This systematic review aimed to compare the influence of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on the efficacy and safety of elderly patients with type 2 diabetes and younger individuals. A comprehensive search of PubMed, Embase, and Web of Science databases was conducted up to September 2022. The summary standard means difference and odds ratios were calculated. Thirteen articles were included in the analysis. The incidence of adverse events (AEs) leading to discontinuation was higher in elderly patients (OR = 0.67, 95% CI 0.47 to 0.96, p = 0.028). However, no significant differences were observed in weight loss (SMD = 0.03, 95% CI –0.12 to 0.19, p = 0.686), HbA1c% (SMD = –0.02, 95% CI –0.11 to 0.08, p = 0.715), FBG levels (SMD = –0.03, 95% CI –0.11 to 0.06, p = 0.537), and the incidence of overall AEs (OR = 0.85, 95% CI 0.71 to 1.01, p = 0.072), serious AEs (OR = 0.68, 95% CI 0.45 to 1.04, p = 0.077), nausea (OR = 0.91, 95% CI 0.81 to 1.03, p = 0.140), vomiting (OR = 0.95, 95% CI 0.79 to 1.13, p = 0.532), diarrhea (OR = 0.86, 95% CI 0.72 to 1.02, p = 0.081), and hypoglycemia (OR = 1.22, 95% CI 0.90 to 1.65, p = 0.193). In conclusion, while certain AEs leading to discontinuation may be more prevalent in older patients, GLP-1RAs are effective for weight loss and lead to decreased glucose concentrations with a low rate of complications in elderly patients.

This meta-analysis was performed to compare the influence of sodium-glucose co-transporter 2 inhibitors (SGLT2i) on the efficacy and safety of elderly patients with type 2 diabetes with the young ones. PubMed, Medline, Web of Science, EMbase, and Cochrane Library were searched for literature published before March 2020 to identify studies comparing efficacy and safety of SGLT2i in elderly diabetes patients (≥65 years) and young controls (<65 years). A fixed or random-effect model was used to calculate the summary standard means difference and odds ratios. A total of 13 articles with data for 86,433 participants were included. Old patients receiving SGLT2i had a smaller reduction in hemoglobin A1c (SMD = –0.07, 95% CI –0.14 to –0.00, p = 0.044) than young ones. They had higher incidence of serious adverse events (SAEs) (OR 1.78, 95% CI 1.25–2.55, p = 0.001), AE leading to discontinuation (OR 2.34, 95%CI 1.53–3.59, p = 0.000), volume depletion (OR 2.80, 95% CI 1.82–4.32, p = 0.000) , and urinary tract infections (OR 1.37, 95% CI 1.18–1.60, p = 0.000), and renal function impairment (OR 2.61, 95% CI 1.78–3.81, p = 0.000) than young patients, and there was a opposite result in genital mycotic infections (OR 0.69, 95% CI 0.55–0.87, p = 0.002). No significant differences were recorded in the reduction of fasting blood glucose, blood pressure, body weight, and in incidence of overall AEs and fracture. In summary, relatively satisfying efficacy was observed in the elderly patients receiving SGLT2i. Although some AEs were more prevalent among older patients, the majority of them were generally mild.

Objective: This systematic review aimed to evaluate the cardiovascular effectiveness and safety of initiating sodium-glucose cotransporter 2 inhibitors (SGLT2i) in comparison to glucagon-like peptide 1 receptor agonists (GLP-1RA) among elderly patients with diabetes.Methods: A comprehensive search of the PubMed, Embase, and Web of Science databases was conducted up to March 2024. The summary standard mean differences and odds ratios were calculated.Results: Twelve studies of eleven articles were included in the analysis. Older patients receiving SGLT2i had a greater incidence of euglycemic ketoacidosis (EKA) (OR 1.622, 95% CI 1.276-2.062, p = 0.000) and genitourinary infection (GUI) (OR 3.59, 95% CI 3.31-3.89, p = 0.00) than did those receiving GLP-1RA, and the opposite was true for acute kidney injury (AKI) (OR 0.902, 95% CI 0.854 - 0.952, p = 0.00). However, no significant differences were detected for major adverse cardiovascular events (MACE) (OR 1.04, 95% CI 0.95-1.13, p = 0.386), hospitalization for heart failure (HHF) (OR 0.98 95% CI 0.83-1.16, p = 0.825), myocardial infarction (MI) (OR 1.09, 95% CI 0.94-1.26, p = 0.265), stroke (OR 1.22, 95% CI 1.02-1.45, p = 0.028), total adverse events (AEs), (OR 0.98, 95% CI 0.83-1.16, p = 0.825), serious AEs (OR 1.02, 95% CI 0.94 -1.11, p = 0.594), fractures (OR 1.07, 95% CI 0.92-1.24, p = 0.394) or hypoglycemia (OR 0.95, 95% CI 0.88-1.02, p = 0.141).Conclusion: In conclusion, although SGLT2i increase the risk of EKA and GUI and GLP-1RA decrease the risk of AKI, SGLT2i are at comparable risk of MACE, HHF, MI, stroke, hypoglycemia, and fracture to GLP-1RA.Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024518348.

This meta-analysis aimed to evaluate the effectiveness of pharmaceutical care in managing asthma and chronic obstructive pulmonary disease (COPD), focusing on clinical outcomes, medication adherence, and quality of life. Randomized controlled trials comparing asthma or COPD patients who received pharmaceutical care intervention on the basis of the original treatment and the control group who only received the original treatment were included. The main results include Asthma Control Test (ACT); COPD Assessment Test (CAT); modified Medical Research Council (mMRC) dyspnea scale. Secondary outcomes were medication adherence; correct rate of inhaler technique; emergency room visit; hospitalization; Asthma Quality of Life Questionnaire (AQLQ); Peak Expiratory Flow Rate (PEFR, L/min). All analyses used a random - effects model. A total of 18 randomized controlled trials involving 4173 patients were included. The results showed that in the pharmaceutical care group, the mean correct inhalation technique rate (OR = 6.53, 95% CI: [3.19, 13.37], P < 0.001), medication adherence (OR = 1.45, 95% CI: [1.03, 2.03], P = 0.031), and the number of patients with better asthma control as indicated by ACT results (OR = 2.51, 95% CI: [2.51, 4.35], P < 0.01) were significantly better than those in the control group. The emergency room visit rate (OR = 0.44, 95% CI: [0.29, 0.67], P < 0.001) and hospital admissions rate (OR = 0.27, 95% CI: [0.19, 0.39], P < 0.001) were significantly lower. The PEFR of patients was better (SMD = 0.37, 95% CI: [0.09, 0.6], P < 0.01). However, no significant changes were observed in CAT, AQLQ, or mMRC. Pharmacists’ interventions exert a positive effect on asthma and COPD management outcomes, though improved research design and quality are still needed.

Carnosine and beta-alanine (β-alanine) have shown potential in the management of chronic conditions, including metabolic disorders. However, their therapeutic efficacy in individuals with type 2 diabetes mellitus (T2DM) and prediabetes remains inconclusive due to heterogeneity in clinical trial results and limited synthesis of human evidence. This systematic review and meta-analysis aim to evaluate the effects of carnosine and β-alanine supplementation on patients with prediabetes and T2DM. We searched PubMed, Cochrane Library, Web of Science, and Embase from inception to 9 October 2024 for randomized controlled trials that compared carnosine or β-alanine supplementation to placebo in prediabetic and diabetic populations. The quality of evidence was appraised using the Jadad scale, and the risk of bias was assessed using the Cochrane Risk of Bias tool. Data were analyzed using RevMan and Stata, employing fixed-effects models and I-V methods. Eight trials met the inclusion criteria, totaling 377 participants. Our analysis indicated that supplementation significantly reduced fasting blood glucose (FBG) (SMD: -0.53; 95% CI: -0.75 to -0.31; p < 0.00001) and hemoglobin A1c (HbA1c) levels (SMD:-0.36; 95% CI:-0.59 to -0.12; p = 0.003) compared to placebo. No significant effects were observed on body mass index (BMI), fasting insulin. low-density lipoprotein cholesterol (LDL-c) or high-density lipoprotein cholesterol (HDL-c), but a lowering effect was observed in total cholesterol (TC). Notably, Homeostasis Model Assessment of Beta-cell Function (HOMA-β) values were improved, suggesting enhanced β-cell function, while changes in homeostasis model assessment of insulin resistance (HOMA-IR) did not reach statistical significance. Carnosine and β-alanine supplementation show potential as adjunct therapies for improving FBG, HbA1c and HOMA-β in prediabetes and T2DM. Further rigorous studies are warranted to establish optimal dosage, treatment duration, and long-term efficacy in clinical practice.