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Chinese Herbal Medicine Versus Other Interventions in the Treatment of Type 2 Diabetes

Diabetes affects 422 million people and directly caused 4.9 million deaths according to the global report on diabetes in 2014. Type 2 diabetes accounts for 90% of people with diabetes around the world. Chinese herbal medicine treatment for diabetes has more than 2000-year history in China. An increasing number of people around the world are trying to manage type 2 diabetes with Chinese herbal medicine. However, there is a lack of evidence to decide if Chinese herbal medicine is effective and safe when compared with other interventions for the treatment of type 2 diabetes We identified 58 randomized controlled trials involving 6637 participants with type 2 diabetes with trial periods lasting from 8 weeks to 1 year (average 12 weeks). We extracted data following a predefined hierarchy. A total of 132 different Chinese herbal medicines were examined. We included studies comparing Chinese herbal medicine with other interventions and excluded trials that did not satisfy the inclusion criteria. We evaluated primary outcomes of trials in accordance with the Cochrane Handbook for Systematic Reviews of Intervention. Fifty-six out of 58 studies reported evidence that Chinese herbal medicines were effective at controlling blood sugar, insulin resistance, and traditional Chinese medicine clinical symptoms for patients with type 2 diabetes. And outcome variables are summarized. However, the evidence is limited because of the quality of the studies. Well-designed long-term studies with large samples and multiple centers as well as standardization and quality control will be required to determine if Chinese herbal medicine treatment is effective and safe for type 2 diabetes.


TABLES
Outcomes The life quality score (QLICD-DM, SF-36FBG) of the patients in both group after treatment were improved significantly, and the improvement in treatment group was better than that in the control group. The improvement of blood sugar (FBG, 2hPG), blood fat and HbAlc were better in treatment group than that in the control group.

No information was reported in terms to adverse effect in this study
Outcomes were assessed at baseline and trial completion Measured liver and kidney metabolism related indexes after the treatment and no abnormal was observed.
Outcomes were assessed at baseline and trial completion The combination group was significantly better than the control group in TCM syndromes score. FPG, 2hPG, FINS, 2hINS levels in integrated group were significantly lower than those in the western medicine group The adverse reactions occurred lower in integrated group than that in the western group.
Outcomes were assessed at baseline and trial completion The effective rate of observation group was significantly higher than control group.
BMI, FBG, 2hPG, HbA1c, TG, high/midst/low shear rate of blood viscosity, plasma viscosity, fibrinogen in two groups were significant decreased after treatment, and the decrease in observation group were significant lower than those of control group were. The score of TCM symptom in observation group was also significant lower than that of control group after treatment.

No information was reported in terms to adverse effect in this study
Outcomes were assessed at baseline and trial completion Fasting blood glucose was controlled within 3.9-7mmol/L and postprandial blood glucose 2 hours was less 10mmol/L, observing the difference of the amount of insulin and incidence of hypoglycemia between two groups. The incidence of hypoglycemia of the treatment group was lower than the controlled group.
No detail information was reported in terms to adverse effect in this study Outcomes were assessed at baseline and trial completion Inclusion criteria, drug naïve patients with BMI within 18kg/m²-28kg/m²; patients who received treatment with metformin at a stable dose ≥750mg/day for at least 3 months before screening with BMI within 18kg/m²-35kg/m²; stable body weight within at least 3 months before screening; poor glycemic control with FPG between 126-234mg/dl (7.0-13mmol/L) and HbA1c≥7.0& at screening.
Exclusion criteria, FPG≥13mmol/L or HbA1c≥11%, more than 3 episodes of severe hypoglycemia within 6 months before screening, allergic to sulfonylureas or their ingredients, treatment with glucose-lowing agents other than metformin or insulin within 3 months before screening or with exogenous insulin for more than 1 week within 3 months before screening, a history of heart disease within 1 year before screening, a history of abnormal kidney function or serum creatinine levels reaching the upper limit of normal, ALT or AST≥2.5 times the upper limit of normal, suffering from acute or chronic hepatitis, haemoglobin disease or chronic anemia, or underlying conditions that could lead to poor complication. Outcome in drug naïve group: patients in the Xiaoke Pill arm were 38% less likely to have any hypoglycemia compared to those in the Glibenclamide arm. The average annual rate of hypoglycemia was 24% lower in patients treated with Xiaoke Pill.
Patients in Xiaoke Pill arm were also 41% less likely to have a mild hypoglycemic episode compared to those in the Glibenclamide arm. All with statistically significant with above outcome.
Outcome in Metformin Group: patients in Xiaoke Pill arm were 24% less likely to have any hypoglycemia compared to those in the Glibenclamide arm. The average annual rate of hypoglycemia was 62% lower in patients treated with Xiaoke Pill. All with statistically significant with above outcome.
Safety and Efficacy outcomes measured by incidence of hypoglycaemia, change in HbA1c level, change in fasting glucose level, β-cell function, insulin resistance levels; fasting lipid profiles and TCM symptoms score.
No serious adverse event reported during the study.
Outcomes were assessed at baseline and trial completion Measured blood, urine and stool routine examination, liver and kidney function examination as well as ECG before and after the study. No abnormal were observed in above test.
I case in JTXZC group had nausea symptom after initial take the herb and better later change to taking herb after meal; 3 cases in Pioglitazone group had some mild adverse effects. No severe adverse reactions observed in both intervention groups.
Outcomes were assessed at baseline and trial completion