RESUMO
BACKGROUND: Lifestyle interventions improve the metabolic control of individuals with hyperglycemia. PURPOSE: We aimed to determine the effect of lifestyle interventions on cardiovascular and all-cause mortality in this population. DATA SOURCES: Searches were made through MEDLINE, Cochrane CENTRAL, Embase, and Web of Science (no date/language restriction, until 15 May 2022). STUDY SELECTION: We included randomized clinical trials (RCTs) of subjects with prediabetes and type 2 diabetes, comparing intensive lifestyle interventions with usual care, with a minimum of 2 years of active intervention. DATA EXTRACTION: Data from the 11 RCTs selected were extracted in duplicate. A frequentist and arm-based meta-analysis was performed with random-effects models to estimate relative risk (RR) for mortality, and heterogeneity was assessed through I2 metrics. A generalized linear mixed model (GLMM) was used to confirm the findings. DATA SYNTHESIS: Lifestyle interventions were not superior to usual care in reducing cardiovascular (RR 0.99; 95% CI 0.79-1.23) or all-cause (RR 0.93; 95% CI 0.85-1.03) mortality. Subgroup, sensitivity, and meta-regression analyses showed no influence of type of intervention, mean follow-up, age, glycemic status, geographical location, risk of bias, or weight change. All of these results were confirmed with the GLMM. Most studies had a low risk of bias according to the RoB 2.0 tool and the certainty of evidence was moderate for both outcomes. LIMITATIONS: Most studies had a low risk of bias according to the RoB 2.0 tool, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach resulted in moderate certainty of evidence for both outcomes. Differences in lifestyle programs and in usual care between the studies should be considered in the interpretation of our results. CONCLUSIONS: Intensive lifestyle interventions implemented so far did not show superiority to usual care in reducing cardiovascular or all-cause mortality for subjects with prediabetes and type 2 diabetes.
Assuntos
Sistema Cardiovascular , Diabetes Mellitus Tipo 2 , Hiperglicemia , Estado Pré-Diabético , Humanos , Estilo de VidaRESUMO
BACKGROUND: Clinical practice guidelines (CPGs) for the nutrition management of adult patients who are critically ill present divergences on recommendations regarding the nutrition care process (NCP), which bring difficulties in their application. We aimed to compare the recommendations from these CPGs and present a synthesis of them for each step of the NCP in intensive care unit (ICU) settings. METHODS: Systematic review of CPGs on nutrition care in ICU, searched in six databases up to January 2022. We have extracted data about CPGs, steps of the NCP, and quality of evidence for each recommendation. We compiled the recommendations from each CPG for each step of the NCP and calculated the relative frequency of agreement between them. RESULTS: Ten CPGs were reviewed, and 9 made recommendations for energy requirement, time to start, and route for nutrition support; however, only 3 presented recommendations on nutrition monitoring. The relative frequency of agreement between the recommendations of the CPGs ranges from 11% to 100%. The highest agreement was for the determination of energy requirements by indirect calorimetry and the provision of high protein for patients who are obese (100%). The lowest agreement among the CPGs was for considering either enteral nutrition or parenteral nutrition (PN) as an acceptable route (11%) and when to start PN (16.7%). Most recommendations were based on expert consensus. CONCLUSIONS: There is a wide divergence on the recommendations to NCP of patients who are critically ill. This systematic review summarizes recommendations to evidence-based practice in ICU settings to facilitate the daily decisions of professionals.