人参（五加属）对血糖控制的影响：随机对照临床试验的系统评价和荟萃分析。
The effect of ginseng (the genus panax) on glycemic control: a systematic review and meta-analysis of randomized controlled clinical trials.
作者信息
Shishtar Esra', Sievenpiper John L, Djedovic Vladimir, Cozma Adrian I, Ha Vanessa, Jayalath Viranda H, Jenkins David J A, Meija Sonia Blanco, de Souza Russell J, Jovanovski Elena, Vuksan Vladimir
机构信息
Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Departments of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
出版信息
PLoS One. 2014 Sep 29;9(9):e107391. doi: 10.1371/journal.pone.0107391. eCollection 2014.
IMPORTANCE
Despite the widespread use of ginseng in the management of diabetes, supporting evidence of its anti-hyperglycemic efficacy is limited, necessitating the need for evidence-based recommendations for the potential inclusion of ginseng in diabetes management.
OBJECTIVE
To elucidate the effect of ginseng on glycemic control in a systematic review and meta-analysis of randomized controlled trials in people with and without diabetes.
DATA SOURCES
MEDLINE, EMBASE, CINAHL and the Cochrane Library (through July 3, 2013).
STUDY SELECTION
Randomized controlled trials ≥30 days assessing the glycemic effects of ginseng in people with and without diabetes.
DATA EXTRACTION
Relevant data were extracted by 2 independent reviewers. Discrepancies were resolved by consensus. The Heyland Methodological Quality Score and the Cochrane risk of bias tool were used to assess study quality and risk of bias respectively.
DATA SYNTHESIS
Sixteen trials were included, in which 16 fasting blood glucose (n = 770), 10 fasting plasma insulin (n = 349), 9 glycated hemoglobin (n = 264), and 7 homeostasis model assessment of insulin resistance (n = 305) comparisons were reported. Ginseng significantly reduced fasting blood glucose compared to control (MD = -0.31 mmol/L [95% CI: -0.59 to -0.03], P = 0.03). Although there was no significant effect on fasting plasma insulin, glycated hemoglobin, or homeostasis model assessment of insulin resistance, a priori subgroup analyses did show significant reductions in glycated hemoglobin in parallel compared to crossover trials (MD = 0.22% [95%CI: 0.06 to 0.37], P = 0.01).
LIMITATIONS
Most trials were of short duration (67% trials<12wks), and included participants with a relatively good glycemic control (median HbA1c non-diabetes = 5.4% [2 trials]; median HbA1c diabetes = 7.1% [7 trials]).
CONCLUSIONS
Ginseng modestly yet significantly improved fasting blood glucose in people with and without diabetes. In order to address the uncertainty in our effect estimates and provide better assessments of ginseng's anti-diabetic efficacy, larger and longer randomized controlled trials using standardized ginseng preparations are warranted.
TRIAL REGISTRATION
ClinicalTrials.gov NCT01841229.
重要性
尽管人参在糖尿病管理中广泛使用，但其降血糖功效的支持证据有限，因此有必要基于证据对人参纳入糖尿病管理的可能性给出建议。
目的
通过对有糖尿病和无糖尿病患者的随机对照试验进行系统评价和荟萃分析，阐明人参对血糖控制的影响。
数据来源
MEDLINE、EMBASE、CINAHL和考克兰图书馆（截至2013年7月3日）。
研究选择
评估人参对有糖尿病和无糖尿病患者血糖影响的≥30天的随机对照试验。
数据提取
由2名独立评审员提取相关数据。分歧通过协商解决。分别使用海兰德方法学质量评分和考克兰偏倚风险工具评估研究质量和偏倚风险。
数据综合
纳入16项试验，其中报告了16项空腹血糖（n = 770）、10项空腹血浆胰岛素（n = 349）、9项糖化血红蛋白（n = 264）和7项胰岛素抵抗稳态模型评估（n = 305）的比较。与人参对照组相比，人参显著降低了空腹血糖（MD = -0.31 mmol/L [95% CI：-0.59至-0.03]，P = 0.03）。虽然对空腹血浆胰岛素、糖化血红蛋白或胰岛素抵抗稳态模型评估没有显著影响，但预先设定的亚组分析确实显示，与交叉试验相比，平行试验中的糖化血红蛋白显著降低（MD = 0.22% [95%CI：0.06至0.37]，P = 0.01）。
局限性
大多数试验持续时间较短（67%的试验<12周），且纳入的参与者血糖控制相对较好（非糖尿病患者糖化血红蛋白中位数 = 5.4% [2项试验]；糖尿病患者糖化血红蛋白中位数 = 7.1% [7项试验]）。
结论
人参在有糖尿病和无糖尿病患者中适度但显著地改善了空腹血糖。为了解决我们效应估计中的不确定性，并更好地评估人参的抗糖尿病功效，有必要开展使用标准化人参制剂的更大规模、更长时间的随机对照试验。
试验注册
ClinicalTrials.gov NCT01841229。
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