Abstract
There is an increasing prevalence of diabetes worldwide and substance abuse has been observed as a problem among some people with diabetes. Therefore, there is an urgent need to understand the association between unhealthy drug use including the abuse of opium and clinical outcomes including its impact on lipid profile in patients with diabetes as the presence of these conditions can increase the risk of cardiovascular morbidity and mortality. Aim: This was a systematic review and meta-analysis which evaluated the impact of opium abuse on lipid profile in patients with diabetes. Method: This systematic review was conducted in line with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Three databases (Embase, PubMed, and PsycINFO) plus Google Scholar were searched for relevant articles from database inception to 18 July 2019 based on the Population, Intervention, Comparator, and Outcomes (PICO) framework. The studies included were based on a set of inclusion and exclusion criteria including patients with diabetes who abused opium. Articles were evaluated for risk of bias and the meta-analysis was conducted using Revman. Results: Six articles that met the criteria were included in the systematic review and meta-analysis. The type of substance abused was opium in all the studies. The results of the meta-analysis showed that opium abuse significantly (P = 0.01) lowered total cholesterol compared to control with a mean difference of −0.17 (95% CI, −0.29, −0.04) in patients with diabetes. With respect to high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, and body mass index, the differences were not statistically significant (P > 0.05) between those who abused opium compared with the control. Nutritional deficiencies, weight loss and lipid dysregulation due to liver dysfunction which are found in people who abuse substances may explain the findings of the current review with respect to lipid profile in patients with diabetes who abuse opium compared with the control. Conclusion: The findings of this systematic review and meta-analysis have shown that opium abuse significantly decreased total cholesterol (P < 0.05) in patients with diabetes. However, the effect of opium abuse on HDL cholesterol, triglycerides, body mass index (BMI) and LDL cholesterol in these patients were not statistically significant (P > 0.05) compared with the control. This result has public health significance in terms of ensuring the promotion of adequate nutritional intake in patients with diabetes who abuse opium.
Highlights
There is an increasing prevalence of diabetes worldwide and this presents a significant public health challenge [1,2]
The results of the meta-analysis showed that opium abuse significantly (P = 0.01) lowered total cholesterol compared to control with a mean difference of −0.17 in patients with diabetes
Shiri et al [6] showed that opium abuse was a common problem among some people with diabetes, while Kim et al [7] noted that substance abuse was on the increase globally and individuals who abuse substances are at increased risk of worse hypertension and diabetes outcomes
Summary
There is an increasing prevalence of diabetes worldwide and this presents a significant public health challenge [1,2]. There is evidence of increased risks and poorer diabetes quality of care which have been associated with substance abuse among patients with diabetes [3,4,5]. Shiri et al [6] showed that opium abuse was a common problem among some people with diabetes, while Kim et al [7] noted that substance abuse was on the increase globally and individuals who abuse substances are at increased risk of worse hypertension and diabetes outcomes. It is essential to understand the association between unhealthy drug use and the clinical outcomes due to its public health significance including its impact on markers of cardiovascular diseases such as total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides [7]. According to Najafipour and Beik [12], while opium may temporarily increase blood lipids, its long term use may aggravate diabetes and dyslipidemia
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