Adequacy of thyroid hormone replacement for people with hypothyroidism in real-world settings: A systematic review and meta-analysis of observational studies.

OBJECTIVE: Thyroid hormone under-replacement and over-replacement are associated with adverse health outcomes. This systematic review aimed to evaluate the extent of thyroid hormone replacement adequacy for patients with known hypothyroidism in real-word settings, excluding those receiving thyroid hormone suppressive therapy as thyroid cancer treatment. DESIGN: Four electronic databases (Embase [Ovid], Medline [Ovid], PubMed and SCOPUS) were searched for published and unpublished observational studies until 12 December 2022. The results of the studies were meta-analysed to calculate pooled prevalence estimates for thyroid hormone supplementation adequacy, over-replacement and under-replacement. Quality assessment of studies was performed using the Joanna-Briggs appraisal tool for prevalence studies. RESULTS: Seven studies with a total of 4230 patients were eligible for quantitative synthesis. The pooled prevalence estimates of adequate thyroid replacement, over-replacement and under-replacement were 0.55 (95% confidence interval [CI]: 0.49-0.60, p = .001), 0.20 (95% CI: 0.14-0.27, p = .001) and 0.24 (95% CI: 0.13-0.36, p = .001), respectively. Four studies subclassified hypothyroidism and hyperthyroidism into overt and subclinical. The pooled prevalence of overt and subclinical hyperthyroidism was 0.04 (95% CI: 0.00-0.11, p = .01) and 0.17 (95% CI: 0.09-0.27 p = .001), respectively. For overt and subclinical hypothyroidism, the pooled prevalence was 0.02 (95% CI: 0.01-0.03, p = .001) and 0.20 (95% CI: 0.12-0.29, p = .001), respectively. CONCLUSIONS: On average, approximately half of patients with hypothyroidism are only treated to target euthyroidism. In real-world practice, a significant number of patients are over-treated or under-treated, leading to adverse healthcare outcomes. It is imperative that more effective thyroid monitoring strategies be implemented, with an emphasis on primary care thyroid function monitoring, to minimise inappropriate thyroid replacement treatments and optimise healthcare outcomes at a population level.

The effectiveness of psychological interventions on mental health and quality of life in people living with type 1 diabetes: a systematic review and meta-analysis.

Background: Living with type 1 diabetes can be associated with significant psychological morbidity, poor glycaemic control, and increased risk for microvascular complications. This systematic review sought to investigate the effects of psychological interventions on depression, anxiety, diabetes-related distress, quality of life, and glycaemic control in people with type 1 diabetes. Methods: Eight electronic databases were searched for published and unpublished randomised controlled trials. Screening, data extraction, and risk of bias assessment (using the Cochrane Collaboration tool for assessing risk of bias 2.0) were independently undertaken by two study authors. The results of the studies were meta-analysed, implementing a random-effects model. The Grading of Recommendations Assessment and Development and Evaluation (GRADE) system was used to determine the confidence in the effect estimates. Results: Twenty studies were identified. Non-significant standardised mean differences (SMD) were found for depression symptoms (SMD = - 0.17, 95% CI [- 0.41, 0.07], p = 0.16) and diabetes-related distress (SMD = - 0.12, 95% CI [- 0.27, 0.04], p = 0.13). Significant SMD was found for quality of life (SMD = 0.27, 95% CI [0.11, 0.42], p = 0.0007). Significant mean difference (MD) was found for HbA1c (MD = - 0.26, 95% CI [- 0.51, - 0.01], p = 0.04). Prespecified subgroup analysis for cognitive behaviour-based interventions showed significant improvement for HbA1c (MD = - 0.23, 95% CI [- 0.44, - 0.02], p = 0.03). Conclusions: Psychological interventions were found to significantly increase quality of life and promote glucose control in people with type 1 diabetes. Depending on their cost-effectiveness, psychological interventions could be incorporated in routine clinical practice for people with type 1 diabetes and concomitant psychological morbidity. Supplementary Information: The online version contains supplementary material available at 10.1007/s13340-021-00564-9.