University of New York State-University at Albany, School of Public Health, Albany, New York, United States of America.
New York State Department of Health, Albany, New York, United States of America.
PLoS One. 2021 Jun 10;16(6):e0252511. doi: 10.1371/journal.pone.0252511. eCollection 2021.
Myocardial ischemia (MI) is a top ranked cause of death among diabetic patients, yet it is mostly asymptomatic or "silent". There is a need for summary epidemiologic measures on this highly lethal and unnoticeable complication of diabetes. The proposed systematic review and meta-analysis aims to estimate of the global prevalence of silent MI among diabetic patients.
This protocol was prepared according to the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) statement. The systematic review will include all observational studies published until March 23, 2021 and reporting on the prevalence of silent MI in diabetic patients. Electronic sources including MEDLINE(PubMed), Embase, Cochrane Library, and Web of Science will be searched for potentially eligible studies, restricted to only studies published in English. Two investigators will select studies and use a pre-pilot tested form to extract data. Further, they will independently perform a qualitative assessment of the risk of bias and overall quality of the selected studies, followed by a quantitative assessment using funnel plots and Egger's tests. The heterogeneity between studies will be assessed with the Cochrane's Q statistic, and the I2 statistic will measure the percentage of variation across studies that is due to their heterogeneity rather than chance; it will decide if a meta-analysis can be conducted. In case a meta-analysis cannot be conducted, a descriptive analysis will be performed. Otherwise, study-specific estimates will be pooled using either a fixed-effects or a random-effects model depending on the value of the I2 statistic. Subgroup and random effects meta-regression analyses will be used to further investigate the potential sources of heterogeneity. Finally, sensitivity analyses will be performed to measure the impact of low-quality studies on the results of the meta-analysis, and power calculations will determine the probability that we will detect a true effect if it does exist.
The intended review will provide an up-to-date summary of the global prevalence of silent MI in diabetic patients. We will conduct a thorough literature search for eligible studies, and we will use robust meta-analysis tools to provide reliable estimates of the global prevalence of silent MI in diabetic patients. Two major limitations could be: the predominance of clinical trials that might limit the generalizability of the findings, given that the strict inclusion criteria of these studies might have excluded other patients; the risk of type 1 error emanating from the high number of subgroup and sensitivity analyses.
CRD42019138136.
心肌缺血（MI）是糖尿病患者死亡的首要原因，但它大多是无症状的或“沉默的”。对于这种高致命性和不可察觉的糖尿病并发症，需要有总结性的流行病学措施。本系统综述和荟萃分析旨在估计全球糖尿病患者无症状性心肌梗死的患病率。
本方案根据系统综述和荟萃分析优先报告项目（PRISMA-P）声明制定。该系统综述将包括截至 2021 年 3 月 23 日发表的所有观察性研究，并报告糖尿病患者无症状性心肌梗死的患病率。电子资源包括 MEDLINE（PubMed）、Embase、Cochrane 图书馆和 Web of Science 将被用于搜索可能符合条件的研究，仅限于以英文发表的研究。两名调查员将选择研究，并使用预先试验的表格提取数据。此外，他们将独立地对所选研究的偏倚风险和整体质量进行定性评估，然后使用漏斗图和 Egger 检验进行定量评估。研究间的异质性将用 Cochrane 的 Q 统计量评估，I2 统计量将衡量研究间变异的百分比是由于其异质性而不是由于偶然性；它将决定是否可以进行荟萃分析。如果不能进行荟萃分析，则将进行描述性分析。否则，将使用固定效应或随机效应模型根据 I2 统计量的值对研究特异性估计值进行汇总。亚组和随机效应荟萃回归分析将用于进一步研究潜在的异质源。最后，将进行敏感性分析以衡量低质量研究对荟萃分析结果的影响，并且功效计算将确定如果存在真实效应，我们检测到它的概率。
拟议的综述将提供糖尿病患者无症状性心肌梗死全球患病率的最新总结。我们将对合格研究进行全面的文献搜索，并使用稳健的荟萃分析工具提供糖尿病患者无症状性心肌梗死全球患病率的可靠估计值。两个主要的局限性可能是：临床试验的主导地位可能限制研究结果的普遍性，因为这些研究的严格纳入标准可能排除了其他患者；由于亚组和敏感性分析数量众多，可能会出现Ⅰ类错误。
PROSPERO 注册号：CRD42019138136。
