The efficacy and safety of dachaihu decoction in the treatment of type 2 diabetes mellitus: A systematic review and meta-analysis

Abstract

Background: Type 2 diabetes mellitus (T2DM) is a clinical metabolic syndrome characterized by persistent hyperglycemia, which is caused by defective insulin secretion and decreased function in regulating glucose metabolism. Dachaihu Decoction (DCHD) is a traditional Chinese medicine formula that has been gradually used in T2DM treatment. A comprehensive analysis on the efficacy and safety of DCHD in T2DM treatment is necessary. Objective: This meta-analysis aimed to systematically assess the clinical efficacy and safety of DCHD in the T2DM treatment and provide a reference for subsequent research and clinical practice. Methods: Both Chinese and English databases were searched from their inceptions to November 2021. All retrieved studies were screened according to inclusion and exclusion criteria and randomized controlled trials about DCHD on T2DM were enrolled. The quality of the literature was assessed using the bias risk assessment tool in the Cochrane Handbook. Data extraction was performed on the selected studies. Review Manager 5.4 and Stata 16.0 were used for meta-analysis. Sources of heterogeneity were also explored by using meta-regression and subgroup analysis. Funnel plot and Egger's test were used to assess publication bias and the evidence quality was assessed by GRADE. Results: 17 eligible studies, involving 1,525 patients, were included in this study. Compared with conventional treatment, combined treatment with DCHD was significantly better in improving HbA1c (MD = -0.90%, 95%CI: -1.20 to -0.60, p < 0.01), FBG (MD = -1.08 mmol/L, 95%CI: -1.28 to -0.87, p < 0.01), 2hPG (MD = -1.25 mmol/L, 95%CI: -1.42 to -1.09, p < 0.01), TC (MD = -0.50 mmol/L, 95%CI: -0.70 to -0.30, p < 0.01), TG (MD = -0.44 mmol/L, 95%CI: -0.61 to -0.26, p < 0.01), LDL-C (MD = -0.58 mmol/L, 95%CI: -0.85 to -0.31, p < 0.01), HOMA-IR (SMD = -2.04, 95%CI: -3.09 to -0.99, p < 0.01), HOMA-β (SMD = 2.48, 95%CI: 2.20 to 2.76, p < 0.01) and BMI (MD = -1.52 kg/m², 95%CI: -2.55 to -0.49, p < 0.01). When DCHD used alone, it had a similar efficacy to conventional treatment in HbA1c (MD = -0.04%, 95%CI: -0.17 to 0.09, p = 0.57) and FBG (MD = 0.13 mmol/L, 95%CI: -0.09 to 0.36, p = 0.24). It can also reduce 2hPG, even if not as effective as conventional treatment (MD = 0.54 mmol/L, 95%CI: 0.19 to 0.89, p < 0.01). Due to the small number of included studies, it is unclear whether DCHD used alone has an improving effect on lipid metabolism, BMI, HOMA-IR and HOMA-β. Analysis of adverse events showed DCHD was relatively safe. No obvious publication bias was detected by Funnel plot and Egger's test. Conclusion: Based on this meta-analysis, we found that the combination with DCHD in the T2DM treatment has more advantages than conventional treatment alone, which can further regulate the glucose and lipid metabolism, reduce insulin resistance, improve islet function and lower BMI. DCHD alone also plays a certain role in regulating glucose. Meanwhile, DCHD is relatively safe. However, limited by the quality and quantity of included studies, the efficacy and safety of DCHD remain uncertain. More high-quality studies are still needed to provide more reliable evidence for the clinical application of DCHD. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021296718, identifier CRD42021296718.

Keywords: dachaihu decoction; meta-analysis; systematic review; traditional Chinese medicine; type 2 diabetes mellitus.

FIGURE 1

Flowchart of study selection and identification.

FIGURE 2

Risk of bias assessment for included studies: (A) Risk of bias graph. (B) Risk of bias summary.

FIGURE 3

Forest plot of the HbA1c: (A) DCHD combined with conventional treatment vs. conventional treatment; (B) DCHD vs. conventional treatment.

FIGURE 4

Meta-regression of the HbA1c for DCHD combined with conventional treatment vs. conventional treatment: (A) Average age; (B) Sample size; (C) Publication year.

FIGURE 5

Sensitivity analysis: DCHD combined with conventional treatment vs. Conventional treatment: (A) HbA1c; (C) FBG; (E) 2hPG; (G) TC; (H) TG; (I) HOMA-IR; (J) HOMA-β; (K) BMI. DCHD vs. Conventional treatment: (B) HbA1c; (D) FBG; (F) 2hPG.

FIGURE 6

Forest plot of the FBG: (A) DCHD combined with conventional treatment vs. conventional treatment; (B) DCHD vs. conventional treatment.

FIGURE 7

Meta-regression of the FBG for DCHD combined with conventional treatment vs. conventional treatment: (A) Average age; (B) Sample size; (C) Publication year.

FIGURE 8

Forest plot of the 2hPG: (A) DCHD combined with conventional treatment vs. conventional treatment; (B) DCHD vs. conventional treatment.

FIGURE 9

Forest plot of the lipid metabolism index: (A) TC: DCHD combined with conventional treatment vs. conventional treatment; (B) TC: DCHD vs. conventional treatment; (C) TG: DCHD combined with conventional treatment vs. conventional treatment; (D) TG: DCHD vs. conventional treatment; (E) HDL-C: DCHD vs. conventional treatment; (F) LDL-C: DCHD combined with conventional treatment vs. conventional treatment; (G) LDL-C: DCHD vs. conventional treatment.

FIGURE 10

Forest plot of the HOMA-IR, HOMA-β and BMI: (A) HOMA-IR: DCHD combined with conventional treatment vs. conventional treatment; (B) HOMA-β: DCHD combined with conventional treatment vs. conventional treatment; (C) BMI: DCHD combined with conventional treatment vs. conventional treatment; (D) BMI: DCHD vs. conventional treatment.

FIGURE 11

Forest plot of the adverse events: (A) liver function; (B) incidence of adverse events.

FIGURE 12

Publication bias of HBA1c, FBG and 2hPG: (A) Funnel plot of HBA1c; (B) Egger’s test of HBA1c; (C) Funnel plot of FBG; (D) Egger’s test of FBG; (E) Funnel plot of 2hPG; (F) Egger’s test of 2hPG.