RESUMEN
BACKGROUND: Prediabetes is a condition preceding the development of diabetes and is associated with an increased risk of a number of complications. The primary mode of management is thought to be lifestyle modification. Pharmacological therapy, such as glucagon-like peptide-1 receptor agonists (GLP-1RAs), were not well addressed in the literature and were only evaluated in trials as secondary and exploratory outcomes with a limited sample size. Here, GLP-1RAs are evaluated as a comprehensive therapy approach for patients with prediabetes. METHODS: A comprehensive search of Web of Science, SCOPUS, PubMed, and Cochrane was performed on May 5, 2023, to retrieve randomized controlled trials (RCTs) comparing the effect of GLP-1RAs to placebo and/or lifestyle modification on prediabetes reversion to normoglycemia, prevention of overt diabetes, glycemic control, anthropometric parameters, and lipid profiles. Review Manager (RevMan) version 5.4 was used. The quality of RCTs was assessed using the revised version of the Cochrane Risk of Bias Tool. GRADE was performed to evaluate the certainty of evidence. RESULTS: Twelve trials involving 2903 patients in the GLP-1RAs group and 1413 in the control group were included in the meta-analysis. Low quality of evidence revealed that GLP-1RAs significantly increased the incidence of prediabetes reversion to the normoglycemic state [RR = 1.76, 95% CI (1.45, 2.13), P < 0.00001] and moderate quality of evidence showed that GLP-1RAs significantly prevented new-onset diabetes [RR = 0.28, 95% CI (0.19, 0.43), P < 0.00001]. Significant reductions in HbA1c, fasting plasma glucose, body weight, waist circumference, triglycerides, and LDL were observed in the GLP-1RAs arm (P < 0.05). However, higher incidences of gastrointestinal disorders were reported in the GLP-1RAs group (P < 0.05). CONCLUSIONS: GLP-1RAs combined with lifestyle modification proved to be a more effective therapy for managing prediabetic patients than lifestyle modification alone, with a tolerable safety profile. Future guidelines should consider GLP-1RAs as an adjunct to lifestyle modification in the management of prediabetic patients to provide better management and improve treatment adherence.
RESUMEN
Factitious disorder (FD) is a psychiatric illness in which an individual assumes the role of a patient by manifesting physical or psychological symptoms without conscious or obvious reward. Here, we present the case of a 28-year-old female with a history of endotracheal intubations 19 times secondary to anaphylaxis. During the current hospital visit, she complained of cough, shortness of breath (SOB), arthralgia, wheezing, and rashes over the chest. Serum C1 esterase inhibitor and C4 levels have been negative on multiple occasions. A previous laryngoscopy showed a normal larynx, normal vocal cords, and no obstruction. Due to the patient's history of multiple invasive procedures, malingering was considered a possible differential diagnosis. The patient also has a past psychiatric history of major depressive disorder (MDD), post-traumatic stress disorder (PTSD), adjustment disorder with anxious mood, and anxiety disorder. Her complicated psychiatric history coupled with her multiple endotracheal intubations associated with normal laboratory findings raise the suspicion of factitious disorder. This case is meant to demonstrate the complicated matter of helping a patient whose psychiatric illnesses have put her at risk of serious health complications for the sake of assuming a sick role.
