Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China; Section II of Endocrinology & Nephropathy Department of Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China.
Section II of Endocrinology & Nephropathy Department of Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China.
Diabetes Res Clin Pract. 2022 Jun;188:109878. doi: 10.1016/j.diabres.2022.109878. Epub 2022 Apr 26.
To evaluate the efficacy of 6 Traditional Chinese patent medicines combined with lifestyle modification in the treatment of prediabetes with network meta-analysis.
The randomized controlled trials (RCTs) of Shen qi jiang tang capsule/granule (Shenqi), Tian mai xiao ke tablet (Tianmai), Tian qi capsule (Tianqi), Jin qi jiang tang tablet (Jinqi), Jin li da granule (Jinlida), Tang mai kang granule (Tangmaikang) in the treatment of prediabetes in PubMed, Web of Science, The Cochrane Library, EMbase, China Knowledge Network (CNKI), WanFang and Weipu databases were searched. Three reviewers independently conducted the screening, extracted the data and assessed methodological quality. Data analysis was performed using Rev Man 5.3 and STATA 15.0 software.
A total of 50 RCTs, including 4594 patients, were included. The addition of Shenqi (OR 0.19 [95 %CI: 0.07, 0.52]) and Jinqi (OR 0.32 [95 %CI: 0.15, 0.71]) to existing lifestyle modification resulted in significant lower incidence rate of DM compared with none/placebo added to lifestyle modification. The addition of Jinlida (SMD -0.41% [95 %CI:-0.81, -0.01]) and Tangmaikang (SMD -0.83%[95 %CI: -1.46,-0.20]) resulted in significant additional HbA1c reductions compared with none/placebo added to lifestyle modification. The addition of all CTPMs except Tianqi resulted in significant additional FBG reductions and the addition of Shenqi (SMD -1.96[95 %CI: -3.64, -0.28]) resulted in significant additional PBG reductions.
For patients with prediabetes, Shenqi + LM was among the most effective in reducing the incidence of diabetes for patients with prediabetes, while Jinlida + LM was among the least effective. Jinqi + LM and Tianqi + LM might be among the most effective, while western oral drugs + LM, Tianmai + LM, Tangmaikang + LM and Placebo + LM might be among the least effective. In addition, Tangmaikang + LM and Jinlida + LM might be among the most effective in reducing HbA1c, while Tianmai + LM, Tangmaikang + LM, Shenqi + LM, Jinlida + LM and Jinqi + LM might be among the most effective in reducing FPG for patients with prediabetes. Yet direct comparison and further investigation to explore mechanisms are warranted.
采用网状Meta 分析评价 6 种中成药联合生活方式干预治疗糖尿病前期的疗效。
计算机检索 PubMed、Web of Science、The Cochrane Library、EMbase、中国知网（CNKI）、万方和维普数据库中关于参芪降糖胶囊/颗粒（参芪）、天麦消渴片（天麦）、天芪降糖胶囊（天芪）、津力达颗粒（津力达）、金芪降糖胶囊（金芪）、糖脉康颗粒（糖脉康）治疗糖尿病前期的随机对照试验（RCT），由 3 位评价员独立筛选文献、提取资料并评价纳入研究的方法学质量后，采用 RevMan 5.3 和 STATA 15.0 软件进行数据分析。
共纳入 50 项 RCT，包含 4594 例患者。与生活方式干预相比，联合参芪（OR=0.19，95%CI：0.07，0.52）和津力达（OR=0.32，95%CI：0.15，0.71）可显著降低糖尿病的发生率；与生活方式干预相比，联合金芪（SMD=-0.41%，95%CI：-0.81，-0.01）和糖脉康（SMD=-0.83%，95%CI：-1.46，-0.20）可显著降低糖化血红蛋白（HbA1c）水平；除天芪外，其余 CTPM 联合生活方式干预均能显著降低空腹血糖（FBG）水平，联合参芪可显著降低餐后 2 小时血糖（PBG）水平（SMD=-1.96，95%CI：-3.64，-0.28）。
对于糖尿病前期患者，参芪联合生活方式干预在降低糖尿病发生率方面可能是最有效的，而金芪联合生活方式干预的效果可能最差。天芪联合生活方式干预、津力达联合生活方式干预可能是最有效的，而西药联合生活方式干预、天麦联合生活方式干预、糖脉康联合生活方式干预、安慰剂联合生活方式干预可能是最无效的。此外，糖脉康联合生活方式干预和金芪联合生活方式干预可能是降低 HbA1c 水平最有效的，而天麦联合生活方式干预、糖脉康联合生活方式干预、参芪联合生活方式干预、津力达联合生活方式干预和金芪联合生活方式干预可能是降低 FPG 水平最有效的。然而，仍需要进行直接比较和进一步的机制探讨。
