Xing Ying, Li Penghui, Pang Guoming, Zhao Hui, Wen Tiancai
Institute of Information on Traditional Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China.
Traditional Chinese Medicine Data Center, China Academy of Chinese Medical Sciences, Beijing, China.
Front Pharmacol. 2024 Jul 19;15:1378140. doi: 10.3389/fphar.2024.1378140. eCollection 2024.
Within-day glycemic variability (GV), characterized by frequent and significant fluctuations in blood glucose levels, is a growing concern in hospitalized patients with type 2 diabetes mellitus (T2DM). It is associated with an increased risk of hypoglycemia and potentially higher long-term mortality rates. Robust clinical evidence is needed to determine whether traditional Chinese medicine (TCM) decoctions can be a beneficial addition to the management of within-day GV in this patient population.
This retrospective cohort study utilized data from adult inpatients diagnosed with T2DM admitted to the Traditional Chinese Medicine Hospital of Kaifeng. The primary outcome investigated was the association between the use of TCM decoctions and improved stability of within-day GV. Blood glucose variability was assessed using the standard deviation of blood glucose values (SDBG). For each patient, the total number of hospitalization days with SDBG below 2 mmol/L was calculated to represent within-day GV stability. Hospitalization duration served as the secondary outcome, compared between patients receiving TCM decoctions and those who did not. The primary analysis employed a multivariable logistic regression model, with propensity score matching to account for potential confounding variables.
A total of 1,360 patients were included in the final analysis. The use of TCM decoctions was significantly associated with enhanced stability of within-day GV (OR = 1.77, 95% CI: 1.34-2.33, < 0.01). This association was most prominent in patients with a diagnosis of deficiency syndrome (predominantly qi-yin deficiency, accounting for 74.8% of cases) and a disease duration of less than 5 years (OR = 2.28, 95% CI: 1.21-4.29, = 0.03). However, TCM decoctions did not exert a statistically significant effect on hospitalization duration among patients with T2DM (OR = 0.96, 95% CI: 0.91-1.01, = 0.22).
This study suggests that TCM decoctions may be effective in improving within-day GV stability in hospitalized patients with T2DM. This effect appears to be most pronounced in patients diagnosed with deficiency syndrome, particularly those with qi-yin deficiency and a shorter disease course. Further investigation is warranted to confirm these findings and elucidate the underlying mechanisms.
日内血糖变异性（GV），其特征为血糖水平频繁且显著波动，在2型糖尿病（T2DM）住院患者中日益受到关注。它与低血糖风险增加以及潜在更高的长期死亡率相关。需要有力的临床证据来确定中药汤剂是否能有益地辅助管理该患者群体的日内GV。
这项回顾性队列研究利用了开封市中医院收治的成年T2DM住院患者的数据。研究的主要结局是中药汤剂的使用与日内GV稳定性改善之间的关联。使用血糖值标准差（SDBG）评估血糖变异性。对于每位患者，计算SDBG低于2 mmol/L的住院天数总数以代表日内GV稳定性。住院时长作为次要结局，在接受中药汤剂治疗的患者与未接受治疗的患者之间进行比较。主要分析采用多变量逻辑回归模型，并进行倾向评分匹配以考虑潜在的混杂变量。
最终分析共纳入1360例患者。中药汤剂的使用与日内GV稳定性增强显著相关（OR = 1.77，95% CI：1.34 - 2.33，< 0.01）。这种关联在诊断为虚证（主要为气阴两虚，占病例的74.8%）且病程小于5年的患者中最为显著（OR = 2.28，95% CI：1.21 - 4.29， = 0.03）。然而，中药汤剂对T2DM患者的住院时长未产生统计学显著影响（OR = 0.96，95% CI：0.91 - 1.01， = 0.22）。
本研究表明，中药汤剂可能有效改善T2DM住院患者的日内GV稳定性。这种效果在诊断为虚证的患者中似乎最为明显，尤其是气阴两虚且病程较短的患者。有必要进行进一步研究以证实这些发现并阐明潜在机制。
