Interventions for prediabetes: an umbrella review of systematic reviews and meta-analyses of randomized controlled trials.

Glucagon-like peptide 1 receptor agonists have been proven to be effective in adults with obesity. However, robust evidence on their effects on body weight, obesity-related metabolic changes, and safety in children and adolescents with obesity remains limited, making them a subpopulation with scant treatment options. Therefore, this meta-analysis aimed to determine more precise estimates of the efficacy and safety of glucagon-like peptide-1 agonists in pediatric obesity. Three databases were searched (PubMed, Embase, and Cochrane Central Register of Controlled Trials) for trials published until the half of September 2024. The search indexing terms included 3 categories: [1] obesity [2], youth, and [3] glucagon-like peptide-1 receptor agonist (GLP-1 RA). Randomized controlled trials in youth with obesity (age ≤ 18 years) that assessed anthropometric and metabolic parameters were included. A total of 2016 studies were retrieved, and 24 full-text articles were screened. The data were analyzed using both mean differences (MDs) and standardized mean differences (SMDs) with 95% CIs and odds ratios (ORs) with 95% CIs. We applied a random effects model. Our outcomes were body weight (BW), BMI, waist circumference (WC), lipid profile, Hb1Ac, fasting blood glucose (FBG), blood pressure, and side effects. Eight studies comprised of 715 children and adolescents were included. On average, GLP-1 RA reduced BMI (SMD -0.67; 95% CI -0.8 to -0.41), BW (SMD -0.60; 95% CI -0.89 to -0.44), and WC (SMD -0.40; 95% CI -0.61 to -0.18). Although lipid profiles, HbA1c, and FBG were unaffected, GLP-1 RA was linked to a slight reduction in SBP (SMD -0.20; 95% CI -0.35 to -0.04) and an increase in HR (SMD + 0.26; 95% CI + 0.07 to +0.46), with no significant effect on DBP. Adverse effects, primarily nausea and vomiting, were more common in the intervention group, although trial withdrawal rates remained low. Within this specific population, GLP-1 RAs exhibit significant reductions in BW, BMI, WC, and SBP. The analyses of lipid profiles, DBP, HbA1c, and FBG showed no significant changes. Also, the administration of these medications is concurrent with an elevated incidence of side effects, which are predominantly gastrointestinal and tolerable. PROSPERO identifier: CRD42024532845.

The impact of intermittent fasting and Mediterranean diet on older adults' physical health and quality of life: A randomized clinical trial.

Digital health tools such as mobile apps and patient portals continue to be embedded in clinical care pathways to enhance mental health care delivery and achieve the quintuple aim of improving patient experience, population health, care team well-being, health care costs, and equity. However, a key issue that has greatly hindered the value of these tools is the suboptimal user engagement by patients and families. With only a small fraction of users staying engaged over time, there is a great need to better understand the factors that influence user engagement with digital mental health tools in clinical care settings. This review aims to identify the factors relevant to user engagement with digital mental health tools in clinical care settings using a sociotechnical approach. A scoping review methodology was used to identify the relevant factors from the literature. Five academic databases (MEDLINE, Embase, CINAHL, Web of Science, and PsycINFO) were searched to identify pertinent articles using key terms related to user engagement, mental health, and digital health tools. The abstracts were screened independently by 2 reviewers, and data were extracted using a standardized data extraction form. Articles were included if the digital mental health tool had at least 1 patient-facing component and 1 clinician-facing component, and at least one of the objectives of the article was to examine user engagement with the tool. An established sociotechnical framework developed by Sittig and Singh was used to inform the mapping and analysis of the factors. The database search identified 136 articles for inclusion in the analysis. Of these 136 articles, 84 (61.8%) were published in the last 5 years, 47 (34.6%) were from the United States, and 23 (16.9%) were from the United Kingdom. With regard to examining user engagement, the majority of the articles (95/136, 69.9%) used a qualitative approach to understand engagement. From these articles, 26 factors were identified across 7 categories of the established sociotechnical framework. These ranged from technology-focused factors (eg, the modality of the tool) and the clinical environment (eg, alignment with clinical workflows) to system-level issues (eg, reimbursement for physician use of the digital tool with patients). On the basis of the factors identified in this review, we have uncovered how the tool, individuals, the clinical environment, and the health system may influence user engagement with digital mental health tools for clinical care. Future work should focus on validating and identifying a core set of essential factors for user engagement with digital mental health tools in clinical care environments. Moreover, exploring strategies for improving user engagement through these factors would be useful for health care leaders and clinicians interested in using digital health tools in care.

The need for a new generation of digital mental health tools to support more accessible, effective and equitable care.

Tirzepatide (TZP) is a GIP and GLP-1 receptor agonist indicated as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults. The SURMOUNT-2 (SM-2) trial demonstrated significant reductions in body weight in participants treated with TZP with a BMI ≥27 kg/m2 and T2D. This subgroup analysis explored changes in BMI during the SM-2 trial. Prespecified subgroup analyses were conducted on the mITT population in the SM-2 trial to assess the effects of weekly treatment (TZP 10 or 15 mg vs placebo (PBO)) on change from baseline in BMI category at week 72. Table shows shifts in BMI category from baseline to week 72. At Week 72, TZP 10 and 15 mg each resulted in statistically significant reductions in BMI from baseline versus PBO (-4.87 and -5.66 versus -1.18 kg/m2 respectively, p<0.001). For TZP 10 mg and 15 mg arms, 64.7% and 69.5% of participants shift down at least one BMI category, versus 20.9% for PBO. A normal BMI (<25kg/m2) at endpoint was achieved by 18.0% of participants in the 15 mg, and 12.2% in the 10 mg TZP arm compared with 1.9% for PBO. The most common adverse reactions were GI across subgroups, consistent with the results of SM-2. In conclusion, participants on TZP had significant mean reductions in BMI from baseline and a greater proportion of participants treated with TZP shifted to a lower BMI category compared with PBO. Disclosure R.J. Galindo: Consultant; Abbott. Other Relationship; Dexcom, Inc. Consultant; Bayer Inc. Other Relationship; Novo Nordisk, Eli Lilly and Company. Consultant; Boehringer-Ingelheim, AstraZeneca. E. Lazarus: Speaker's Bureau; Novo Nordisk, Eli Lilly and Company. H. Wang: None. L. Garcia-Perez: Employee; Eli Lilly and Company. Stock/Shareholder; Eli Lilly and Company. M.X. Zhang: Employee; Eli Lilly and Company. Stock/Shareholder; Eli Lilly and Company. G. Grant: Employee; Eli Lilly and Company. Stock/Shareholder; Eli Lilly and Company. R. Malik: Employee; Eli Lilly and Company. Stock/Shareholder; Eli Lilly and Company. Funding Eli Lilly and Company

BackgroundAs mental illness continues to affect 1 in 5 individuals, and the need for support has increased during the COVID-19 pandemic, the promise of digital mental health tools remains largely unrealized due to a lack of uptake by patients and providers. Currently, most efforts on supporting the uptake of digital mental health tools remain fragmented across organizations and geography. There is a critical need to synthesize these efforts in order to provide a coordinated strategy of supporting the adoption of digital mental health tools.ObjectiveThe specific aim of this project is to develop a web-based resource document to support the engagement of mental health providers and patients in the use of digital mental health tools.MethodsThe web-based resource was developed using a multimethod approach. A grey literature review was conducted in 2019 to identify relevant toolkits that are available in the public domain. This was supplemented with an environmental scan where individuals with expertise in the development, acquisition, implementation, and evaluation of digital mental health tools were invited to contribute additional tools or documents not identified in the grey literature search. An engagement workshop was held with stakeholders to explore how the resource document should be developed and delivered. These findings were collectively used to develop the final iteration of the resource document.ResultsBased on a gray literature review and environmental scan with 27 experts, 25 resources were identified and included in the resource guide. These resources were developed for patients and providers by organizations from 5 countries. An engagement workshop was held with 14 stakeholders, and barriers related to cultural sensitivity, sustainability, and accessibility of the toolkit were identified. The final iteration of the resource document was developed by the research team using findings from the gray literature review, environmental scan, and engagement workshop. The contents of the 45-page resource guide are directed at mental health care providers, administrators, and patients (inclusive of families and caregivers).ConclusionsThe use of a multimethod approach led to the development of a resource guide that builds on existing evidence on digital mental health tools and was co-designed with stakeholders and end-users. The resource guide is now publicly available online for free and is being promoted through digital health and mental health websites. Future work should explore how this document can be integrated into clinical care delivery and pathways.

Background In 2019, Digital Health was on the agenda of the European Union (EU) and its Member States (MS), and the digital health transformation of both healthcare services and Public Health has been well underway for several years. The COVID-19 pandemic crisis required an unexpectedly quick adaptation of social norms and exerted great pressure on healthcare and public health systems. Although implemented strategies and results have varied, Digital Health tools emerged as a fundamental aspect of the pandemic fight across the EU. Methods The objective of this study was to determine and compare Digital Health Strategies and COVID-19 Response in EU MS 43% had no interoperability with other apps. We analyzed the 27 MS of the EU and determined several parameters relevant before and during the pandemic: 1 - Preexisting national digital health strategy in 2019; 2 - COVID-19 General Information Website; 3 - Real time updated COVID-19 online dashboard; 4 - Mobile application for contact tracing; 4.1 - Mobile app launch date; 4.2 - Interoperability with other mobile apps; 5 - Shift to telemedicine; 6 - Official public health communication through social media; 7 - Dedicated COVID-19 Information System for Public Health Workforce. Information from publicly available sources. Results All EU MS had a preexisting digital health strategy before the pandemic, developed a dedicated COVID-19 General Information Website and a COVID-19 dashboard with real-time updates on relevant statistics. The majority of MS (79%) developed a mobile app for contact tracing (43% had no interoperability with other apps), and of those that had not developed an app as of April 30th 2021, 50% had one under development. Most apps were launched in the first trimester of 2021. Other results were heterogeneous. Conclusions In some aspects, there is a clear convergence between EU MS in the deployment of digital health tools to fight the COVID-19 pandemic. Key messages All European Union Member States used digital health tools to fight the COVID-19 pandemic. The success of national level deployment of specific digital health tools must be assessed in order to develop a more integrated digital health response plan at the European level in the future.

The efficacy and safety of glucagon-like peptide-1 receptor agonists in non-diabetic adults with overweight/obesity: An umbrella review of systematic reviews and meta-analyses.

Dipeptidyl peptidase-4 inhibitors, glucagon-like peptide 1 receptor agonists and sodium-glucose co-transporter-2 inhibitors for people with cardiovascular disease: a network meta-analysis.

Throughout the world, millions of Muslims fast daily during the month of Ramadan from sunrise (Sahar) until sunset (Iftar). Considering the impacts of environment on physiological functions, we performed this study in order to examine the effects of Ramadan fasting on some blood parameters of healthy volunteers and hypertensive patients.The study was carried out on 50 healthy, volunteer medical students of different tertiary health centers in the city. Inclusion CriteriaHealthy young, medical students aged between 18 to 28 years, they should be fasting according to the recommendations of Ramadan fasting for the whole month. Exclusion Criteria:Students with any major illness like hypertension, type-2 diabetes mellitus, hyperthyroidism, hypothyroidism, hypercholesterolemia, Cushing’s disease or on any medication.The mean age was 22.5 years with standard deviation of 2.763. This reduction in Body Weight after Ramadan fasting is found to be statistically significant. (P value < 0.05). The difference of these values shows statistically significant reduction in BMI. (P value < 0.05). The reduction in Waist-Circumference is statistically significant. (P value < 0.01). The reduction in Waist to Hip ratio is statistically significant. (P value < 0.05). The Pre-Ramadan Mean Pulse Rate is reduced from 75.31 ± 4.23 beats/min (M±SD) to Post Ramadan Mean Pulse Rate of 75.12 ± 4.03 beats/min (M±SD). Pre-Ramadan Mean Systolic Blood Pressure decreases from 121.23 ± 6.32 mm of Hg (M±SD) to Post Ramadan Mean Systolic Blood Pressure of 119.46 ± 5.01mm of Hg (M±SD). However, this reduction in Systolic Blood Pressure is statistically not significant. (P value > 0.05). The reduction in Diastolic Blood Pressure is however statistically not significant. (P value > 0.05).Conclusion: Thus, it is concluded that Ramadan type of intermittent fasting has beneficial effect on the human body in terms of betterment in physiological systems and significant reduction in Body Weight, Body Mass Index, Waist-Circumference, Waist to Hip Ratio, Pulse Rate.

This study evaluated the efficacy of glucagon-like peptide-1 receptor agonists (GLP-1-RAs) in idiopathic intracranial hypertension (IIH), focusing on their effects on clinical outcomes, management escalation, and mortality. The authors conducted a cohort study using the TriNetX Research Network, comparing IIH patients treated with GLP-1-RAs to untreated patients, employing propensity score matching. Clinical outcomes, including headaches, visual and cognitive deficits, acetazolamide use, surgery, and mortality, were assessed at 6-month and 1-year follow-up (FU). At 6-month FU, 5750 patients in the GLP-1-RA cohort were matched to 5750 in the control group. At 1-year FU, 4968 patients in the GLP-1-RA cohort were matched to 4968 in the control group. The GLP-1-RA group demonstrated a significant reduction in BMI (p < 0.001) at 6 months, with a standardized mean difference of 1.083 kg/m2, which increased to 1.635 kg/m2 at 1 year. The control group showed a smaller reduction (p = 0.006), with a standardized mean difference of 0.695 kg/m2 at 6 months and 0.758 kg/m2 at 1 year. Furthermore, GLP-1-RA users had significantly lower odds of new-onset headache (OR 0.660, 95% CI 0.543-0.799, p < 0.001), visual deficits (OR 0.423, 95% CI 0.324-0.546, p < 0.001), cognitive deficits (OR 0.368, 95% CI 0.246-0.539, p < 0.001), and acetazolamide use (OR 0.295, 95% CI 0.249-0.348, p < 0.001) at 6 months. These trends persisted at 1 year for visual deficits (OR 0.606, 95% CI 0.489-0.747, p < 0.001), cognitive deficits (OR 0.590, 95% CI 0.432-0.801, p = 0.006), and acetazolamide use (OR 0.374, 95% CI 0.320-0.437, p < 0.001). Shunt placement for GLP-1-RA users also showed significantly lower risk at 1 year (OR 0.375, 95% CI 0.171-0.753, p = 0.047). Mortality rates were lower in the GLP-1-RA group at both 6 months (OR 0.060, 95% CI 0.031-0.106, p < 0.001) and 1 year (OR 0.115, 95% CI 0.070-0.179, p < 0.001). Kaplan-Meier survival curves confirmed these findings, additionally showing cumulative significance for headache reduction (p = 0.008). GLP-1-RAs may provide clinical benefits for patients with IIH, improving outcomes and reducing the need for invasive interventions. Future randomized, prospective studies are warranted to confirm these findings and optimize treatment strategies.

Has traditional medicine had its day? The need to redefine academic medicine

(1) Background: Oral semaglutide represents the first oral GLP-1 RA approved for the treatment of type 2 diabetes mellitus (T2DM). This real-world retrospective study aimed at evaluating its effectiveness and tolerability in the treatment of patients with T2DM when patients switched from a glucose-lowering agent to it and when it was added to the usual therapy. (2) Methods: Adult patients with T2DM taking oral semaglutide and followed in the ASUGI Diabetes Center were identified with the use of electronic medical records between October 2022 and May 2023. (3) Results: A total of 129 patients were recruited. The median follow-up was 6 months. Be it as a switchover or as an add-on therapy, oral semaglutide significantly reduced HbA1c and BMI. Switching from DPPIV inhibitors to oral semaglutide was associated with a significant reduction in HbA1c and BMI, switching from SGLT2 inhibitors was associated with a significant reduction in HbA1c, and switching from sulphonylureas was associated with a significant reduction in BMI. The median HbA1c change was associated with baseline HbA1c. SBP significantly decreased in the add-on group. Oral semaglutide was well tolerated. (4) Conclusions: This study shows that in the real-world setting, oral semaglutide is effective and safe as a switchover or as an add-on therapy for the treatment of T2DM.

&lt;p dir="ltr"&gt;&lt;a href="" target="_blank"&gt;Background&lt;/a&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have advanced rapidly in recent years.&lt;/p&gt;&lt;p dir="ltr"&gt;Purpose&lt;/p&gt;&lt;p dir="ltr"&gt;An updated synthesis on effects of GLP-1RAs on weight, BMI and waist circumference incorporating newer RCTs, particularly in overweight or obese patients, is timely.&lt;/p&gt;&lt;p dir="ltr"&gt;Data Sources&lt;/p&gt;&lt;p dir="ltr"&gt;We systematically searched PubMed, EMBASE and CENTRAL for RCTs published from inception to Oct 4, 2024.&lt;/p&gt;&lt;p dir="ltr"&gt;Study Selection&lt;/p&gt;&lt;p dir="ltr"&gt;The search was limited to RCTs evaluating the use of GLP1-RAs for mean differences from baseline in weight, BMI and waist circumference in obese or overweight adult patients with or without diabetes mellitus.&lt;/p&gt;&lt;p dir="ltr"&gt;Data Extraction&lt;/p&gt;&lt;p dir="ltr"&gt;Two independent reviewers performed the literature search and data extraction, resolving disagreements via consensus or third reviewer consultation.&lt;/p&gt;&lt;p dir="ltr"&gt;Data Synthesis&lt;/p&gt;&lt;p dir="ltr"&gt;47 RCTs were included with a combined cohort of 23,244 patients. GLP-1RAs demonstrated a mean weight reduction of -4.57 kg (95% CI -5.35 to -3.78), mean BMI reduction of -2.07 kg/m&lt;sup&gt;2&lt;/sup&gt; (95% CI -2.53 to -1.62), and mean waist circumference reduction of -4.55 cm (95% CI -5.72 to -3.38) compared to placebo. This effect was consistent across diabetic status, GLP-1RA used and route of administration. The greatest treatment benefit appeared to favour patients who were younger, female, non-diabetic, with higher baseline weight and BMI, but lower baseline HbA1c, and treated over a longer duration.&lt;/p&gt;&lt;p dir="ltr"&gt;Limitations&lt;/p&gt;&lt;p dir="ltr"&gt;Limitations include substantial statistical heterogeneity, in part due to broad inclusion criteria. However, this heterogeneity may improve generalizability by reflecting a wide range of study designs and patient populations.&lt;/p&gt;&lt;p dir="ltr"&gt;Conclusions&lt;/p&gt;&lt;p dir="ltr"&gt;GLP-1RAs demonstrated significant weight, BMI, and waist circumference reduction benefits in this meta-analysis.&lt;/p&gt;

&lt;p dir="ltr"&gt;&lt;a href="" target="_blank"&gt;Background&lt;/a&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have advanced rapidly in recent years.&lt;/p&gt;&lt;p dir="ltr"&gt;Purpose&lt;/p&gt;&lt;p dir="ltr"&gt;An updated synthesis on effects of GLP-1RAs on weight, BMI and waist circumference incorporating newer RCTs, particularly in overweight or obese patients, is timely.&lt;/p&gt;&lt;p dir="ltr"&gt;Data Sources&lt;/p&gt;&lt;p dir="ltr"&gt;We systematically searched PubMed, EMBASE and CENTRAL for RCTs published from inception to Oct 4, 2024.&lt;/p&gt;&lt;p dir="ltr"&gt;Study Selection&lt;/p&gt;&lt;p dir="ltr"&gt;The search was limited to RCTs evaluating the use of GLP1-RAs for mean differences from baseline in weight, BMI and waist circumference in obese or overweight adult patients with or without diabetes mellitus.&lt;/p&gt;&lt;p dir="ltr"&gt;Data Extraction&lt;/p&gt;&lt;p dir="ltr"&gt;Two independent reviewers performed the literature search and data extraction, resolving disagreements via consensus or third reviewer consultation.&lt;/p&gt;&lt;p dir="ltr"&gt;Data Synthesis&lt;/p&gt;&lt;p dir="ltr"&gt;47 RCTs were included with a combined cohort of 23,244 patients. GLP-1RAs demonstrated a mean weight reduction of -4.57 kg (95% CI -5.35 to -3.78), mean BMI reduction of -2.07 kg/m&lt;sup&gt;2&lt;/sup&gt; (95% CI -2.53 to -1.62), and mean waist circumference reduction of -4.55 cm (95% CI -5.72 to -3.38) compared to placebo. This effect was consistent across diabetic status, GLP-1RA used and route of administration. The greatest treatment benefit appeared to favour patients who were younger, female, non-diabetic, with higher baseline weight and BMI, but lower baseline HbA1c, and treated over a longer duration.&lt;/p&gt;&lt;p dir="ltr"&gt;Limitations&lt;/p&gt;&lt;p dir="ltr"&gt;Limitations include substantial statistical heterogeneity, in part due to broad inclusion criteria. However, this heterogeneity may improve generalizability by reflecting a wide range of study designs and patient populations.&lt;/p&gt;&lt;p dir="ltr"&gt;Conclusions&lt;/p&gt;&lt;p dir="ltr"&gt;GLP-1RAs demonstrated significant weight, BMI, and waist circumference reduction benefits in this meta-analysis.&lt;/p&gt;