Background: Exercise has been recommended as a cornerstone for diabetes management. Supervised exercise is more efficient than unsupervised exercise but is less convenient and accessible. Objective: We aimed to determine the efficiency of exercise using a fitness app and heart rate band to remotely monitor patients with type 2 diabetes in comparison with that of traditional exercise. Methods: Patients with type 2 diabetes without severe complications or comorbidities were recruited to participate in this multicenter randomized controlled trial and were allocated to either the intervention or control group (1:1 ratio). Participants in both groups were asked to engage in moderate to vigorous physical activity for at least 150 minutes per week; each participant was prescribed individualized exercises. Participants in the intervention group were asked to follow exercise videos on the app and to wear a chest band; heart rate, exercise duration, and exercise intensity were recorded by the app. Participants in the control group self-reported exercise intensity and duration. Cardiopulmonary endurance, body composition, blood glucose level, and insulin level were assessed before and after a 3-month exercise program. Results: Of the 101 participants who were enrolled, the majority of them (85/101, 84.2%) completed the study. Both groups had similar baseline characteristics, with the exception that participants in the intervention group were slightly younger and less likely to have hypertension. Self-reported exercise duration was longer than app-recorded exercise duration (control: mean 214 minutes/week; intervention: mean 193 minutes/week); in addition, a higher proportion of participants in the control group (29/41, 71%) than in the intervention group (18/44, 41%) met the 150-minute target for moderate to vigorous physical activity. However, compared with the control group, the intervention group had a larger increase in cardiopulmonary endurance (mean difference –2.0 bpm [beats per minute] vs 1.0 bpm; P=.02) and a larger decrease in body fat percentage (mean difference –1.8% vs –0.8%; P=.01). There was no difference in hemoglobin A1c level reduction between the two groups, yet more participants in the intervention group stopped taking their antidiabetic drugs or had their dosages lowered by an endocrinologist, compared with those in the control group. There were no serious adverse events in either group. Conclusions: This was the first randomized controlled trial in China, to our knowledge, to test the efficiency of exercise using a fitness app and heart rate band to remotely monitor prescribed exercise in patients with type 2 diabetes. The findings of our study suggest that exercise programs may be more efficient if participants are remotely monitored with an app and heart rate band than if participants are not monitored. Trial Registration: Chinese Clinical Trial Register ChiCTR1800015963; http://www.chictr.org.cn/showprojen.aspx?proj=27080

Objective To determine the harms of ezetimibe in people who need lipid-lowering treatment. Design Systematic review and meta-analysis. Data sources Randomised controlled trials and cohort studies. Eligibility criteria for selecting studies Studies comparing ezetimibe with placebo, standard care, or other lipid-lowering agents in people who need lipid-lowering treatment with a follow-up duration of at least six months (or 24 weeks). The relative effects for potential harms of ezetimibe were pooled by use of random effect pairwise meta-analyses for randomised controlled trials and the evidence from observational studies was narratively summarised. The certainty of evidence was assessed using the Grading of Recommendation Assessment, Development, and Evaluation. Results 48 randomised controlled trials with 28 444 participants (median follow-up 34 weeks, range 24-312 weeks) and four observational studies with 1667 participants (median follow-up 282 weeks, range 72-400 weeks) were included. The meta-analyses of randomised trials showed moderate to high certainty that ezetimibe was not associated with cancer (relative risk 1.01; 95% confidence interval 0.92 to 1.11), fractures (0.90; 0.74 to 1.10), discontinuation due to any adverse event (0.87; 0.74 to 1.03), gastrointestinal adverse events leading to discontinuation (1.34; 0.58 to 3.08), myalgia or muscular pain leading to discontinuation (0.82; 0.51 to 1.33), neurocognitive events (1.48; 0.58 to 3.81), or new-onset diabetes (0.88; 0.61 to 1.28). The narrative analysis of observational studies provided consistent findings. No credible subgroup effects were identified for the harm outcomes, including shorter versus longer follow-up duration of trials. Conclusions Ezetimibe results in little to no difference in adverse events or other undesirable effects compared with placebo, usual care or other lipid-lowering agents. Review registration PROSPERO CRD42020187437.

Background: Patient education is a cornerstone of modern healthcare. Health literacy improves health-related quality of life and health outcomes of patients, enhanced by effective patient education. Inadequate competency of patient education in healthcare providers triggered this review to summarize common approaches and recent advancements. Methods: This narrative review summarizes common approaches and recent advancements in patient education with their relations to health literacy, their strengths, limitations, and practical issues. Results: This review highlighted the multifaceted approaches to patient education, emphasizing the importance of tailoring methods to meet the diverse needs of patients. By integrating various strategies, including intrapersonal, interpersonal, and societal/community-level interventions, healthcare providers can create a more comprehensive educational experience that addresses the complexities of patient needs, meanwhile improving the health literacy of patients. With the rise of digital media and artificial intelligence, there is an increasing need for innovative educational resources that can effectively reach and engage patients. Ongoing research and collaboration among healthcare professionals and policymakers will be essential to refine educational strategies and adapt to emerging challenges. It is essential to remain vigilant about potential conflicts of interest that may compromise the integrity of educational content. Conclusion: Effective patient education empowers individuals and their contributions to a healthier society by fostering informed decision-making and encouraging proactive health management.