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Objective: The aim of this study was to examine the most effective delivery format of cognitive behavioral therapy for insomnia (CBT‐I) on insomnia in cancer patients. Methods: We searched five databases up to February 2021 for randomized clinical trials that compared CBT‐I with inactive or active controls for insomnia in cancer patients. Outcomes were insomnia severity, sleep efficiency, sleep onset latency (SOL), wake after sleep onset (WASO), and total sleep time (TST). Pairwise meta‐analyses and frequentist network meta‐analyses with the random‐effects model were applied for data analyses. Results: Sixteen unique trials including 1523 participants met inclusion criteria. Compared with inactive control, CBT‐I could significantly reduce insomnia severity (mean differences [MD] = −4.98 points, 95% confidence interval [CI]: −5.82 to −4.14), SOL (MD = −12.29 min, 95%CI: −16.48 to −8.09), and WASO (MD = −16.58 min, 95%CI: −22.00 to −11.15), while increasing sleep efficiency (MD = 7.62%, 95%CI: 5.82% to 9.41%) at postintervention. Compared with active control, CBT‐I could significantly reduce insomnia severity (MD = −2.75 points, 95%CI: −4.28 to −1.21), SOL (MD = −13.56 min, 95%CI: −18.93 to −8.18), and WASO (MD = −6.99 min, 95%CI: −11.65 to −2.32) at postintervention. These effects diminished in short‐term follow‐up and almost disappeared in long‐term follow‐up. Most of the results were rated as "moderate" to "low" certainty of evidence. Network meta‐analysis showed that group CBT‐I had an increase in sleep efficiency of 10.61%, an increase in TST of 21.98 min, a reduction in SOL of 14.65 min, and a reduction in WASO of 24.30 min, compared with inactive control at postintervention, with effects sustained at short‐term follow‐up. Conclusions: CBT‐I is effective for the management of insomnia in cancer patients postintervention, with diminished effects in short‐term follow‐up. Group CBT‐I is the preferred choice based on postintervention and short‐term effects. The low quality of evidence and limited sample size demonstrate the need for robust evidence from high‐quality, large‐scale trials providing long‐term follow‐up data. [ABSTRACT FROM AUTHOR]

Objective To systematically evaluate the effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on urinary tract infections or genital infections in patients with type 2 diabetes mellitus. Methods We searched PubMed, EMbase, Web of Science, Clinical trials and Cochrane Library, as well as Chinese literature databases such as China national knowledge infrastructure (CNKI), Wanfang, VIP, and SinoMed databases from the establishment of the databases to 31st, August 2021 for randomized controlled trials (RCT) that involved SGLT2i and safety events of urinary tract infections or genital infections. A series of network Meta-analysis were performed on all available evidence. The titles, interventions, background medication, outcome events, sample size and other information of the included studies were extracted. In a multi-layered mesh Meta-analysis of all available evidence, the relative effect values of urinary tract infection or genital infection were showed as odds ratio (OR) values and 95% confidence intervals (95%CI). Results A total of 100 studies were included, 97 of which reported urinary tract infections and 28 of which reported genital infections. The total sample size of SGLT2i group was 46 697, including Canagliflozin, Dapagliflozin, Bexagliflozin, Remogliflozin, Ertugliflozin and Henagliflozin, etc. The total sample size of the control group including other hypoglycemic drugs and placebo was 33 284. Other hypoglycemic drugs included dipeptidyl peptidase IV inhibitor (DPP-4i), insulin, sulfonylureas, etc. Some kinds of SGLT2i were associated with an increasing risk of urinary tract infections at different magnitude. The risk of urinary tract infection induced by Canagliflozin was lower than that of Dapagliflozin (OR=0.67, 95%CI 0.45-0.99), Bexagliflozin (OR=0.43, 95%CI 0.19-0.98) and Remogliflozin (OR=0.27, 95%CI 0.08-0.97). Ertugliflozin increased the risk of urinary tract infection (OR=1.21, 95%CI 1.04-1.40) compared with placebo. Compared with Henagliflozin and insulin, Bexagliflozin increased the risk of urinary tract infection with the OR values (95%CI) of 4.15 (1.08-15.95) and 12.16 (1.27-116.55), respectively. In addition, Hengglitazin reduced the risk of urinary tract infection (OR=0.15, 95%CI 0.03-0.80) compared with Remogliflozin. Compared with insulin and sulfonylureas, Remogliflozin might increase the risk of urinary tract infection with the OR values (95%CI) of 19.32 (1.65-226.07) and 5.82 (1.11-30.57), respectively. The results of network Meta-analysis also showed that SGLT2i significantly increased the risk of genital infections compared with other hypoglycemic drugs (OR=4.18, 95%CI 2.33-7.53). A detailed comparison showed that SGLT2i had a higher risk of genital infection compared with DPP-4i (OR=3.26, 95%CI 1.18-9.06), in which Canagliflozin had an increased risk compared with DPP-4i (OR=3.80, 95%CI 1.08-13.39). Conclusions In patients with T2DM, SGLT2i was associated with a higher risk of genital infections compared with other hypoglycemic drugs, especially DPP-4i. Dapagliflozin, Ertugliflozin, Bexagliflozin, and Remogliflozin were associated with increasing risk of urinary tract infections. [ABSTRACT FROM AUTHOR]

In the past years, network meta‐analysis (NMA) has been widely used among clinicians, guideline makers, and health technology assessment agencies and has played an important role in clinical decision‐making and guideline development. To inform further development of NMAs, we conducted a bibliometric analysis to assess the current status of published NMA methodological studies, summarized the methodological progress of seven types of NMAs, and discussed the current challenges of NMAs. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the comparative effects of incretin‐based therapies, including glucagon‐like peptide‐1 receptor agonists (GLP‐1 RAs) and dipeptidyl peptidase‐4 inhibitors (DPP‐4Is), on β‐cell function and insulin resistance in patients with type 2 diabetes mellitus (T2DM). Materials and Methods: Medline, Embase, the Cochrane Library and www.clinicaltrials.gov were searched for randomized controlled trials (RCTs) with a duration of at least 4 weeks. Network meta‐analysis was performed, followed by subgroup analysis and meta‐regression. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the quality of evidence. Outcomes of interest include homeostasis model assessment for β cell function (HOMA‐β) and insulin resistance (HOMA‐IR), fasting C‐peptide and fasting plasma glucose (FPG). Weighted mean difference (WMD) with 95% confidence interval (CI) was calculated as the measure of effect size. Results: A total of 360 RCTs (74% at least double‐blinded) with 157 696 patients were included. Incretin‐based therapies were compared with six other classes of glucose‐lowering drugs or with placebo. Compared with placebo, a significant increase in HOMA‐β and fasting C‐peptide was detected for GLP‐1RAs (WMD = 20.31 [95% CI, 16.34‐24.39] with low quality; WMD = 0.16 ng/mL [95% CI, 0.03‐0.29] with low quality) and for DPP‐4Is (WMD = 9.90 [95% CI, 8.27‐11.61] with moderate quality; WMD = 0.09 ng/mL [95% CI, 0.04‐0.14] with moderate quality) separately, while a significant reduction in HOMA‐IR and FPG were found in favour of GLP‐1RAs (WMD = −0.67 [95% CI, −1.08 to −0.27] with low quality; WMD = −1.04 mmol/L [95% CI, −1.26 to −0.83] with moderate quality) and DPP‐4Is (WMD = −0.23 [95% CI, −0.38 to −0.08] with low quality; WMD = −0.77 mmol/L [95% CI, −0.98 to −0.57] with moderate quality), respectively. Conclusions: Incretin‐based therapies not only show an increase in HOMA‐β and fasting C‐peptide level, but also achieve a reduction in HOMA‐IR and FPG in comparison with placebo. Although GRADE scores indicate low to moderate for most comparisons, incretin‐based therapies seem to be an advisable option for long‐term treatment to preserve β‐cell function. [ABSTRACT FROM AUTHOR]

Aims: To evaluate current evidence of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on blood pressure, heart rate, and hypertension in patients with type 2 diabetes.Methods: Medline, Embase, the Cochrane library, and the website www.clinicaltrials.gov were searched on April 5th, 2014. Randomized-controlled trials with available data were included if they compared GLP-1RAs with placebo and traditional antidiabetic drugs in patients with type 2 diabetes with duration ≥ 12 weeks. Weighted mean difference for blood pressure and heart rate, odds ratio (OR) for hypertension were calculated by random-effect model. Network meta-analysis was performed to supplement direct comparisons.Results: Sixty trials with 14 treatments were included. Compared with placebo, insulin, and sulfonylureas, GLP-1RAs decreased systolic blood pressure with range from -1.84 mmHg (95% CI: -3.48 to -0.20) to -4.60 mmHg (95% CI: -7.18 to -2.03). Compared with placebo, a reduction in diastolic blood pressure was detected significantly only for exenatide-10 μg-twice-daily (-1.08 mmHg, 95% CI: -1.78 to -0.33). Exenatide (2 mg once weekly), liraglutide 1.2 mg once daily), and liraglutide (1.8 mg once daily) increased heart rate by 3.35 (95% CI: 1.23-5.50), 2.06 (95% CI: 0.43, 3.74), and 2.35 (95% CI: 0.94-3.76) beats/min versus placebo. This effect was evident compared with active control (range: 2.22-3.62). No significant association between incident hypertension and GLP-1RAs was detected, except for the association between exenatide-10 μg-twice-daily and sulfonylureas (OR, 0.40, 95% CI: 0.16, 0.82).Conclusions: GLP-1RAs were associated with modest reduction on blood pressure, a slight increase in heart rate, yet no significant association with hypertension. Further investigation to explore mechanisms is warranted. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to systematically evaluate the effect of dipeptidyl peptidase 4 inhibitors on gastrointestinal adverse events in patients with type 2 diabetes. Methods MEDLINE, Embase, the Cochrane Library, and ClinicalTrials.gov were searched from inception through April 28, 2016. Randomized controlled trials that compared dipeptidyl peptidase 4 inhibitor–based therapies with placebo and other hypoglycemic agents in type 2 diabetes were included. The duration of studies was at least 4 weeks. Findings A total of 165 randomized controlled trials and 122,072 patients were included in the study. Dipeptidyl peptidase 4 inhibitors did not increase the incidence of gastrointestinal adverse events after the treatment with alogliptin (odds ratio [OR] = 0.83; 95% CI, 0.59–1.15), linagliptin (OR = 1.11; 95% CI, 0.92–1.35), saxagliptin (OR = 0.96; 95% CI, 0.80–1.15), sitagliptin (OR = 0.95; 95% CI, 0.64–1.14), teneligliptin (OR = 1.50; 95% CI, 0.81–2.77), and vildagliptin (OR = 0.80; 95% CI, 0.63–1.01) compared with placebo. Compared with glucagon-like peptide 1 receptor agonists, dipeptidyl peptidase 4 inhibitors significantly decreased the incidence of gastrointestinal adverse events with alogliptin (OR = 0.26; 95% CI, 0.15–0.44), linagliptin (OR = 0.43; 95% CI, 0.25–0.74), saxagliptin (OR = 0.28; 95% CI, 0.17–0.46), sitagliptin (OR = 0.24; 95% CI, 0.17–0.35), and vildagliptin (OR = 0.27; 95% CI, 0.18–0.41). Dipeptidyl peptidase 4 inhibitors were not associated with an increased risk of gastrointestinal adverse events relative to metformin and α-glucosidase inhibitors, respectively. Implications The network meta-analysis found that compared with glucagon-like peptide 1 receptor agonists, metformin, and α-glucosidase inhibitor, dipeptidyl peptidase 4 inhibitors are associated with a lower incidence of gastrointestinal adverse events. [ABSTRACT FROM AUTHOR]

Abstract: Aims: Integrating evidence from all randomized controlled trials (RCTs) of glucagon-like peptide-1 receptor agonists (GLP-1s) to assess the safety of cardiovascular disease (CVD) and efficacy of glycemic control. Methods: Besides performing pairwise meta-analysis, network meta-analysis of all RCTs was used to combine direct and indirect estimates of the effect of GLP-1 with placebo, active comparator drugs (ACD), or another GLP-1 agent with treatment duration ≥8 weeks in T2DM patients, 15,883 for CVD safety from 45 RCTs and 14,136 for glycemic control from 36 RCTs. Results: For CVD safety, both of the results from pairwise and network meta-analysis failed to demonstrate significant difference between any two comparators. For glycemic control, the effect of any GLP-1 was better than placebo, but no difference was found between GLP-1s. We also found that liraglutide was the only GLP-1 drug shown to be more effective on improving glycemic control than ACD and exenatide. The results based on direct or indirect estimates were similar for two outcomes. Conclusion: Our network meta-analysis provides a complete picture of the associations between GLP-1s, ACD and placebo on CVD safety and glycemic control. The GLP-1s are promising candidates for the treatment of T2DM, but more long-term trials are needed to confirm potential CVD safety. [Copyright &y& Elsevier]