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Kineski biljni lijekovi za osobe s poremećenom tolerancijom glukoze ili poremećenom razinom glukoze natašte

Abstract

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Background

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.

Objectives

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).

Search methods

We searched the following databases: The Cochrane Library, PubMed, EMBASE, AMED, a range of Chinese language databases, SIGLE and databases of ongoing trials.

Selection criteria

Randomised clinical trials comparing Chinese herbal medicines with placebo, no treatment, pharmacological or non‐pharmacological interventions in people with IGT or IFG were considered.

Data collection and analysis

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.

Main results

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.

Authors' conclusions

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.

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Plain language summary

Kineski biljni lijekovi za osobe s poremećenom tolerancijom glukoze ili poremećenom razinom glukoze natašte

Gotovo 308 milijuna ljudi širom svijeta ima "poremećenu toleranciju glukoze". Te osobe imaju višu razinu glukoze u krvi od uobičajene, ali ne zadovoljavaju dijagnostičke kriterije za dijabetes tipa 1 ili 2. Taj poremećaj mogao bi predstavljati priliku da se spriječi ili odgodi nastanak dijabetesa i komplikacija povezanih s dijabetesom kao što su srčano‐žilne bolesti. Procjenjuje se da će unutar deset godina od postavljanja dijagnoze "poremećene tolerancije glukoze" 25‐75% osoba razviti dijabetes.

Ovaj Cochrane sustavni pregled analizirao je 16 randomiziranih kontroliranih pokusa u kojima je ispitano 15 različitih kineskih biljnih lijekova. Studije su trajale od 4 tjedna do 2 godine (prosječno 9 mjeseci) i ukupno su uključile 1391 ispitanika. Smrt od bilo kojeg uzroka, dijabetičke komplikacije i troškovi terapije nisu istraživani u tim pokusima. Nisu zabilježene ozbiljne nuspojave.

Dostupni dokazi pokazuju da kineski biljni lijekovi mogu sniziti i normalizirati glukozu u krvi. Zbog niza pristranosti u pronađenim pokusima potrebna su daljnja visoko‐kvalitetna i rigorozno provedena istraživanja prije nego se mogu donijeti čvrsti zaključci o učinku kineskih biljnih lijekova na poremećenu toleranciju glukoze i odgodu nastanka dijabetesa.