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Shang W, Zhang Y, Wang G, et al. Benefits of continuous positive airway pressure on glycaemic control and insulin resistance in patients with type 2 diabetes and obstructive sleep apnoea: A meta-analysis. Diabetes Obes Metab. 2021 Feb;23(2):540-548. doi: 10.1111/dom.14247. Epub 2020 Dec 2. (Systematic review)
Abstract

AIM: To conduct a meta-analysis to determine the effects of continuous positive airway pressure (CPAP) treatment on glycaemic control and insulin resistance in patients with type 2 diabetes and obstructive sleep apnoea (OSA).

METHODS: A systematic search was made of the MEDLINE, SCOPUS, ISI Web of Science, Cochrane databases, and clinicaltrials.gov, without language restrictions. Randomized controlled trials on treatment of type 2 diabetes and OSA with CPAP, compared with sham CPAP or no CPAP, were reviewed. Studies were pooled to obtain standardized mean differences (SMDs), with 95% confidence intervals (CIs).

RESULTS: Seven trials (enrolling 691 participants) met the inclusion criteria. CPAP showed significant effects on glycated haemoglobin (HbA1c; SMD -0.32, 95% CI -0.60 to -0.03; P = 0.029), fasting glucose (SMD -0.39, 95% CI -0.76 to -0.02; P = 0.040), homeostatic model assessment of insulin resistance (HOMA-IR; SMD -1.05, 95% CI -1.91 to -0.19; P = 0.016), systolic blood pressure (SMD -1.18, 95% CI -2.29 to -0.07 mm Hg; P = 0.037), and diastolic blood pressure (SMD -1.29, 95% CI -2.48 to -0.09; P = 0.035).

CONCLUSIONS: Continuous positive airway pressure treatment significantly improved glycaemic control and insulin resistance, as shown by the decreased HbA1c levels, fasting glucose levels and HOMA-IR values in patients with type 2 diabetes and OSA.

Ratings
Discipline Area Score
Family Medicine (FM)/General Practice (GP) 6 / 7
General Internal Medicine-Primary Care(US) 6 / 7
Endocrine 6 / 7
Respirology/Pulmonology 6 / 7
Comments from MORE raters

General Internal Medicine-Primary Care(US) rater

I have many patients with DM and OSA. It's nice to see that use of CPAP improved diabetic control. This will give me further information to help convince patients to stick with their CPAP.

Respirology/Pulmonology rater

There was significant heterogeneity among the included studies for all the main outcomes.

Respirology/Pulmonology rater

The usefulness of the information does not depend on this review.
Comments from EvidenceAlerts subscribers

Dr. Vijay Venkatesan (12/26/2020 9:46 AM)

Statistically different but not clinically significant. 0.3% is well within the margin of error of variability for A1c measurement, and all other useful drugs for diabetes should help more than that. At most, this can be added to the list of benefits for counseling patients: improves sleep quality and energy, blood pressure control, glycemic control, etc.