertainment of potential confounding factors for these both types of studies, because misclassification could result from suboptimal approaches to these issues. We planned to assess publication bias but were unable to do so owing to very low event rates. Data collection. We collected the following information from each eligible randomised controlled trial: . If a trial had multiple reports, we collated all data into one study. If a trial had both reports from Clincial. Trials. gov and journal publications, we carefully checked data from these two sources for consistency. If outcome data were reported at multiple follow- up points, we used data from the longest follow- up. For observational studies, we collected data similar to randomised controlled trials (eg, total number of patients, sex, age, diabetes duration, body mass index, baseline Hb. A1c). We documented, for each observational study, the definition of outcomes and sources of data for the outcomes. In addition, we documented information on. We collected adjusted estimates and their associated 9. Data analysis. We conducted separate analyses for randomised controlled trials and observational studies. We also separately analysed the data on heart failure and hospital admission for heart failure, because those two outcomes, although sharing the same clinical and pathophysiological features, represent differential seriousness of the effect of DPP- 4 inhibitors treatment on patients and society. Heart failure could be subclinical and might not be diagnosed; admission for heart failure is, however, always a clinical event and a condition important to patients and clinicians. We considered admission for heart failure as the more important outcome for patients. For the analysis of trials, we pooled outcome data using Peto’s methods because of very low event rates,2. Peto odds ratios and associated 9. We examined heterogeneity among studies with the Cochrane . We explored sources of heterogeneity with four prespecified subgroup hypotheses: . We carried out sensitivity analyses by using alternative effect measures (odds ratios v risk ratios), pooling methods (Peto v Mantel- Hanszel method), and statistical models regarding heterogeneity (random v fixed effects). In the analysis of observational studies, we qualitatively summarised the data for heart failure, because of the substantial variations in the comparison (that is, type of control) and patient populations in those studies. Download Free Cookbook With Weekly Mediterranean Diet Meal Plan. What is The Egg Diet Weight Loss Fast? Have you heard about the egg diet weight loss fast? This is the first one of a few articles where I will share my experience and recipes for this egg fast diet. One of the frustrating things that has happened to me is that my weight on Keto/LCHF has just basically been stalled no matter what ratios I have tried. Must eat eggs as the primary source of fat and protein. I must eat an egg no later than 3. The egg meals ideally should be eaten every 3 hours, but not more than every 5 hours. I will follow this schedule even if I’m not hungry, however I’ll only have 1 egg when that happens. Cheese will be permitted up to one ounce per egg. A minimum of a half- dozen eggs must be consumed daily. The eggs will be local pastured eggs loaded with healthy omega- 3 fats and vitamin D. Egg consumption will cease three hours before bedtime. Diet soda will be allowed up to 3 cans daily with a goal of 1 or less. Ok, so now you have HIS rules that he made for himself.
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