Quality assessment of systematic reviews assessing the effects of traditional Chinese exercises in the control of diabetes mellitus

Abstract

To assess the quality of systematic reviews assessing the effects of traditional Chinese exercises on controlling blood indices, anthropometric indices, psychological indices, and quality of life in patients with diabetes. Systematic studies/meta-analyses of intervention with traditional Chinese exercises on diabetes mellitus were searched in the PubMed, Web of Science, the China National Knowledge Infrastructure Databases (CNKI), Wan Fang Database, and Chinese Scientific Journal Database (VIP). Two researchers independently screened the studies and extracted the data. The methodology and quality of evidence of the included studies were assessed using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, respectively. A total of 32 systematic reviews/meta-analyses were included in the present study. Of them, the methodological quality of 4 studies was graded as low, while that of the other 28 was graded as extremely low. The most common quality flaws in key items included a lack of preliminary proposals for systematic reviews, failure to explain the reasons for the inclusion criteria, failure to provide a list of excluded studies and reasons for exclusion, failure to report potential conflicts of interest, and inadequate assessment of publication bias. The quality of evidence for most of the 18 outcomes was subsequently graded as medium or low. Overall, the results of these studies indicated that Tai Chi, health qigong, and other traditional Chinese exercises lowered fasting blood glucose (FBG), 2-hour postprandial blood glucose (2hPBG), hemoglobin A1c (HbAlc), and body mass index, and relieved anxiety and depression in patients with diabetes. Our findings indicate that the methodological quality of systematic reviews related to traditional Chinese exercises in the diabetic population is generally low, and the quality of evidence is also relatively poor. Therefore, we suggest that the quality of systematic reviews and meta-analyses on traditional Chinese exercises for controlling diabetes mellitus needs to be improved. In the future, researchers should conduct higher-quality clinical studies with reference to the AMSTAR2 checklist and GRADE system.