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.
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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)