Prevention of Type 2 Diabetes with the Chinese Herbal Medicine Tianqi Capsule: A Systematic Review and Meta-Analysis

Diabetes Therapy, Oct 2017

Introduction Prevention of the rapid growth in incidence of type 2 diabetes (T2DM) is a big challenge for clinicians. In China, many trials have indicated that Tianqi capsule, which contains several Chinese herbal medicines as part of a large healing system called traditional Chinese medicine, could decrease the incidence of T2DM. The review assessed the effectiveness of Tianqi capsule in prevention of T2DM. Methods Seven electronic databases were searched to identify eligible trials published from the inception of the databases up until May 1, 2017. Randomized controlled trials (RCTs) of Tianqi capsule for impaired glucose tolerance (IGT) were included. Data extraction and quality assessment were performed according to the Cochrane review standards. A random or a fixed effect model was used to analyze outcomes which were expressed as risk ratios (RRs) or mean differences (MD), and I 2 statistics were used to assess heterogeneity. Results Six trials were identified that included 1027 subjects. Meta-analysis showed that subjects who received Tianqi capsule plus lifestyle modification (LM) were less likely to progress to T2DM compared to controls (RR 0.55, 95% CI 0.44–0.68). Subjects who received Tianqi capsule plus LM were more likely to have glucose return to normal compared to controls (RR 0.69; 95% CI 0.62–0.78); and they had reduced fasting plasma glucose (FBG) (MD − 0.35; 95% CI − 0.55 to − 0.16) and 2-h plasma glucose (2 h PG) (MD − 1.04; 95% CI − 1.75 to − 0.32). There was no statistical difference between the two groups for IGT stabilized incidence (RR 0.89; 95% CI 0.71–1.12). No obvious adverse events occurred. Conclusion In patients with IGT, Tianqi capsule reduced the risk of progression to T2DM and increased the possibility of regression toward normoglycemia. As a result of the limited number of RCTs and the methodological drawbacks of the included studies, the results should be interpreted with caution.

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Prevention of Type 2 Diabetes with the Chinese Herbal Medicine Tianqi Capsule: A Systematic Review and Meta-Analysis

Prevention of Type 2 Diabetes with the Chinese Herbal Medicine Tianqi Capsule: A Systematic Review and Meta-Analysis Feng-mei Lian . Xiao-lin Tong 0 1 2 0 J. Liu Sinobioway Group Co., Ltd., Heilongjiang Tian Ren Pharmaceutical Co., Ltd. , Beijing , China 1 Y. Zhang Centre for Evidence-Based Chinese Medicine, Beijing University of Traditional Chinese Medicine , Beijing , China 2 B. Pang L. He Y. Zheng F. Lian (&) X. Tong (&) Department of Endocrinology, Guang' anmen Hospital of China Academy of Chinese Medical Sciences , Beijing , China Introduction: Prevention of the rapid growth in incidence of type 2 diabetes (T2DM) is a big challenge for clinicians. In China, many trials have indicated that Tianqi capsule, which contains several Chinese herbal medicines as part of a large healing system called traditional Chinese medicine, could decrease the incidence of T2DM. The review assessed the effectiveness of Tianqi capsule in prevention of T2DM. - Methods: Seven electronic databases were searched to identify eligible trials published from the inception of the databases up until May 1, 2017. Randomized controlled trials (RCTs) of Tianqi capsule for impaired glucose tolerance (IGT) were included. Data extraction and quality assessment were performed according to the Cochrane review standards. A random or a fixed effect model was used to analyze outcomes which were expressed as risk ratios (RRs) or mean differences (MD), and I2 statistics were used to assess heterogeneity. Results: Six trials were identified that included 1027 subjects. Meta-analysis showed that subjects who received Tianqi capsule plus lifestyle modification (LM) were less likely to progress to T2DM compared to controls (RR 0.55, 95% CI 0.44–0.68). Subjects who received Tianqi capsule plus LM were more likely to have glucose return to normal compared to controls (RR 0.69; 95% CI 0.62–0.78); and they had reduced fasting plasma glucose (FBG) (MD - 0.35; 95% CI - 0.55 to - 0.16) and 2-h plasma glucose (2 h PG) (MD - 1.04; 95% CI - 1.75 to - 0.32). There was no statistical difference between the two groups for IGT stabilized incidence (RR 0.89; 95% CI 0.71–1.12). No obvious adverse events occurred. Conclusion: In patients with IGT, Tianqi capsule reduced the risk of progression to T2DM and increased the possibility of regression toward normoglycemia. As a result of the limited number of RCTs and the methodological drawbacks of the included studies, the results should be interpreted with caution. INTRODUCTION Prediabetes was defined in 2015 by the American Diabetes Association (ADA) as including impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), or mild elevation of hemoglobin A1c (HbA1c) in the 5.7–6.4% range, and indicated an increased risk of progression to diabetes and the development of cardiovascular events [ 1 ]. The prevalence of prediabetes is 50.1%, accounting for a total of 493.4 million people in China [2], and 70.7% of those with prediabetes had IGT [3] and form an important high-risk target group for intervention aimed at preventing T2DM [4, 5]. Current guidelines recommend that IGT patients undergo lifestyle modifications, which have been shown to be effective for reducing the incidence of T2DM [6–8]. However, it is not easy to maintain rigorous and sustained lifestyle intervention for the long term. Metformin is commonly used to treat prediabetes and acarbose use is restricted to specific countries, but neither is formally approved for this indication, while other oral anti-diabetic drugs and anti-obesity drugs are also not currently recommended for diabetes prevention, although randomized controlled trials (RCTs) have shown effectiveness [9, 10]. Chinese herbs have been applied to treat diabetes, and a few are suggested to be modestly useful. For instance, Tianqi capsule is reported to decrease hemoglobin A1c and blood glucose [ 11–14 ]. It consists of Radix Astragali (Huang Qi), Radix Trichosanthis (Tian Hua Fen), Rhizoma Coptidis (Huang Lian), Radix et Rhizoma Ginseng (Ren Shen), Caulis Dendrobii (Shi Hu), Herba Ecliptae (Mo Han Lian), Cortex Lycii (Di Gu Pi), Fructus Ligustri Lucidi (Nv Zen Zi), and Fructus Corni (Shan Zhu Yu). Clinical studies and animal experiments have also demonstrated that Tianqi capsule could reduce the risk of T2DM and increased the regression towards normoglycemia, but systematic evidence is lacking. We performed a systematic review and meta-analysis to assess the efficacy and safety of Tianqi capsule in preventing T2DM. METHODS The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO registration no. CRD 42017068571: http://www.crd.york.ac.uk/ PROSPERO/myprospero.php). This article was written using PRISMA reporting guidelines and was based on previously conducted studies. These data do not include any new human or animal studies performed by the authors. Search Strategy The systematic review and meta-analysis was perfo (...truncated)


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Bing Pang, Ying Zhang, Jing Liu, Li-sha He, Yu-jiao Zheng, Feng-mei Lian, Xiao-lin Tong. Prevention of Type 2 Diabetes with the Chinese Herbal Medicine Tianqi Capsule: A Systematic Review and Meta-Analysis, Diabetes Therapy, 2017, pp. 1-16, DOI: 10.1007/s13300-017-0316-x