Eleni Athanasiadou

Efficacy and safety of empagliflozin for type 2 diabetes: a systematic review and meta-analysis.

To assess the efficacy and safety of the novel sodium‐glucose cotransporter 2 (SGLT2) inhibitor empagliflozin compared with placebo or other antidiabetic agents in patients with type 2 diabetes.

The protective role of the Mediterranean diet on the prevalence of metabolic syndrome in a population of Greek obese subjects.

Background: Obesity is a rapidly expanding epidemic in Western societies, with rates of more than 30% across Europe, and it is associated with an increased risk of metabolic disturbances. Previous reports have documented an association of reduced physical activity and abstinence from the traditional Mediterranean diet (MD) with increased mortality rate and prevalence of obesity in a population of Greek subjects. Objective: The aim of the present study was to evaluate and analyze the dietary habits in a population of Greek overweight and obese subjects and to investigate the potential associations between those patterns and the prevalence of metabolic syndrome components. Methods: The study recruited 226 consecutive adult (30 men, 169 women) overweight or obese (body mass index >25 kg/m2) individuals attending the Metabolic Diseases Unit. Medical history, dietary history, and anthropometric parameters were recorded during the first visit. Fasting blood samples were collected for biochemistry assaying. Results: According to the nutrient intake history and Mediterranean Diet Scale (MDS), participants were divided into 3 groups: those adhering to the MD and those not following the MD, who were further subdivided into the high-carbohydrate (HC) and high-fat (HF) diet groups according to the source of maximum energy intake. Adherence to the MD was associated with a lower prevalence of metabolic syndrome (27.3%, 69.2%, and 60.4% in MD, HC, and HF respectively, p  =  0.006), lower low-density lipoprotein cholesterol (p  =  0.009, MD vs. HF), and lower postchallenge glucose values (p  =  0.028, MD vs. HF). Conclusions: Adherence to the MD seems to be declining among Greek overweight and obese subjects, a phenomenon that is associated with an increase in the prevalence of the metabolic syndrome.

Efficacy and safety of once‐weekly glucagon‐like peptide 1 receptor agonists for the management of type 2 diabetes: a systematic review and meta‐analysis of randomized controlled trials

To assess the efficacy and safety of recently approved once‐weekly glucagon‐like peptide 1 receptor agonists (GLP‐1 RAs) in patients with type 2 diabetes.

Accuracy of Magnetic Resonance Imaging in Diagnosis of Liver Iron Overload: A Systematic Review and Meta-analysis

BACKGROUND & AIMS Guidelines advocate use of magnetic resonance imaging (MRI) to estimate concentrations of iron in liver, to identify patients with iron overload, and to guide titration of chelation therapy. However, this recommendation was not based on a systematic synthesis and analysis of the evidence for MRIs diagnostic accuracy. METHODS We conducted a systematic review and meta-analysis to investigate the diagnostic accuracy of MRI in identifying liver iron overload in patients with hereditary hemochromatosis, hemoglobinopathy, or myelodysplastic syndrome; liver biopsy analysis was used as the reference standard. We searched MEDLINE and EMBASE databases, the Cochrane Library, and gray literature, and computed summary receiver operating curves by fitting hierarchical models. We assessed methodologic quality using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. RESULTS Our final analysis included 20 studies (819 patients, total). Sensitivity and specificity values varied greatly, ranging from 0.00 to 1.00 and from 0.50 to 1.00, respectively. Because of substantial heterogeneity and variable positivity thresholds, we calculated only summary receiver operating curves (and summary estimate points for studies that used the same MRI sequences). T2 spin echo and T2* gradient-recalled echo MRI sequences accurately identified patients without liver iron overload (liver iron concentration > 7 mg Fe/g dry liver weight) (negative likelihood ratios, 0.10 and 0.05 respectively). However, these MRI sequences are less accurate in establishing a definite diagnosis of liver iron overload (positive likelihood ratio, 8.85 and 4.86, respectively). CONCLUSIONS Based on a meta-analysis, measurements of liver iron concentration by MRI may be accurate enough to rule out iron overload, but not to definitely identify patients with this condition. Most studies did not use explicit and prespecified MRI thresholds for iron overload, therefore some patients may have been diagnosed inaccurately with this condition. More studies are needed of standardized MRI protocols and to determine the effects of MRI surveillance on the development of chronic liver disease and patient survival.

Artificial pancreas treatment for outpatients with type 1 diabetes: systematic review and meta-analysis.

Abstract Objective To evaluate the efficacy and safety of artificial pancreas treatment in non-pregnant outpatients with type 1 diabetes. Design Systematic review and meta-analysis of randomised controlled trials. Data sources Medline, Embase, Cochrane Library, and grey literature up to 2 February 2018. Eligibility criteria for selecting studies Randomised controlled trials in non-pregnant outpatients with type 1 diabetes that compared the use of any artificial pancreas system with any type of insulin based treatment. Primary outcome was proportion (%) of time that sensor glucose level was within the near normoglycaemic range (3.9-10 mmol/L). Secondary outcomes included proportion (%) of time that sensor glucose level was above 10 mmol/L or below 3.9 mmol/L, low blood glucose index overnight, mean sensor glucose level, total daily insulin needs, and glycated haemoglobin. The Cochrane Collaboration risk of bias tool was used to assess study quality. Results 40 studies (1027 participants with data for 44 comparisons) were included in the meta-analysis. 35 comparisons assessed a single hormone artificial pancreas system, whereas nine comparisons assessed a dual hormone system. Only nine studies were at low risk of bias. Proportion of time in the near normoglycaemic range (3.9-10.0 mmol/L) was significantly higher with artificial pancreas use, both overnight (weighted mean difference 15.15%, 95% confidence interval 12.21% to 18.09%) and over a 24 hour period (9.62%, 7.54% to 11.7%). Artificial pancreas systems had a favourable effect on the proportion of time with sensor glucose level above 10 mmol/L (−8.52%, −11.14% to −5.9%) or below 3.9 mmol/L (−1.49%, −1.86% to −1.11%) over 24 hours, compared with control treatment. Robustness of findings for the primary outcome was verified in sensitivity analyses, by including only trials at low risk of bias (11.64%, 9.1% to 14.18%) or trials under unsupervised, normal living conditions (10.42%, 8.63% to 12.2%). Results were consistent in a subgroup analysis both for single hormone and dual hormone artificial pancreas systems. Conclusions Artificial pancreas systems are an efficacious and safe approach for treating outpatients with type 1 diabetes. The main limitations of current research evidence on artificial pancreas systems are related to inconsistency in outcome reporting, small sample size, and short follow-up duration of individual trials.

Once-weekly dipeptidyl peptidase-4 inhibitors for type 2 diabetes: a systematic review and meta-analysis

ABSTRACT Objective: To assess the efficacy and safety of omarigliptin and trelagliptin, novel dipeptidyl peptidase-4 inhibitors administered once-weekly (DPP-4i QW). Methods: We systematically searched for placebo- and active-controlled randomized trials in adults with type 2 diabetes mellitus. Results: Fifteen primary studies with 5709 participants were included. DPP-4i QW were more effective than placebo in reducing hemoglobin A1c (HbA1c) (Weighted Mean Difference (WMD) −0.63%; 95% CI −0.80, −0.46; I2 = 84%) and had a similar glucose-lowering effect with daily DPP-4i (WMD 0.01%; −0.08, 0.11%; I2 = 34%). Omarigliptin was less effective compared with oral antidiabetic agents, other than daily DPP-4i, (WMD 0.24%; 0.10, 0.38; I2 = 12%). Omarigliptin did not affect body weight (WMD versus placebo 0.60 kg; 0.25, 0.96; I2 = 0%). Risk for any hypoglycemia was similar between DPP-4i QW and placebo (Odds Ratio 1.32; 0.78, 2.22; I2 = 0%). Incidence of other adverse events did not differ between DPP-4i QW and control. Conclusions: DPP-4i QW were superior to placebo and similar to daily DPP-4i in terms of glycemic control, and were not associated with any specific adverse events. There is limited comparative effectiveness evidence against other agents, while their effect on hard clinical safety outcomes is unknown.

Fixed ratio combinations of glucagon like peptide 1 receptor agonists with basal insulin: a systematic review and meta-analysis

PurposeBasal insulin controls primarily fasting plasma glucose but causes hypoglycaemia and weight gain, whilst glucagon like peptide 1 receptor agonists induce weight loss without increasing risk for hypoglycaemia. We conducted a systematic review and meta-analysis of randomised controlled trials to investigate the efficacy and safety of fixed ratio combinations of basal insulin with glucagon like peptide 1 receptor agonists.MethodsWe searched Medline, Embase, and the Cochrane Library as well as conference abstracts up to December 2016. We assessed change in haemoglobin A1c, body weight, and incidence of hypoglycaemia and gastrointestinal adverse events.ResultsWe included eight studies with 5732 participants in the systematic review. Switch from basal insulin to fixed ratio combinations with a glucagon like peptide 1 receptor agonist was associated with 0.72% reduction in haemoglobin A1c [95% confidence interval –1.03 to –0.41; I2 = 93%] and 2.35 kg reduction in body weight (95% confidence interval –3.52 to –1.19; I2 = 93%), reducing also risk for hypoglycaemia [odds ratio 0.70; 95% confidence interval 0.57 to 0.86; I2 = 85%] but increasing incidence of nausea (odds ratio 6.89; 95% confidence interval 3.73–12.74; I2 = 79%). Similarly, switching patients from treatment with a glucagon like peptide 1 receptor agonist to a fixed ratio combination with basal insulin was associated with 0.94% reduction in haemoglobin A1c (95% confidence interval –1.11 to –0.77) and an increase in body weight by 2.89 kg (95% confidence interval 2.17–3.61).ConclusionsFixed ratio combinations of basal insulin with glucagon like peptide 1 receptor agonists improve glycaemic control whilst balancing out risk for hypoglycaemia and gastrointestinal side effects.

The Value and Services of Urban Stream Polygnotou, Thessaloniki

Grey, blue and green infrastructure supports socio-ecological processes the city undergoes. Yet, procedures of constructing anthropogenic habitats often undermine the value of natural landscape elements such as urban streams. Thessaloniki’s backbone comprises of urban streams that run from the suburban forest of ‘Seih-Sou’ to the Thermaikos Gulf acting as corridors of the natural urban matrix. Policies of the past have dealt with urban streams through extensive engineering drainage methods, eliminating the risk of flooding, yet resulting in rapid stormwater runoff, water quality problems, disturbed riparian ecosystems, leading to the urban stream syndrome. Furthermore, they have failed to address urban streams as an inseparable part of the landscape and thus to incorporate them in people’s mental map and everyday activities. The paper discusses the case of ‘Polygnotou stream’ which forms the beginning of the large scale engineered peripheral moat of Thessaloniki, constructed in the 60’s, and playing the role of the water recipient for six urban streams in total. It falls unknown to the majority of people living in the area, yet its services as an ecosystem ought to be acknowledged, helping inform decision makers of its socio-ecologic, perceptual and economic value. In addition, Polygnotou stream, adjacent streams and the peripheral moat overall, could be considered as a touristic product of great importance.

The Role of Monitoring Spatio-Temporal Change in Achieving Resilience of the Suburban Landscape

A city is a constructed landscape which epitomizes human intelligence and creativity, depicts social, cultural and economic development and still remains the most favorable and important habitat for the human species. Cities continue to grow, yet covering only about 3% of the earth’s surface, causing major negative impacts to the environment such as the natural resources depletion, carbon emissions, pollution of ground water, etc. A resilient city is a flexible, adaptable to change organism which comes in a form of equilibrium to meet quality criteria of living. Change is always reflected in form. The hypothesis of this study is whether monitoring of spatio-temporal landscape change is an important method in examining landscape resilience. It focuses mainly on the notions of transformation, time and process using the principles of landscape ecology, in order to capture the way a landscape may respond to environmental, social and economic change. A relative research presented hereby was conducted between 2010 and 2012 and included the study of the spatio-temporal change in the suburban landscape east of the city of Thessaloniki, an area of approximately 10 K hectares. Results demonstrated change in LULC patterns of thirteen (13) different land use/cover types and the transformation of a once arable agricultural landscape into a suburban landscape with mixed residential and agricultural uses. Socio-economic and ecological factors influenced this drastic change in structure and function of the landscape in study. The study concludes that monitoring spatio-temporal landscape change contributes in examining the potentially of a landscape towards resilience.