scholarly journals Hypertriglyceridemia and Other Plasma Lipid Profile Abnormalities among People Living with Diabetes Mellitus in Ethiopia: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Baye Dagnew ◽  
Yigizie Yeshaw ◽  
Demeke Geremew ◽  
Dessie Abebaw Angaw ◽  
Henok Dagne ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Lipid Profile ◽  
Random Effects ◽  
Meta Analysis ◽  
Plasma Lipid ◽  
Sensitivity Analyses ◽  
Random Effects Model ◽  
Pooled Prevalence ◽  
Lipid Abnormalities

Background. Dyslipidemia is one of the leading causes of cardiovascular complications in diabetes mellitus (DM) patients. Though it is a major public health problem in Ethiopia, there is no a nation-wide study to determine dyslipidemia among DM patients yet. Therefore, this systematic review and meta-analysis intended to estimate the prevalence of hypertriglyceridemia and other plasma lipid abnormalities among people living with DM in Ethiopia. Methods. We systematically searched PubMed, Google Scholar, African Journals Online, Hinari, and direct Google. Studies conducted until May 9, 2020, that reports the prevalence of dyslipidemia among people living with DM were included. The DerSimonian and Laird random-effects model was used to determine the pooled prevalence of lipid profile abnormalities. Heterogeneity was checked using the I 2 statistic, whereas publication bias was tested by funnel plot and Egger’s test. Besides, subgroup and sensitivity analyses were performed. Results. We used 18 primary studies, including 4961 participants living with DM, which met the eligibility criteria for the meta-analysis of hypertriglyceridemia. The estimate of hypertriglyceridemia (≥150 mg/dl) was 48.15% (95% CI: 38.15-58.15, I 2 = 98.4 % ) after performing the main meta-analysis using the random-effects model. The subgroup analysis showed a higher pooled estimate of hypertriglyceridemia among T2DM (57.80% (95% CI: 50.50-65.10), I 2 = 92.5 % ), studies that used probability sampling technique (59.09% (95% CI: 43.58-74.59), I 2 = 98.6 % , p < 0.001 ), and studies from primary data sources (51.43% (95% CI: 40.72-62.13), I 2 = 98.0 % , p < 0.001 ). Moreover, the estimated pooled prevalence of the total plasma cholesterol ( TC ≥ 200   mg / dl ) was 34.08% (95% CI: 28.41-39.75, I 2 = 92.4 % ), LDL − C ≥ 100   mg / dl was 41.13% (95% CI: 27.15-55.11, I2 = 98.8%), and HDL ≤ 40   mg / dl   for   men   and ≤ 50   mg / dl   for   women was 44.36% (95% CI: 31.82-56.90, I 2 = 98.8 % ). Conclusions. The pooled prevalence of hypertriglyceridemia and other lipid abnormalities among DM patients was relatively high in Ethiopia. It strongly suggests the need to give maximal attention to the adherence of DM management to reduce the circulatory lipid profile abnormalities and subsequent complications. Prospero Registration. CRD42020182291.

scholarly journals A systematic analysis on prevalence and sub-regional distribution of undiagnosed diabetes mellitus among adults in African countries

2020 ◽  
Author(s):  
Getenet Dessie ◽  
Henok Mulugeta ◽  
Desalegne Amare ◽  
Ayenew Negesse ◽  
Fasil Wagnew ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Random Effects ◽  
Meta Analysis ◽  
Eastern Africa ◽  
Undiagnosed Diabetes ◽  
Random Effects Model ◽  
Western Africa ◽  
Pooled Prevalence ◽  
High Prevalence ◽  
Undiagnosed Diabetes Mellitus

Abstract Background Despite the high prevalence of diabetes in Africa, the extent of undiagnosed diabetes in the region is still poorly understood. This systematic review and meta-analysis was designed to determine the pooled prevalence of undiagnosed diabetes mellitus among adults in Africa. Methods We conducted a systematic desk review and electronic web-based search of PubMed, Google Scholar, EMBASE, and the World Health Organization’s Hinari portal (which includes the SCOPUS, African Index Medicus, and African Journals Online databases), identifying peer-reviewed research studies on the prevalence of undiagnosed diabetes among adult individuals using pre-defined quality and inclusion criteria. We ran our search from June 1, 2018 to Jun 14, 2020. We extracted relevant data and presented descriptive summaries of the studies in tabular form. The I2 test was used to assess heterogeneity across studies. A random effects model was used to estimate the pooled prevalence of undiagnosed diabetes mellitus at a 95% confidence interval (CI). Funnel plot asymmetry and Egger’s tests were used to check for publication bias. The final effect size was determined by applying a trim and fill analysis in a random-effects model. Results Our search identified 1442 studies amongst which 23 articles were eligible for inclusion in the final meta-analysis. The average pooled prevalence of undiagnosed diabetes mellitus among adults was 3.85 (95% CI: 3.10–4.60). The pooled prevalence of undiagnosed diabetes mellitus based on geographic location was 4.43 (95% CI: 3.12–5.74) in Eastern Africa; 4.72 (95% CI: 2.64–6.80) in Western Africa; 4.27 (95% CI: 1.77–6.76) in Northern Africa and 1.46 (95%CI: 0.57–2.34) in southern Africa respectively. Conclusion Our findings indicate a high prevalence of undiagnosed diabetes in Africa and suggest that it may be more prevalent in Western Africa than the rest of the regions. Given the high levels of undiagnosed diabetes in the Africa region, more attention should be paid to incorporating diabetes screening and treatment services into existing diabetes related programs to reduce the prevalence of undiagnosed cases.

scholarly journals A Global Mutational Profile of SARS-CoV-2: A Systematic Review and Meta-Analysis of 368,316 COVID-19 Patients

Life ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 1224
Author(s):  
Wardah Yusof ◽  
Ahmad Adebayo Irekeola ◽  
Yusuf Wada ◽  
Engku Nur Syafirah Engku Abd Rahman ◽  
Naveed Ahmed ◽  
...  
Keyword(s):  
Systematic Review ◽  
Random Effects ◽  
Meta Analysis ◽  
Spike Protein ◽  
Random Effects Model ◽  
Potential Influence ◽  
Viral Genomes ◽  
Pooled Prevalence ◽  
The Usa ◽  
New Mutations

Since its first detection in December 2019, more than 232 million cases of COVID-19, including 4.7 million deaths, have been reported by the WHO. The SARS-CoV-2 viral genomes have evolved rapidly worldwide, causing the emergence of new variants. This systematic review and meta-analysis was conducted to provide a global mutational profile of SARS-CoV-2 from December 2019 to October 2020. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA), and a study protocol was lodged with PROSPERO. Data from 62 eligible studies involving 368,316 SARS-CoV-2 genomes were analyzed. The mutational data analyzed showed most studies detected mutations in the Spike protein (n = 50), Nucleocapsid phosphoprotein (n = 34), ORF1ab gene (n = 29), 5′-UTR (n = 28) and ORF3a (n = 25). Under the random-effects model, pooled prevalence of SARS-CoV-2 variants was estimated at 95.1% (95% CI; 93.3–96.4%; I2 = 98.952%; p = 0.000) while subgroup meta-analysis by country showed majority of the studies were conducted ‘Worldwide’ (n = 10), followed by ‘Multiple countries’ (n = 6) and the USA (n = 5). The estimated prevalence indicated a need to continuously monitor the prevalence of new mutations due to their potential influence on disease severity, transmissibility and vaccine effectiveness.

scholarly journals Prevalence of Headache in Patients With Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis of 14,275 Patients

2020 ◽  
Vol 11 ◽  
Author(s):  
Md Asiful Islam ◽  
Sayeda Sadia Alam ◽  
Shoumik Kundu ◽  
Tareq Hossan ◽  
Mohammad Amjad Kamal ◽  
...  
Keyword(s):  
Systematic Review ◽  
Quality Assessment ◽  
Confidence Intervals ◽  
Random Effects ◽  
Critical Appraisal ◽  
Meta Analysis ◽  
Clinical Manifestations ◽  
Random Effects Model ◽  
Pooled Prevalence ◽  
Significant Difference

Background: Coronavirus disease 2019 (COVID-19) started to spread globally since December 2019 from Wuhan, China. Headache has been observed as one of the clinical manifestations in COVID-19 patients. We aimed to conduct a comprehensive systematic review and meta-analysis to estimate the overall pooled prevalence of headache in COVID-19 patients.Methods: PubMed, Scopus, ScienceDirect, and Google Scholar databases were searched to identify studies published between December 2019 and March 2020. Adult (≥18 years) COVID-19 patients were considered eligible. We used random-effects model to estimate the pooled prevalence with 95% confidence intervals (CIs). Quality assessment was done using the Joanna Briggs Institute critical appraisal tools. This study is registered with PROSPERO (CRD42020182529).Results: We identified 2,055 studies, of which 86 studies (n = 14,275, 49.4% female) were included in the meta-analysis. Overall, the pooled prevalence of headache in COVID-19 patients was 10.1% [95% CI: 8.76–11.49]. There was no significant difference of headache prevalence in severe or critical vs. non-severe (RR: 1.05, p = 0.78), survived (recovered or discharged) vs. non-survived (RR: 1.36, p = 0.23), and ICU vs. non-ICU (RR: 1.06, p = 0.87) COVID-19 patients. We detected 64.0, 34.9, and 1.1% of the included studies as high, moderate, and low quality, respectively.Conclusions: From the first 4-month data of the outbreak, headache was detected in 10.1% of the adult COVID-19 patients.

scholarly journals Precancerous cervical lesion in Ethiopia: systematic review and meta-analysis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Ayele Semachew Kasa ◽  
Tadesse Dagget ◽  
Yeshiwork Beyene ◽  
Getnet Dessie ◽  
Aklilu Endalamaw ◽  
...  
Keyword(s):  
Systematic Review ◽  
Random Effects ◽  
Addis Ababa ◽  
Meta Analysis ◽  
Cervical Lesion ◽  
Random Effects Model ◽  
Cervical Lesions ◽  
Precancerous Cervical Lesion ◽  
Pooled Prevalence ◽  
Precancerous Cervical Lesions

Abstract Background Though cervical cancer is largely preventable, it is still the second most common female cancer globally and the leading cause of cancer deaths among females in African. Though many efforts have been done to study the burden of the disease in Ethiopia, primary studies examining the prevalence of precancerous cervical lesions are fragmented. Hence, this systematic review and meta-analysis is aimed at estimating the pooled prevalence of precancerous cervical lesion and its trends in Ethiopia. Methods This systematic review and meta-analysis was conducted using the following electronic databases. PubMed, Web of Science, SCOPUS, Science Direct, Google Scholar, African Index Medicus (AIM), African Journals Online databases, and Addis Ababa and Bahir Dar Universities research repositories were searched following the Preferred Items for Systematic Review and Meta-analysis (PRISMA) Guideline. STATA 15 statistical software was used to analyze the data. The quality of the included studies was assessed using the Joanna Briggs Institute (JBI) quality appraisal tool for meta-analysis. Heterogeneity between studies was assessed using the Cochrane Q test and I2 test statistics based on the random effects model. A random effects model was computed to estimate the pooled prevalence of precancerous cervical lesion in Ethiopia. Finally, the trend of precancerous cervical lesion in the country was presented. Result Seventeen studies with a total of 26,112 participants were included in the analysis. The pooled prevalence of precancerous cervical lesion was 15.16 (95% CI 10.16–19.70). The subgroup analysis by region showed the highest prevalence of precancerous cervical lesion at the Southern Nations and Nationalities Peoples Region (19.65%; 95% CI 15.51–23.80). The trend of precancerous cervical lesion prevalence showed an increased pattern over time. Conclusion Approximately one among six of the study participants had precancerous cervical lesion. The trend also showed that there is still an increasing precancerous cervical lesion in Ethiopia. Best practices in achieving high vaccination coverage shall be informed by practices in other successful countries.

scholarly journals Prevalence of and risk factors for severe malaria caused by Plasmodium and dengue virus co-infection: a systematic review and meta-analysis

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Manas Kotepui ◽  
Kwuntida Uthaisar Kotepui ◽  
Giovanni De Jesus Milanez ◽  
Frederick Ramirez Masangkay
Keyword(s):  
Systematic Review ◽  
Dengue Virus ◽  
Severe Malaria ◽  
Random Effects ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Prevalence Estimate ◽  
Severe Dengue ◽  
Random Effects Model ◽  
Pooled Prevalence

Abstract Background Co-infection with both Plasmodium and dengue virus (DENV) infectious species could have serious and fatal outcomes if left undiagnosed and without timely treatment. The present study aimed to determine the pooled prevalence estimate of severe malaria among patients with co-infection, the risk of severe diseases due to co-infection, and to describe the complications of severe malaria and severe dengue among patients with co-infection. Methods Relevant studies published between databases between 12 September 1970 and 22 May 2020 were identified and retrieved through a search of the ISI Web of Science, Scopus, and MEDLINE. The pooled prevalence and 95% confidence interval (CI) of severe malaria among patients with Plasmodium and DENV co-infection was estimated with a random-effects model to take into account the between-study heterogeneity of the included studies. The risks of severe malaria and severe diseases due to co-infection were estimated with the pooled odds ratio (OR) and 95% CI with a random-effects model. Results Of the 5653 articles screened, 13 studies were included in the systematic review and meta-analysis. The results demonstrated that the pooled prevalence estimate of severe malaria among patients with co-infection was 32% (95% CI: 18–47%, I2 = 92.3%). Patients with co-infection had a higher risk of severe diseases than those with DENV mono-infection (odds ratio [OR] = 3.94, 95% CI: 1.96–7.95, I2 = 72%). Patients with co-infection had a higher risk of severe dengue than those with DENV mono-infection (OR = 1.98, 95% CI: 1.08–3.63, I2 = 69%). The most severe complications found in severe dengue were bleeding (39.6%), jaundice (19.8%), and shock/hypotension (17.9%), while the most severe complications found in severe malaria were severe bleeding/bleeding (47.9%), jaundice (32.2%), and impaired consciousness (7.43%). Conclusions The present study found that there was a high prevalence of severe malaria among patients with Plasmodium and DENV co-infection. Physicians in endemic areas where these two diseases overlap should recognize that patients with this co-infection can develop either severe malaria or severe dengue with bleeding complications, but a greater risk of developing severe dengue than severe malaria was noted in patients with this co-infection. Trial registration The protocol of this study was registered at PROSPERO: CRD42020196792.

scholarly journals Preliminary review on the prevalence, proportion, geographical distribution, and characteristics of naturally acquired Plasmodium cynomolgi infection in mosquitoes, macaques, and humans: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Manas Kotepui ◽  
Frederick Ramirez Masangkay ◽  
Kwuntida Uthaisar Kotepui ◽  
Giovanni De Jesus Milanez
Keyword(s):  
Systematic Review ◽  
Random Effects ◽  
Meta Analysis ◽  
Human Infection ◽  
Preliminary Review ◽  
Random Effects Model ◽  
Plasmodium Cynomolgi ◽  
Pooled Prevalence ◽  
Natural Hosts ◽  
Mean Differences

Abstract Background Plasmodium cynomolgi is a simian malaria parasite that has been reported as a naturally acquired human infection. The present study aims to systematically review reports on naturally acquired P. cynomolgi in humans, mosquitoes, and macaques to provide relevant data for pre-emptive surveillance and preparation in the event of an outbreak of zoonotic malaria in Southeast Asia. Methods The protocol of the systematic review was registered at PROSPERO with approval ID CRD42020203046. Three databases (Web of Science, Scopus, and MEDLINE) were searched for studies reporting the prevalence of P. cynomolgi infections in Southeast Asian countries between 1946 and 2020. The pooled prevalence or pooled proportion of P. cynomolgi parasitemia in humans, mosquitoes, and macaques was estimated using a random-effects model. Differences in the clinical characteristics of P. cynomolgi infections were also estimated using a random-effects model and presented as pooled odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs). Results Thirteen studies reporting on the prevalence of naturally acquired P. cynomolgi in humans (3 studies, 21 cases), mosquitoes (3 studies, 28 cases), and macaques (7 studies, 334 cases) were included. The results demonstrated that the pooled proportion of naturally acquired P. cynomolgi in humans was 1% (95% CI, 0.1%, I2, 0%), while the pooled proportion of P. cynomolgi infecting mosquitoes was 18% (95% CI, 10–26%, I2, 32.7%). The pooled prevalence of naturally acquired P. cynomolgi in macaques was 47% (95% CI, 27–67%, I2, 98.3%). Most of the cases of naturally acquired P. cynomolgi in humans were reported in Cambodia (62%) and Malaysia (38%), while cases of P. cynomolgi in macaques were reported in Malaysia (35.4%), Singapore (23.2%), Indonesia (17.3%), Philippines (8.5%), Laos (7.93%), and Cambodia (7.65%). Cases of P. cynomolgi in mosquitoes were reported in Vietnam (76.9%) and Malaysia (23.1%). Conclusions This study demonstrated the occurrence of naturally acquired P. cynomolgi infection in humans, mosquitoes, and macaques. Further studies of P. cynomolgi in asymptomatic human cases in areas where vectors and natural hosts are endemic are extensively needed if human infections with P. cynomolgi do become public health problems.

scholarly journals Prevalence of Smell or Taste Dysfunction Among Children With COVID-19 Infection: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 9 ◽  
Author(s):  
Qingzi Yan ◽  
Dan Qiu ◽  
Xiang Liu ◽  
Xiaolan Guo ◽  
Yixiang Hu
Keyword(s):  
Systematic Review ◽  
Quality Assessment ◽  
Random Effects ◽  
Meta Analysis ◽  
Random Effects Model ◽  
R Software ◽  
Effective Strategies ◽  
Pooled Prevalence ◽  
Younger Age ◽  
Taste Dysfunction

Background: Smell and taste dysfunctions are common and have been reported as an early indicator of COVID-19. The prevalence of smell and taste dysfunctions among children with COVID-19 varies greatly across studies, which remains to be summarized quantitatively. This review aimed at examining the pooled prevalence of smell or taste dysfunctions among children with COVID-19, summarizing possible causes of the inconsistencies in the current estimates.Methods: Systematic searches of databases were conducted for literature published until 12 January 2021. Statistical analyses were performed using R software, the pooled prevalence was combined using random effects model. The Loney criteria were used for quality assessment.Results: A total of 18 eligible studies were included. The results showed that the pooled prevalence of smell dysfunction among children with COVID-19 was 15.97% (95% CI: 8.18–23.77%), the pooled prevalence of taste dysfunction among children with COVID-19 was 9.20% (95% CI: 4.25–14.16%), the pooled prevalence of smell or taste dysfunction among children with COVID-19 was 15.50% (95% CI: 10.30–20.70%) and the pooled prevalence of smell and taste dysfunction among children with COVID-19 was 20.21% (95% CI: 14.14–26.28%). Higher smell or taste dysfunction rates were associated with being female, younger age, smaller sample size, patients in Asia, and with comorbidities.Conclusions: Evidence suggests that smell or taste dysfunctions were common among children with COVID-19. Further research is needed to identify effective strategies for preventing and treating smell and taste dysfunctions among children with COVID-19.

scholarly journals Prevalence of Depression among Epileptic Patients and its Association with Drug Therapy: A Systematic Review and Meta-Analysis

2018 ◽  
Author(s):  
Getenet Dessie ◽  
Henok Mulugeta ◽  
Cheru Tessema Leshargie ◽  
Fasil Wagnew ◽  
Sahai Burrowes
Keyword(s):  
Systematic Review ◽  
Random Effects ◽  
Meta Analysis ◽  
Sub Saharan Africa ◽  
Random Effects Model ◽  
Pooled Prevalence ◽  
Prevalence Of Depression ◽  
Epileptic Patients ◽  
Sub Saharan ◽  
Patients With Epilepsy

AbstractBackgroundDespite the high prevalence of epilepsy in sub-Saharan Africa and the established relationship between depression and epilepsy, the extent of comorbid epilepsy and depression in the region is still poorly understood. This systematic review and meta-analysis aims to address this gap in the literature by determining the pooled prevalence of depression among epileptic patients in sub-Saharan Africa.MethodsA systematic desk review and electronic web-based search of PubMed, Google Scholar, EMBASE, PsycINFO and the World Health Organization’s Hinari portal (which includes the SCOPUS, African Index Medicus, and African Journals Online databases) identified peer-reviewed research studies and doctoral dissertations on the prevalence of depression among patients with epilepsy using pre-defined quality and inclusion criteria. Relevant data were extracted and descriptive summaries of the studies presented in tabular form. The I2 test was used to assess heterogeneity across studies. A random effects model was used to estimate the pooled prevalence of comorbidity at a 95% confidence interval (CI). Funnel plot asymmetry and Egger’s tests were used to check for publication bias. The final effect size was determined by applying a trim and fill analysis in a random-effects model.ResultsOur search identified 167 studies, of which 16 articles were eligible for inclusion the final analysis. The pooled estimate of prevalence of depression among patients with epilepsy was 32.71 (95% CI: 25.50 - 39.91). Regional sub-group analysis found that the pooled prevalence in East Africa was 34.52 (95% CI: 23.53 - 45.51) and 29.69 (95% CI: 22.7 - 36.68) in Southern and West Africa. The odds of depression among epileptic patients receiving polytherapy were 2.65 higher than in those receiving monotherapy (95% CI: 1.49 - 4.71, I2=79.1%, p < 0.05).ConclusionOur findings indicate high comorbidity in sub-Saharan Africa and suggests that it may be more prevalent there than elsewhere. Comorbidity is statistically associated with polytherapy. Given the high levels of epilepsy in the region, more attention should be paid to incorporating depression screening and treatment into existing epilepsy programs and to revising treatment guidelines on comorbid depression to reduce polytherapy.

scholarly journals Systematic Review and Meta-Analysis of Good Self-Care Practice among People Living with Type 2 Diabetes Mellitus in Ethiopia: A National Call to Bolster Lifestyle Changes

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Baye Dagnew ◽  
Getu Debalkie Demissie ◽  
Dessie Abebaw Angaw
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Random Effects ◽  
Meta Analysis ◽  
Self Care ◽  
Care Practice ◽  
Random Effects Model

Background. Self-care practice is the mainstay of management for good glycemic control. Despite the presence of a few pocket studies, no comprehensive study was conducted in Ethiopia to demonstrate the overall good self-care practice among diabetic patients in Ethiopia. Therefore, we intended to conduct this systematic review and meta-analysis to estimate the overall good self-care practice among people living with type 2 diabetes mellitus (T2DM) in Ethiopia. Methods. We systematically searched PubMed, Scopus, Science Direct, Cochrane library, Google scholar, and direct Google to retrieve relevant studies. Forest plot was used to present the pooled estimate of good self-care practice using DerSimonian and Laird’s random-effects model. We checked publication bias using Egger’s test and funnel plot. Potential heterogeneity was tested using the I-squared statistic. Moreover, subgroup and sensitivity analyses were performed. Results. In this review, 12 primary studies (with a total sample size of 4030) were included. Because of the presence of heterogeneity, we employed a random-effects model. After running the random-effects model, the pooled estimate of overall good self-care practice was 51.12% (95% CI: 41.90–60.34). Furthermore, the pooled estimate of good dietary practice was 50.18% (95% CI: 32.75–67.60), good physical exercise practice was 48.29% (95% CI: 34.14–62.43), the good footcare practice was 63.61% (95% CI: 45.56–81.66), and appropriate self-monitoring of the blood glucose level was 31.89% (95% CI: −4.62–68.41). In this meta-analysis, there was serious interstudy variation, but there was no publication bias. Conclusions. The overall good self-care practice among people living with T2DM was low which necessitates the need for designing strategies to increase the self-care practice. The health sector has to bolster awareness creation to allow better plasma glucose control and preventing diabetes-related complications. This trial is registered with CRD42019147694.

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