1997-2008 年間的台灣糖尿病患者服用中藥相關性研究台灣健保資料庫之分析

Abstract

Objective：Type 2 diabetes is becoming a pandemic disorder and its alarming increase in prevalence of either microvascular or macrovascular disease raises significant concerns. As the same in Taiwan, type 2 diabetes mellitus (DM) is one of the most prevalent and fastest growing diseases. Traditional Chinese medicine (TCM) as a unique traditional therapy for various ailments has been used in Taiwan for over hundreds of years. The consumption of Chinese herbal products (CHPs) is increasing exponentially in Taiwan. However, the scientific evidence is lacking and there is an urgent requirement for detailed pharmacoepidemiological information on CHP usage. The aim of the study is to explore the demographics and utilization patterns between Chinese herbal products (CHPs) users and non-users among people with diabetes and to determine how frequent the concurrent use of hypoglycemic drugs with CHPs on a nationwide level in real practice. We believe that this study provides evidence-based information for formulating appropriate management strategies of drug safety and integrative medicine. Methods：The usage, frequency of services, and CHP prescribed among diabetic patients using hypoglycemic drugs were evaluated, recruited from a randomly sampled cohort of 1,000,000 beneficiaries from the National Health Insurance Research Database. The logistic regression method was employed to estimate the odds ratios (ORs) for the co-prescription of a CHP and hypoglycemic drugs. In addition, to investigate the incidence rate of consuming traditional Chinese medicine among diabetic patients with newly diagnosed end-stage renal disease (ESRD) from 1998 to 2008 in Taiwan. Result: 77.9 percent (n = 31,289) of diabetic patients utilized traditional Chinese medicine (TCM) during the 11-year study period. Most type 2 diabetic patients also received western medicine (WM) treatment, and only 8.4 percent (n = 3,370 ) never used WM. Females, regular salary earners, and living in Central and Kaohsiung city were more likely to consume CHPs and hypoglycemic drugs concurrently. Among concurrent users, “symptoms, signs, and ill-defined conditions” (612,380 visits) was the most frequent major disease category for concurrent use hypoglycemic drugs and CHPs. Most type 2 diabetes diabetes patients took two hypoglycaemic agents (n = 13,609, 33.9％) in WM treatment. Metformin plus Sulfonylureas (n = 11,636, 29.0％) and Liu-Wei-Di-Huang-Wan were the most prescribed hypoglycemic drugs and Chinese formula, respectively. In comparison with control group, there was a lower incidence rate (ESRDs/ 1,000 person-years) of the traditional Chinese medicine users (TCM nonusers, n = 14.5, male, n = 15.6, female, n = 12.6; TCM users, n = 3.9, male, n = 5.0, female, n = 2.8). Discussion: the utilization of TCM among adults with type 2 diabetes in Taiwan during the study period appeared to be high compared with previous findings. TCM as a unique traditional therapy for various ailments which has been used in Taiwan for over hundreds of years may be the main contributor to the high prevalence of TCM usage among type 2 diabetic subjects. Moreover, TCM treatment has been covered by the NHI system. Unsurprisingly, the prevalence of CHP for treating type 2 diabetes among adults is comparatively higher in Taiwan than in other countries. However, we inferred that TCM for type 2 diabetes in Taiwan was generally used as adjuncts to diabetes treatment, rather than as replacements for it. Further analysis found that TCM doctors tended to use Chinese herbal medicine (CHMs) to deal with diabetes and gastrointestinal disorders which might be the uncomfortable side effects of diabetes drugs. And the present study indicated that acupuncture in Taiwan was used by this population mainly for diseases of the musculoskeletal system and connective tissue (Diseases of the musculoskeletal system and connective tissue ICD-9 code 710-739). In comparison with control group, utilization of traditional Chinese medicine had the protective effect and lowing inducing diabetic nephropathy, but the active components need to be determined accurately. Conclusions：During the 11-year study period, 77.9 percent of type 2 diabetic patients utilized traditional Chinese medicine (TCM), and only 8.4 percent never used WM in Taiwan. Hence, we inferred that TCM for type 2 diabetes in Taiwan was generally used as adjuncts to diabetes treatment, rather than as replacements for it. Liu-Wei-Di-Huang-Wan and its derivatives are the most frequent prescribed formulas by TCM doctors in Taiwan for type 2 diabetic patients. Utilization of traditional Chinese medicine had the protective effect and lowing inducing diabetic nephropathy (incidence rate: TCM nonusers, n = 14.5; TCM users, n = 3.9). Although some evidence does support the use TCM to treat diabetes, the results from the current study could have been confounded by placebo effect, emphasizing the need for well conducted, double-blind, randomized, placebo-controlled studies to further evaluate the efficacy of TCM on patients with type 2 diabetes.