Zhang Xiaolin, Cao Di, Yan Minhui, Liu Mingjun
College of Acupuncture and Massage, Changchun University of Chinese Medicine.
Department of rehabilitation, Changchun Hospital of Chinese Medicine.
Medicine (Baltimore). 2020 Aug 21;99(34):e21894. doi: 10.1097/MD.0000000000021894.
At present, metformin is mainly used in the treatment of type 2 diabetes mellitus (T2DM). When the therapeutic effect is achieved, there are side effects and secondary failure will occur if taken for a long time. It is of great significance to actively explore the clinical scheme of reducing drug use while ensuring the therapeutic effect of T2DM.
To evaluate the feasibility of Chinese massage (CM) in the treatment of T2DM.
Literature retrieval is divided into 2 aspects: Electronic Retrieval and Personal Check. We will search PubMed, EMBASE, CNKI, Cochrane Central, which were registered in international clinical trials registry platform systems, select all eligible studies published before November 2, 2019, and use Personal Check method to retrieve papers, conference papers, ongoing experiments, internal reports, and so on. With fasting blood glucose, 2-hour fasting blood glucose, glycosylated hemoglobin, and insulin index as the main observation indexes, we also pay attention to traditional Chinese medicine syndrome score scale, insulin resisting index, body mass index , serum total cholesterol, Curative effect and the occurrence of all adverse reactions in drug treatment.Of the research group 2 researchers respective selected literature, extracted data, and evaluated the risk of bias. After that we used Revman 5.7 and Stata 12.1 statistical software for meta-analysis.
A total of 769 subjects were included in 10 studies for meta-analysis. Compared with metformin hydrochloride tablets, CM plus baseline treatment can reduce fasting plasma glucose (weighted mean difference [WMD] = -0.33, 95% confidence interval [CI] [-0.54, -0.13], Z = 3.15, P = .002), 2 hours postprandial blood glucose (WMD = -0.52, 95% CI [-0.70, -0.34), Z = 5.66, P < .00001], hemoglobin A1c (WMD = 0.12, 95% CI [0.04, 0.20], Z = 2.94, P = .003), fasting insulin (WMD = -3.59, 95% CI [-5.56, -1.42], Z = 10.29,P < .00001), traditional Chinese medicine syndrome score scale (WMD = -4.55, 95% CI [-7.58, -1.51], Z = 2.94, P = .003),homeostasis model assessment of insulin resistance (WMD = -1.76, 95% CI [-2.25, -1.27), Z = 7.08, P < .00001),body mass index (WMD = -1.28, 95% CI [-1.65, -0.92], Z = 6.91, P < .00001), serum total cholesterol (WMD = -1.01, 95% CI [-1.14, -0.83], Z = 15.51, P < .00001), meanwhile, the effective rate was increased (risk ratio [RR] = 1.31, 95% CI [1.21, 1.42], Z = 6.57, P < .00001).
CM combined with metformin hydrochloride tablet has a synergistic effect. It can not only be used as an auxiliary treatment of T2DM, but also as an important reference way of reducing drug treatment of T2DM, improving Clinical Efficacy and reducing adverse reactions.
PROSPERO CRD42020158839.
目前，二甲双胍主要用于治疗2型糖尿病（T2DM）。在取得治疗效果的同时，存在副作用，长期服用会出现继发性失效。积极探索在保证T2DM治疗效果的同时减少用药的临床方案具有重要意义。
评估中医推拿（CM）治疗T2DM的可行性。
文献检索分为电子检索和人工检索两方面。检索PubMed、EMBASE、中国知网、考克兰中心注册于国际临床试验注册平台系统的所有符合条件的研究，选择2019年11月2日前发表的文献，并采用人工检索方法检索论文、会议论文、正在进行的实验、内部报告等。以空腹血糖、餐后2小时血糖、糖化血红蛋白和胰岛素指数作为主要观察指标，同时关注中医证候评分量表、胰岛素抵抗指数、体重指数、血清总胆固醇、疗效及药物治疗中所有不良反应的发生情况。研究组2名研究人员分别筛选文献、提取数据并评估偏倚风险。之后使用Revman 5.7和Stata 12.1统计软件进行Meta分析。
10项研究共纳入769例受试者进行Meta分析。与盐酸二甲双胍片相比，CM联合基础治疗可降低空腹血糖（加权均数差[WMD] = -0.33，95%置信区间[CI][-0.54，-0.13]，Z = 3.15，P = 0.002）、餐后2小时血糖（WMD = -0.52，95%CI[-0.70，-0.34]，Z = 5.66，P < 0.00001）、糖化血红蛋白（WMD = -0.12，95%CI[0.04，0.20]，Z = 2.94，P = 0.003）、空腹胰岛素（WMD = -3.59，95%CI[-5.56，-1.42]，Z = 10.29，P < 0.00001）、中医证候评分量表（WMD = -4.55，95%CI[-7.58，-1.51]，Z = 2.94，P = 0.003）、胰岛素抵抗稳态模型评估（WMD = -1.76，95%CI[-2.25，-1.27]，Z = 7.08，P < 0.00001）、体重指数（WMD = -1.28，95%CI[-1.65，-0.92]，Z = 6.91，P < 0.00001）、血清总胆固醇（WMD = -1.01，95%CI[-1.14，-0.83]，Z = 15.51，P < 0.00001），同时有效率提高（风险比[RR] = 1.31，95%CI[1.21，1.42]，Z = 6.57，P < 0.00001）。
CM联合盐酸二甲双胍片具有协同作用。它不仅可作为T2DM的辅助治疗方法，还可作为减少T2DM药物治疗、提高临床疗效及降低不良反应的重要参考途径。
PROSPERO CRD42020158839。
