Abstract
Introduction Patients with type 2 diabetes are widely prescribed metformin for controlling blood glucose levels to avoid related comorbidities. In Taiwan, traditional Chinese medicine (TCM) is also commonly used, especially Liu Wei Di Huang Wan (LWDHW), which has been reported to delay the occurrence of kidney failure. However, the effect of combinational therapy of TCM and oral antidiabetic drugs is still unclear. This study aims to estimate their efficacy in delaying insulin use. Materials and Methods This case-control study was conducted using one million randomized samples from the National Health Insurance Research Database in Taiwan. The effects of TCM and LWDHW were estimated using the Cox proportional hazards model. Results In this study, 70,036 diabetic patients were enrolled; of them, 17,451 (24.9%) used insulin, while the rest (52,585, 75.1%) did not. TCM users had a lower risk for insulin use (HR: 0.58, 95% CI: 0.56–0.60). LWDHW users had a lower risk compared with patients who used other TCM (HR: 0.86, 95% CI: 0.82–0.90) and presented a dose-dependent effect. Conclusion The use of LWDHW and oral antidiabetic drugs is highly associated with the delay in the use of insulin. Clinical practitioners may take them into consideration when treating patients with type 2 diabetes.
Highlights
Patients with type 2 diabetes are widely prescribed metformin for controlling blood glucose levels to avoid related comorbidities
The gender ratios of insulin users and insulin nonusers were similar, while insulin users were older than insulin nonusers. e prevalence of comorbidities such as hypertension, coronary artery disease, heart failure, stroke, and chronic kidney disease was higher among insulin users, except that of hyperlipidemia
Compared with that of Chinese herbal products (CHPs) nonusers, the hazard ratio of patients who used CHPs including Liu Wei Di Huang Wan (LWDHW) was 0.52, while that of patients who used CHPs excluding LWDHW was 0.58
Summary
Type 2 diabetes is one of the most important noncommunicable diseases in the world. It poses a public health financial burden on the government because its related comorbidities are 2 to 4 times higher than cardiovascular risk [1]. Diabetes is a well-known complex disease; and many previous studies suggested that earlier multifactorial interventions for diabetic patients could reduce the risks of acute myocardial infarction, stroke, and death. Such is called the legacy effect of diabetic control [2, 3]. Despite the increasing prescription of TCM for type 2 diabetic patients in Taiwan, the long-term evidence of benefits from the combinational therapy of TCM and Western OADs is limited. Ere are two major medical systems in Taiwan: modern Western medicine and TCM Both have been practiced in Taiwan for centuries and both are covered by the health insurance system. E medicines and herbs in the database were coded with the number specified by the Ministry of Health and Welfare. e types of antidiabetic drugs were classified with Anatomical erapeutic Chemical Classification System (see Table 2). e study period began at the diagnosis of diabetes and ended at the first use of insulin, on December 31, 2012, for cases with no eventual use of insulin. e analysis was conducted using SAS 9.4 (SAS Institute, Cary, NC) with the hazard ratio and 95% confidence interval generated using the Cox proportional hazards model
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