Objective:To compare the benefits and harms of drug treatments for adults with type 2 diabetes, adding non-steroidal mineralocorticoid receptor antagonists (including finerenone) and tirzepatide (a dual glucose dependent insulinotropic polypeptide (GIP)/glucagon-like peptide-1 (GLP-1) receptor agonist) to previously existing treatment options. Design:Systematic review and network meta-analysis. Data sources:Ovid Medline, Embase, and Cochrane Central up to 14 October 2022. Eligibility criteria for selecting studies:Eligible randomised controlled trials compared drugs of interest in adults with type 2 diabetes. Eligible trials had a follow-up of 24 weeks or longer. Trials systematically comparing combinations of more than one drug treatment class with no drug, subgroup analyses of randomised controlled trials, and non-English language studies were deemed ineligible. Certainty of evidence was assessed following the GRADE (grading of recommendations, assessment, development and evaluation) approach. Results:The analysis identified 816 trials with 471 038 patients, together evaluating 13 different drug classes; all subsequent estimates refer to the comparison with standard treatments. Sodium glucose cotransporter-2 (SGLT-2) inhibitors (odds ratio 0.88, 95% confidence interval 0.83 to 0.94; high certainty) and GLP-1 receptor agonists (0.88, 0.82 to 0.93; high certainty) reduce all cause death; non-steroidal mineralocorticoid receptor antagonists, so far tested only with finerenone in patients with chronic kidney disease, probably reduce mortality (0.89, 0.79 to 1.00; moderate certainty); other drugs may not. The study confirmed the benefits of SGLT-2 inhibitors and GLP-1 receptor agonists in reducing cardiovascular death, non-fatal myocardial infarction, admission to hospital for heart failure, and end stage kidney disease. Finerenone probably reduces admissions to hospital for heart failure and end stage kidney disease, and possibly cardiovascular death. Only GLP-1 receptor agonists reduce non-fatal stroke; SGLT-2 inhibitors are superior to other drugs in reducing end stage kidney disease. GLP-1 receptor agonists and probably SGLT-2 inhibitors and tirzepatide improve quality of life. Reported harms were largely specific to drug class (eg, genital infections with SGLT-2 inhibitors, severe gastrointestinal adverse events with tirzepatide and GLP-1 receptor agonists, hyperkalaemia leading to admission to hospital with finerenone). Tirzepatide probably results in the largest reduction in body weight (mean difference -8.57 kg; moderate certainty). Basal insulin (mean difference 2.15 kg; moderate certainty) and thiazolidinediones (mean difference 2.81 kg; moderate certainty) probably result in the largest increases in body weight. Absolute benefits of SGLT-2 inhibitors, GLP-1 receptor agonists, and finerenone vary in people with type 2 diabetes, depending on baseline risks for cardiovascular and kidney outcomes (https://matchit.magicevidence.org/230125dist-diabetes). Conclusions:This network meta-analysis extends knowledge beyond confirming the substantial benefits with the use of SGLT-2 inhibitors and GLP-1 receptor agonists in reducing adverse cardiovascular and kidney outcomes and death by adding information on finerenone and tirzepatide. These findings highlight the need for continuous assessment of scientific progress to introduce cutting edge updates in clinical practice guidelines for people with type 2 diabetes.

AIM: To evaluate the effectiveness of nurse-led care for obstructive sleep apnoea compared with physician-led care. BACKGROUND: The incidence of obstructive sleep apnoea is increasing worldwide. There is a need for cost-effective care models to ease off the pressure on tertiary care centres and divert care to the community. DESIGN: Systematic review and meta-analysis. DATA SOURCES: We searched major electronic databases (MEDLINE, EMBASE, AMED, British Nursing Index, CINAHL, HMIC, PsycINFO, Health Business Elite and the Cochrane Central Register of Controlled Trials CENTRAL) from inception till December 2016 using a structured search strategy for all randomized trials evaluating nurse-led treatment interventions for adults with obstructive sleep apnoea compared with physician-led ones. We screened relevant articles against a predefined inclusion criterion. We applied no search limitations. REVIEW METHODS: We assessed the risk of bias as per Cochrane recommendations. We calculated weighted mean difference with 95% confidence intervals for continuous outcomes and used a random-effects model to meta-analyse data. RESULTS: We screened 309 articles and only four studies met our inclusion criteria. All studies used continuous-positive airway pressure as the main treatment strategy with similar compliance rate in both comparison groups. The scores of the Epworth Sleepiness Scale, the SF-36 questionnaires for vitality, physical function and the SF-36 mental health were all similar between the two groups. There was a significant heterogeneity in all meta-analyses (I2 > 92%). CONCLUSION: Nurse-led care for adults with obstructive sleep apnoea is non-inferior to physician-led care. More research is needed to standardize nurse-led interventions and evaluate their long-term effectiveness and cost-effectiveness.

AIM: To evaluate the effectiveness of nurse-led care for obstructive sleep apnoea compared with physician-led care. BACKGROUND: The incidence of obstructive sleep apnoea is increasing worldwide. There is a need for cost-effective care models to ease off the pressure on tertiary care centres and divert care to the community. DESIGN: Systematic review and meta-analysis. DATA SOURCES: We searched major electronic databases (MEDLINE, EMBASE, AMED, British Nursing Index, CINAHL, HMIC, PsycINFO, Health Business Elite and the Cochrane Central Register of Controlled Trials CENTRAL) from inception till December 2016 using a structured search strategy for all randomised trials evaluating nurse-led treatment interventions for adults with obstructive sleep apnoea compared with physician-led ones. We screened relevant articles against a predefined inclusion criteria. We applied no search limitations. REVIEW METHODS: We assessed the risk of bias as per Cochrane recommendations. We calculated Weighted Mean Difference with 95% confidence intervals for continuous outcomes and used a random-effects model to meta-analyse data. RESULTS: We screened 309 articles and only four studies met our inclusion criteria. All studies used continuous-positive airway pressure as the main treatment strategy with similar compliance rate in both comparison groups. The scores of the Epworth Sleepiness Scale, the SF-36 questionnaires for vitality, physical function and the SF-36 mental health were all similar between the two groups. There was a significant heterogeneity in all meta-analyses (I2 >92%). CONCLUSION: Nurse-led care for adults with obstructive sleep apnoea is non-inferior to physician-led care. More research is needed to standardise nurse-led interventions and evaluate their long-term effectiveness and cost-effectiveness.