Chinese herbal medicines for people with impaired glucose tolerance or impaired fasting blood glucose.
Chinese herbal medicines for people with impaired glucose tolerance or impaired fasting blood glucose.
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DOI：
10.1002/14651858.cd006690.pub2
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发表时间：
2009-10-07
影响因子：
8.4
通讯作者：
Li, Xun
中科院分区：
文献类型：
--
作者：
Grant, Suzanne J.;Bensoussan, Alan;Chang, Dennis;Kiat, Hosen;Klupp, Nerida L.;Liu, Jian Ping;Li, Xun
据估计，全球约有3.08亿人患有糖耐量受损（IGT）;其中25%至75%将在最初诊断后的十年内发展为糖尿病。在诊断时，一半人会有组织相关的损伤，所有人患冠心病的风险都会增加。本综述的目的是评估中草药治疗糖耐量受损或空腹血糖受损（IFG）的疗效和安全性。我们检索了以下数据库：科克伦图书馆、PubMed、EMBASE、AMED、一系列中文数据库、SIGLE和正在进行的试验数据库。随机临床试验比较中草药与安慰剂，没有治疗，药物或非药物干预IGT或IFG的人被认为。两位作者独立提取数据。根据关键标准评估试验的偏倚风险：随机序列生成、分配隐藏、受试者盲法、结局评估者和干预提供者、结局数据不完整、选择性结局报告和其他偏倚来源。本综述分析了16项试验，持续4周至2年，涉及1391名参与者，他们接受了15种不同的中草药，进行了8种不同的比较。没有试验报告死亡率、发病率或费用。未观察到严重不良事件，如重度低血糖。8项试验的荟萃分析显示，接受中草药结合生活方式改变的患者空腹血糖水平恢复正常的可能性是接受中草药治疗的患者的两倍多（即空腹血糖<7.8 mmol/L和2小时血糖<11.1 mmol/L）与单独改变生活方式相比（RR 2.07; 95%置信区间（CI）1.52至2.82）。在试验期间，接受中药治疗的患者不太可能进展为糖尿病（RR 0.33; 95%CI 0.19至0.58）。然而，所有的试验都有相当大的偏倚风险，并且没有一个特定的草药比较数据来自一项以上的研究。此外，结果可能受到正常葡萄糖水平自然恢复率的混淆。支持中草药治疗IGT或IFG的积极证据受到以下因素的限制：缺乏测试相同草药的试验，缺乏联合干预措施的细节，随机化方法不明确，报告不佳和其他偏倚风险。
Around 308 million people worldwide are estimated to have impaired glucose tolerance (IGT); 25% to 75% of these will develop diabetes within a decade of initial diagnosis. At diagnosis, half will have tissue-related damage and all have an increased risk for coronary heart disease. The objective of this review was to assess the effects and safety of Chinese herbal medicines for the treatment of people with impaired glucose tolerance or impaired fasting glucose (IFG). We searched the following databases: The Cochrane Library, PubMed, EMBASE, AMED, a range of Chinese language databases, SIGLE and databases of ongoing trials. Randomised clinical trials comparing Chinese herbal medicines with placebo, no treatment, pharmacological or non-pharmacological interventions in people with IGT or IFG were considered. Two authors independently extracted data. Trials were assessed for risk of bias against key criteria: random sequence generation, allocation concealment, blinding of participants, outcome assessors and intervention providers, incomplete outcome data, selective outcome reporting and other sources of bias. This review examined 16 trials lasting four weeks to two years involving 1391 participants receiving 15 different Chinese herbal medicines in eight different comparisons. No trial reported on mortality, morbidity or costs. No serious adverse events like severe hypoglycaemia were observed. Meta-analysis of eight trials showed that those receiving Chinese herbal medicines combined with lifestyle modification were more than twice as likely to have their fasting plasma glucose levels return to normal levels (i.e. fasting plasma glucose <7.8 mmol/L and 2hr blood glucose <11.1 mmol/L) compared to lifestyle modification alone (RR 2.07; 95% confidence intervall (CI) 1.52 to 2.82). Those receiving Chinese herbs were less likely to progress to diabetes over the duration of the trial (RR 0.33; 95% CI 0.19 to 0.58). However, all trials had a considerable risk of bias and none of the specific herbal medicines comparison data was available from more than one study. Moreover, results could have been confounded by rates of natural reversion to normal glucose levels. The positive evidence in favour of Chinese herbal medicines for the treatment of IGT or IFG is constrained by the following factors: lack of trials that tested the same herbal medicine, lack of details on co-interventions, unclear methods of randomisation, poor reporting and other risks of bias.