ABSTRACT
NODAT (new-onset diabetes after transplantation) is an important complication after liver transplant, however, there is variation in the reported incidence of NODAT. Therefore, a meta-analysis was performed to estimate the incidence of NODAT in liver transplant. Electronic databases were searched for articles regarding NODAT incidence after liver transplantation. Incidence of NODAT were analyzed at six different timepoints. Summary statistics were calculated using a generalized linear mixed model in random effects. 28 articles were included and out of a pooled population of 71,257 patients, overall incidence of NODAT was found to be 15.51%, 16.09%, 18.30%, 20.86%, 18.08%, 25.05% for three-months, six-months, one-year, three-year, five-year, and ten-year timepoints respectively. After a sensitivity analysis which only included articles with clear definitions of NODAT, the incidence of NODAT was found to be higher at three-year (21.79%), five-year (25.82%), and ten-year (44.95%) timepoints. Subgroup analysis according to ethnicity found no significant differences for all timepoints. However, studies with predominantly Asian participants generally had a higher incidence of NODAT. In conclusion, this meta-analysis provides a pooled estimate of the incidence of NODAT following liver transplantation. Further studies are required to provide a more comprehensive understanding on how ethnicity can affect the incidence of NODAT.
ABSTRACT
OBJECTIVE/BACKGROUND: This study sought to uncover the perspectives of various stakeholders towards multidisciplinary team (MDT) care, discover new understandings and help inform current practice on MDT care for diabetic patients. METHODS: 5 electronic databases were searched for articles that evaluated patients' and providers' perspectives on type 2 Diabetes Mellitus (T2DM) MDT management. Articles retrieved were sieved, coded and findings were analytically themed together in accordance to Thomas and Harden methodology. RESULTS: 15 articles were identified with three common themes: interactions between healthcare providers, benefits to patients and constraints and facilitators of the healthcare system. Trust and synergistic teamwork are important factors in promoting effective care. Patients commended MDT's improved accessibility and convenience and felt more welcomed. Often plagued by poor support, lack of manpower and resources, MDTs are less efficient and incapable of realizing their full potential. CONCLUSION: This review illustrates that the MDT model does improve diabetes treatment outcome, help prevent or reduce complications. Nevertheless, the MDT model can be a double-edged sword as poor interactions between HCPs can hamper quality patient care. The current MDT model is also based on available resources of the health system. More effort is needed to modify the MDT model to meet the changing needs of patients.