Abstract

Background: Type 2 diabetes mellitus (T2DM) complicated with dyslipidaemia is associated with a high risk of cardiovascular diseases. The Jiangtang Tiaozhi (JTTZ) recipe is a Chinese herbal formula that has been used to regulate the blood glucose and lipid levels for many years. Interestingly, a previous study has demonstrated its efficacy; however, the associated mechanism remains unclear. We hypothesised that the therapeutic effect of the JTTZ on patients with T2DM may be mediated by the modulation of metabolites secreted by the gut microbiota. This study aims to examine this mechanism. Methods and analysis: This study is a randomised, positive drug parallel-controlled, open-label clinical trial in patients with T2DM and dyslipidaemia. A total of 96 patients will be recruited and randomly assigned to treatment with JTTZ or metformin for 12 weeks. The primary outcome will be the rates of effectively regulated blood glucose and lipid levels (measured with the levels of glycated haemoglobin, fasting plasma glucose, 2-h plasma glucose, triglyceride, and low-density lipoprotein cholesterol). The secondary outcomes will be the changes in body weight, body mass index, and waist circumference and Traditional Chinese Medicine symptom scores. In addition, 16S rRNA gene sequencing will be performed on the gut microbiota obtained from faeces, and metabolomics analysis will be performed based on blood and gut microbiota samples. Intention-to-treat, per-protocol analysis and safety analysis will be performed. Clinical trial registration number: https://clinicaltrials.gov/ct2/show/NCT04623567

Highlights

  • Type 2 diabetes mellitus (T2DM) complicated with dyslipidaemia is associated with a high risk of cardiovascular diseases

  • This study aims to include 96 patients with T2DM and dyslipidaemia

  • Metabolomic analysis of the intestinal microorganisms may partially reveal the mechanism of the Jiangtang Tiaozhi (JTTZ) recipe action on the intestinal microorganisms, blood glucose, and lipid metabolism

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Summary

Introduction

Type 2 diabetes mellitus (T2DM) complicated with dyslipidaemia is associated with a high risk of cardiovascular diseases. A previous study has demonstrated its efficacy; the associated mechanism remains unclear. Type 2 diabetes mellitus (T2DM) and dyslipidaemia are associated with an increased cardiovascular disease (CVD) risk. The prevalence of T2DM and dyslipidaemia are estimated to be 11.2% (Li et al, 2020) and 34% (Pan et al, 2016) in China, respectively. Statin use is the first-line approach to lowdensity lipoprotein cholesterol (LDL-C) level lowering and cardioprotection prescribed in addition to lifestyle interventions and glycaemic control in patients with T2DM complicated with dyslipidaemia. Metformin is the first-line pharmacologic treatment for T2DM (American Diabetes Association, 2019); a growing body of evidence supports its performance in antiatherosclerosis and CVD risk reduction among T2DM patients. Metformin may activate adenosine 5‘-monophosphate -activated protein kinase and reduce the LDL-C levels. (Xu et al, 2015a)

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