Meditation Programs for Adults with Type 2 Diabetes Mellitus: A Protocol for a Systematic Review and Meta-analysis

doi:10.21203/rs.3.rs-966739/v1

Download PDF

Protocol

Meditation Programs for Adults with Type 2 Diabetes Mellitus: A Protocol for a Systematic Review and Meta-analysis

https://doi.org/10.21203/rs.3.rs-966739/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Background

Type 2 diabetes mellitus is intimately linked to chronic stress. Meditation programs belong to mind-body therapies, which could benefit patients’ disease management. Though some clinical trials have proved that meditation programs have the ability to improve level of blood glucose, quality of life, body mass index and blood indexes related to metabolism in individuals with type 2 diabetes mellitus, the efficacy of meditation programs needs further confirmation. Thus, we will conduct this systematic evaluation and meta-analysis to summarize and analyze all the results included to obtain reliable evidence.

Method

We will search several English and Chinese databases for relevant clinical trials published up to July 2021, and randomized controlled trials or controlled trials among adults with type 2 diabetes mellitus are included. Two reviewers will extract data and assess the quality of included studies independently. The main outcomes of this research are glycosylated hemoglobin level and fasting blood glucose level. The secondary outcomes are high-density lipoprotein, low-density lipoprotein, body mass index, remission of depression and anxiety, and quality of life. Stata v.14.0 and Review Manager V5.3 will be used to synthesize and analyze all data included.

Discussion

This systematic review is the first to analyze the efficacy of different types of meditation for type 2 diabetes mellitus, which could provide evidence for the use of mediation programs as non-drug approaches. Lack of enough randomized controlled trials is the main limitation of this protocol. So, we will gradually finish this protocol in the future and reduce the risk of bias.

Registration

https://doi.org/10.37766/inplasy2021.10.0008. NO. 2021100008.

Cellular Metabolism

Endocrinology & Metabolism

Meditation programs

Type 2 diabetes mellitus

glycosylated hemoglobin

fasting blood glucose

systematic review

protocol

According to the International Diabetes Federation (IDF) Diabetes Atlas (9th edition) published by World Health Organization (WHO), nearly 4.63 million adults aged between 20 to 79 suffer from diabetes mellitus (DM) globally, and this number is projected to reach 578 million by 2030, and 700 million by 2045[1]. Type 2 diabetes (T2DM) with a feature of insulin resistance is the most common form of diabetes [2]. T2DM could trigger numerous complications, including microvascular, macrovascular complications and diabetic neuropathies [3, 4], and increases the risk of stroke, cognitive impairment and cancer [5, 6, 7]. A survey from IDF indicates that the global economic burden of diabetes-related diseases is around US $673 billion in 2015[8].

The development of T2DM is closely associated with low-level, chronic inflammation, insulin resistance and various metabolic disorders [9, 10, 11]. Human lifestyle alterations, like prolonged sedentary lifestyle, depression and anxiety, intake of refined sugar and high-fat diet, have contributed to a rapid increase of T2DM worldwide [12, 13]. Demand of modern life makes people suffer from chronic stress for a long time [14]. Chronic stress could cause excitement of sympathetic nerve, leading to activation of the hypothalamus-pituitary-adrenal axis (HPA) [15]. The activation of HPA could trigger the release of glucocorticoids and cortisol, affecting body's blood sugar homeostasis, which could finally cause insulin resistance [16]. Additionally, there is currently considerable evidence of an association between negative stress (like depression and anxiety) and T2DM. DM is reciprocally linked to depression through many ways [17]. Researches have proved that depression may make the body in a low-grade inflammation state, and C-reactive protein (CRP), as an inflammatory-related factors, partially mediates the relationship between depression and diabetes [18]. Negative emotional state could be changed by mind-body therapies. As a non-drug approach for T2DM, mind-body therapies have gained more attention than ever before, which could also help reduce social medical costs.

Meditation is a kind of mind-body interventions,a form of metal training that helps individuals train their attention and awareness to achieve mental well-being[19]. Derived from religion, meditation has many forms, like transcendental meditation and mindfulness meditation [20]. It could also be combined with some physical exercises to forms of yoga and tai chi. At present, meditation programs have been widely used to treat depression, anxiety, insomnia and other psychological problems [21, 22, 23]. Additionally, meditation may also benefit to other stress-related medical diseases, such as chronic obstructive pulmonary disease (COPD), hypertension, and chronic pain [24, 25, 26]. In 2013, the American Heart Association (AHA) has recommended transcendental meditation as an alternative therapy for hypertension with level IIb evidence [27]. Meditation could reduce many indicators related to the metabolic syndrome, such as blood pressure, blood lipid levels, blood sugar level, glycosylated hemoglobin and body mass index (BMI)[28]. Clinical trials have found that meditation programs could also affect HbA1c level and improve quality of live (QoL) of T2DM patients [29, 30].

Though the mechanism of meditation for T2DM is not clear enough [26], some studies have found that meditation programs may improve symptoms of T2DM patients through many ways. The development and progression of T2DM are associated with the dysfunction of HPA axis, which could be regulated by meditation [16]. A study found that emerging adults trained with transcendental meditation have lower morning cortisol level and cortisol awakening response [31]. Inflammation plays an important role in T2DM. A meta-analysis in 2017 has summarized the influence of meditation for T2DM, and the results show that mindfulness meditation could reduce the activity of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), lower the level of CRP and increase the level of CD4⁺[32]. Furthermore, some researches have confirmed that meditation programs have positive impacts on the length of telomeres and reduce the reactive oxygen species (ROS), and reduce the development of DM related to aging [33].

Now, meditation has received more attention among people. There are also a number of clinical trials exploring the impact of various meditation programs on T2DM patients and gained considerable results [26, 34]. But discrepancies also exist in these studies and there is a lack of lateral contrasts among researches related to different meditation programs. Therefore, this meta-analysis aims to analyze the RCTs and CTs studies about meditation programs, further evaluate the effectiveness and safety of meditation programs for T2DM, and find out whether there are any differences in the efficacy of different meditation programs for T2DM.

Study design

This protocol follows preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) guideline [35].And this study will be performed in agreement with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines[36].

Registration

The protocol for the systematic review was registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (NO. 2021100008).

Eligibility criteria

Participants

Adults diagnosed with T2DM are included in this study. In this review, the definition for T2DM should follow relevant guidelines, such as American Diabetes Association standard for clinical diagnosis and treatment of diabetes.

Interventions

Our protocol contains researches taking different forms of meditation as treatment, whether as a primary or complementary therapy. It also includes some other comprehensive therapies including meditation, such as yoga and Tai Chi.

Controls

Placebo treatment, treatment as usual or no treatment.

Outcomes

The main outcomes will be fasting blood glucose levels and HbA(1c). The second outcomes are remission of depression and anxiety level, quality of life, BMI, high-density lipoprotein cholesterol (HDL), low-density lipoprotein (LDL) and level of blood pressure.

Study types

This study includes Random clinical trials (RCTs), controlled trials(CTs), while case studies, conference papers, review, comments, retrospective cohort studies, cluster trials, cross-sectional studies are excluded.

Search strategy

We will search literature databases including Embase, PubMed, MEDLINE, Cochrane Library, Ovid database, China National Knowledge Infrastructure (CNKI), Wanfang and VIP information databases. And then all databases mentioned above will be retrieved from 1990 to present. Details of how PubMed will be retrieved are provided in Table 1.

Table 1

Search Strategy (PubMed)
Search	Query
1#	“meditation” [MeSH Terms]
2#	"meditate"[Title/Abstract] OR "meditated"[Title/Abstract] OR "meditating"[Title/Abstract] OR "meditation"[Title/Abstract] OR "meditations"[Title/Abstract] OR "meditational"[Title/Abstract] OR "meditative"[Title/Abstract] OR "meditator"[Title/Abstract] OR "meditators"[Title/Abstract] OR "transcendental"[Title/Abstract] OR "transcendental meditation"[Title/Abstract] OR "minds"[Title/Abstract] OR "minded"[Title/Abstract] OR "mindful"[Title/Abstract] OR "mindfulness"[MeSH Terms] OR "minding"[Title/Abstract] OR "meditated"[Title/Abstract] OR "meditating"[Title/Abstract] OR "meditative"[Title/Abstract] OR "yoga"[MeSH Terms] OR "Tai chi"[Title/Abstract] OR "Tai ji"[Title/Abstract] OR "yoga"[Title/Abstract]) OR "Yogic"[Title/Abstract]
3#	"Diabetes Mellitus, Type 2" [MeSH Terms]
4#	“Type 2 Diabetes Mellitus” [Title/Abstract] OR “Type 2 Diabetes” [Title/Abstract] OR “T2DM” [Title/Abstract] OR “Diabetes, Type 2” [Title/Abstract] OR “Diabetes Mellitus, Type II” [Title/Abstract] OR “Insulin resistance” [Title/Abstract] OR “NIDDM” [Title/Abstract] OR “Stable Diabetes Mellitus” [Title/Abstract] OR “Diabetes Mellitus, Noninsulin-Dependent” [Title/Abstract] OR “Adult-Onset Diabetes Mellitus” [Title/Abstract] OR “Diabetes Mellitus, Type II” [Title/Abstract] OR “Non-Insulin-Dependent Diabetes Mellitus” [Title/Abstract] OR “Diabetes Mellitus, Maturity-Onset” [Title/Abstract]
6#	1# OR 2#
7#	3# OR 4#
8#	5# AND 6#

Table 2

Abbreviations in this protocol
American Heart Association	AHA
Body mass induce	BMI
C-reactive protein	CRP
Chronic obstructive pulmonary disease	COPD
China National Knowledge Infrastructure	CNKI
Controlled trials	CTs
Diabetes mellitus	DM
Glycosylated hemoglobin	HbA(1c)
High-density lipoprotein cholesterol	HDL
Hypothalamus-pituitary-adrenal	HPA
International Diabetes Federation	IDF
International Platform of Registered Systematic Review and Meta-analysis Protocols	INPLASY
Low-density lipoprotein	LDL
Mean differences	MDs
Newcastle-Ottawa-Scale	NOS
Nuclear factor kappa-light-chain-enhancer of activated B cells	NF-κB
Systematic Reviews and Meta-Analyses	PRISMA
Preferred reporting items for systematic review and meta-analysis protocols	PRISMA-P
Quality of live	QoL
Randomized controlled trials	RCTs
Reactive oxygen species	ROS
Type 2 diabetes mellitus	T2DM
World Health Organization	WHO

Study selection and data extraction

Study selection

Two review authors will scan all literatures’ titles, abstracts, and full text according to eligibility criteria, and remove repeated and irrelevant studies. If there is any doubt about studies screened in this process, the articles will be evaluated again by a third reviewers besides them. Researches will be retrieved further which met the inclusion criteria. Figure 1 presents PRISMA flow diagram of the study selection process.

Fig. 1 Flow chart and descriptions of study selection

Data extraction

Two reviewers will extract data independently according to a standard model we made before. Any dissents between them will be solved with assistance of a third reviewer. Specific extraction contents are as follows: a) essential information of included studies (first author, country, year of publication), b) design of study (randomization, blinding), c) details of participants (age, gender, duration of T2DM, total number of participants), d) intervention and control (type of meditation, duration of treatment), e) outcome measurements (HbA1c, fasting blood glucose levels, quality of life, remission of depression and anxiety level, quality of life, BMI and level of blood pressure). Data not provided in published articles will be collected from corresponding authors by e-mail.

Quality assessment of included studies

Cochrane Risk of Bias tool will be used to assess random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting and other bias of all included studies. Then make judgment for every studies with low risk, unclear risk and high risk. And Newcastle-Ottawa-Scale (NOS) will be used to evaluate studies which are not RCTs.

Data synthesis and statistical analysis

All statistical analyses will be performed using Revman5.3.0 (Cochrane information management system) and Stata V.16.0 software. For continuous outcomes,we will calculate mean differences (MDs) with 95% CIs and I² statistic for heterogeneity across studies. A value of P<0.05 would be considered statistically significant. If there was homogeneity among studies (P>0.1, I²<50%), fixed-effect model will be used. Random effect model would be used to analyze when there was heterogeneity among the studies (P ≤0.1༌I²༞50%).

Sensitivity and subgroup analyses

We will also perform a sensitivity analysis by excluding studies with high risk of bias. Subgroup meta-analyses and meta-regressions are conducted to explore reasons of heterogeneity, such as types of study design, populations and different meditation programs.

Assessment of publication bias

Egger test will be conducted to evaluate publication bias, and results displayed by funnel plot. If there is publication bias (P༜0.05), we would use a trim and fill method to adjust bias.

Quality assessment

Two authors will independently assess included trials’ methodological with the Grading of Recommendations Assessment, Development, and Evaluation guidelines (GRADE) (37).

Previous systematic reviews have confirmed that mind-body interventions could affect serum glucose levels, QoL of patients with T2DM. So far, our study is the first to analyze effects of different meditation projects for type 2 diabetes, and would provide a detailed summary of available evidence. This review may be limited by the quality of all included studies. The potential risk of bias in each study would also be assessed. T2DM patients are always with metabolic disorders, so we would further assess the impact of meditation programs on metabolic related indicators, like LDL, HDL and BMI. Studies have shown that the incidence of depression is higher in individuals with T2DM, and this protocol would evaluate the improvement of depression and anxiety of patients. Our protocol provides a clear and structured procedure to extract relevant information comprehensively and provide the effects of meditation projects on patients with T2DM and compared the differences among meditation programs. The results of this systematic review could be a interest for patients and physicians who pay attention to mind-body interventions and provide evidence for it to be included in the guidelines as a part of non-drug approaches.

There are some abbreviations in this studies. Table 2 includes all abbreviations in this article.

Strengths

Provided a detailed protocol for a systematic review of meditation programs for adults with type 2 diabetes mellitus published in journals firstly.

Limitations

Absence of adequate randomized controlled trials and controlled trials is the main limitation of this meta-analysis.

Ethics and dissemination

This study is a meta-analytic review without patients enrolled, therefore ethics approval is not essential. After finishing this study, all results will be submitted to peer-reviewed journals.

Consent for publication

Not applicable.

Competing interests

All authors declare that there are no competing interests.

Funding

This research was supported by both Guangdong Province Key Field R&D Program Project (No.2019B020201012) and the special foundation of Guangzhou Key Laboratory (No. 202002010004).

Authors' contributions

Mei M and Song J designed the study. Mei M, Li Z, Zhu W drafted and registered the protocol. Mei M, Li Z and Jiang M will screen the studies for data analysis. Song P, Zhu W, Mei M and Li Z revised the protocol. All authors read and approved the final manuscript.

Acknowledgements

We appreciate the support of the fund and all authors who participated.

Authors' information

Manxue Mei, E-mail: [email protected]

Min Jiang, E-mail: [email protected]

Zunjiang Li, E-mail: [email protected]

Wei Zhu, E-mail: [email protected]

Jianping Song, E-mail: [email protected]

Provenance and peer review

Not commissioned; externally peer reviewed.

Patient consent for publication

Not required.

1. Federation ID. IDF Diabetes Atlas (9th edition 2019).2021.In: http://diabetesatlas.org/en/resources.Accessed 9 Oct 2021.

2. Punthakee Z, Goldenberg R, Katz P. Definition, Classification and Diagnosis of Diabetes, Prediabetes and Metabolic Syndrome. Canadian journal of diabetes. 2018;42 Suppl 1:S10-s5. https://doi.org/ 10.1016/j.jcjd.2017.10.003

3. Guo X, Shi Y, Huang X, Ye M, Xue G, Zhang J. Features analysis of lower extremity arterial lesions in 162 diabetes patients. Journal of diabetes research. 2013;2013:781360. https://doi.org/ 10.1155/2013/781360

4. Pop-Busui R, Boulton AJ, Feldman EL, Bril V, Freeman R, Malik RA, et al. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes care. 2017;40(1):136-54. https://doi.org/ 10.2337/dc16-2042

5. Samson SL, Garber AJ. Metabolic syndrome. Endocrinology and metabolism clinics of North America. 2014;43(1):1-23. https://doi.org/ 10.1016/j.ecl.2013.09.009

6. Iadecola C. Neurovascular regulation in the normal brain and in Alzheimer's disease. Nature reviews Neuroscience. 2004;5(5):347-60. https://doi.org/ 10.1038/nrn1387

7. Shigeoka T, Nomiyama T, Kawanami T, Hamaguchi Y, Horikawa T, Tanaka T, et al. Activation of overexpressed glucagon-like peptide-1 receptor attenuates prostate cancer growth by inhibiting cell cycle progression. Journal of diabetes investigation. 2020;11(5):1137-49. https://doi.org/ 10.1111/jdi.13247

8. Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U, Guariguata L, Cho NH, et al. IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes research and clinical practice. 2017;128:40-50. https://doi.org/ 10.1016/j.diabres.2017.03.024

9. Tilves CM, Zmuda JM, Kuipers AL, Nestlerode CS, Evans RW, Bunker CH, et al. Association of Lipopolysaccharide-Binding Protein With Aging-Related Adiposity Change and Prediabetes Among African Ancestry Men. Diabetes care. 2016;39(3):385-91. https://doi.org/10.2337/dc15-1777

10. Lontchi-Yimagou E, Sobngwi E, Matsha TE, Kengne AP. Diabetes mellitus and inflammation. Current diabetes reports. 2013;13(3):435-44. https://doi.org/ 10.1007/s11892-013-0375-y

11. Francois ME, Myette-Cote E, Bammert TD, Durrer C, Neudorf H, DeSouza CA, et al. Carbohydrate restriction with postmeal walking effectively mitigates postprandial hyperglycemia and improves endothelial function in type 2 diabetes. American journal of physiology Heart and circulatory physiology. 2018;314(1):H105-h13. https://doi.org/ 10.1152/ajpheart.00524.2017

12. Kolb H, Martin S. Environmental/lifestyle factors in the pathogenesis and prevention of type 2 diabetes. BMC medicine. 2017;15(1):131. https://doi.org/ 10.1186/s12916-017-0901-x

13. Després JP, Poirier P. Diabetes: Looking back at Look AHEAD--giving lifestyle a chance. Nature reviews Cardiology. 2013;10(4):184-6. https://doi.org/ 10.1038/nrcardio.2013.16

14. Ren F, Liu N. Emotion computing using Word Mover's Distance features based on Ren_CECps. PloS one. 2018;13(4):e0194136. https://doi.org/ 10.1371/journal.pone.0194136

15. Günther AC, Bottai M, Schandl AR, Storm H, Rossi P, Sackey PV. Palmar skin conductance variability and the relation to stimulation, pain and the motor activity assessment scale in intensive care unit patients. Critical care (London, England). 2013;17(2):R51. https://doi.org/ 10.1186/cc12571

16. Joseph JJ, Golden SH. Cortisol dysregulation: the bidirectional link between stress, depression, and type 2 diabetes mellitus. Annals of the New York Academy of Sciences. 2017;1391(1):20-34. https://doi.org/ 10.1111/nyas.13217

17. Belvederi Murri M, Mamberto S, Briatore L, Mazzucchelli C, Amore M, Cordera R. The interplay between diabetes, depression and affective temperaments: A structural equation model. Journal of affective disorders. 2017;219:64-71. https://doi.org/ 10.1016/j.jad.2017.05.018

18. Dona AC, DeLouize AM, Eick G, Thiele E, Salinas Rodríguez A, Manrique Espinoza BS, et al. Inflammation and central adiposity as mediators of depression and uncontrolled diabetes in the study on global AGEing and adult health (SAGE). American journal of human biology : the official journal of the Human Biology Council. 2020;32(6):e23413. https://doi.org/ 10.1002/ajhb.23413

19. Walsh R, Shapiro SL. The meeting of meditative disciplines and Western psychology: a mutually enriching dialogue. The American psychologist. 2006;61(3):227-39. https://doi.org/ 10.1037/0003-066X.61.3.227

20. Priya G, Kalra S. Mind-Body Interactions and Mindfulness Meditation in Diabetes. European endocrinology. 2018;14(1):35-41. https://doi.org/ 10.17925/EE.2018.14.1.35

21. Tolahunase MR, Sagar R, Faiq M, Dada R. Yoga- and meditation-based lifestyle intervention increases neuroplasticity and reduces severity of major depressive disorder: A randomized controlled trial. Restorative neurology and neuroscience. 2018;36(3):423-42. https://doi.org/10.3233/RNN-170810

22. Hoge EA, Bui E, Marques L, Metcalf CA, Morris LK, Robinaugh DJ, et al. Randomized controlled trial of mindfulness meditation for generalized anxiety disorder: effects on anxiety and stress reactivity. The Journal of clinical psychiatry. 2013;74(8):786-92. https://doi.org/ 10.4088/JCP.12m08083

23. Ong JC, Manber R, Segal Z, Xia Y, Shapiro S, Wyatt JK. A randomized controlled trial of mindfulness meditation for chronic insomnia. Sleep. 2014;37(9):1553-63. https://doi.org/ 10.5665/sleep.4010

24. la Cour P, Petersen M. Effects of mindfulness meditation on chronic pain: a randomized controlled trial. Pain medicine (Malden, Mass). 2015;16(4):641-52. https://doi.org/ 10.1111/pme.12605

25. Chan RR, Lehto RH. The Experience of Learning Meditation and Mind/Body Practices in the COPD Population. Explore (New York, NY). 2016;12(3):171-9. https://doi.org/ 10.1016/j.explore.2016.02.004

26. Lee SH, Hwang SM, Kang DH, Yang HJ. Brain education-based meditation for patients with hypertension and/or type 2 diabetes: A pilot randomized controlled trial. Medicine. 2019;98(19):e15574. https://doi.org/ 10.1097/MD.0000000000015574

27. Ooi SL, Giovino M, Pak SC. Transcendental meditation for lowering blood pressure: An overview of systematic reviews and meta-analyses. Complementary therapies in medicine. 2017;34:26-34. https://doi.org/10.1016/j.ctim.2017.07.008

28. Anderson JG, Taylor AG. The metabolic syndrome and mind-body therapies: a systematic review. Journal of nutrition and metabolism. 2011;2011:276419. https://doi.org/ 10.1155/2011/276419

29. Xia T, Yang Y, Li W, Tang Z, Huang Q, Li Z, et al. Meditative Movements for Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis. Evidence-based complementary and alternative medicine : eCAM. 2020;2020:5745013. https://doi.org/ 10.1155/2020/5745013

30. Bogusch LM, O'Brien WH. The Effects of Mindfulness-Based Interventions on Diabetes-Related Distress, Quality of Life, and Metabolic Control Among Persons with Diabetes: A Meta-Analytic Review. Behavioral medicine (Washington, DC). 2019;45(1):19-29. https://doi.org/ 10.1080/08964289.2018.1432549

31. Klimes-Dougan B, Chong LS, Samikoglu A, Thai M, Amatya P, Cullen KR, et al. Transcendental meditation and hypothalamic-pituitary-adrenal axis functioning: a pilot, randomized controlled trial with young adults. Stress (Amsterdam, Netherlands). 2020;23(1):105-15. https://doi.org/ 10.1080/10253890.2019.1656714

32. Black DS, Slavich GM. Mindfulness meditation and the immune system: a systematic review of randomized controlled trials. Annals of the New York Academy of Sciences. 2016;1373(1):13-24. https://doi.org/ 10.1111/nyas.12998

33. Tolahunase M, Sagar R, Dada R. Impact of Yoga and Meditation on Cellular Aging in Apparently Healthy Individuals: A Prospective, Open-Label Single-Arm Exploratory Study. Oxidative medicine and cellular longevity. 2017;2017:7928981. https://doi.org/ 10.1155/2017/7928981

34. Hussain N, Said ASA. Mindfulness-Based Meditation Versus Progressive Relaxation Meditation: Impact on Chronic Pain in Older Female Patients With Diabetic Neuropathy. Journal of evidence-based integrative medicine. 2019;24:2515690x19876599. https://doi.org/ 10.1177/2515690X19876599

35. Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ (Clinical research ed). 2015;350:g7647. https://doi.org/ 10.1136/bmj.g7647

36. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ (Clinical research ed). 2021;372:n71. https://doi.org/ 10.1136/bmj.n71

37. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. Journal of clinical epidemiology. 2011;64(4):383-94. https://doi.org/ 10.1016/j.jclinepi.2010.04.026

PRISMAPchecklist.docx

Download PDF

Version 1

posted

You are reading this latest preprint version

Meditation Programs for Adults with Type 2 Diabetes Mellitus: A Protocol for a Systematic Review and Meta-analysis

Status:

Version 1

Abstract

Figures

Introduction

Methods

Study design

Registration

Eligibility criteria

Participants

Interventions

Controls

Outcomes

Study types

Search strategy

Study selection and data extraction

Quality assessment of included studies

Data synthesis and statistical analysis

Sensitivity and subgroup analyses

Assessment of publication bias

Quality assessment

Discussion

Abbreviations

Strengths and limitations of this study

Declarations

References

Supplementary Files

Status:

Version 1