Effectiveness and safety of traditional Chinese medicine decoction for diabetic gastroparesis: A network meta-analysis

Abstract

BACKGROUND Diabetic gastroparesis (DGP) is a prevalent complication of diabetes that impairs people's quality of life and places a significant financial burden on them. The gastrointestinal symptoms of DGP patients can be improved by several Traditional Chinese Medicine (TCM) decoctions that have been shown to be effective in treating the disease. There are still many unanswered questions regarding the identification of appropriate therapeutic agents for the treatment of DGP in clinical practice. AIM To analyze the efficacy of several TCM decoctions in the treatment of DGP using Bayesian network meta-analysis for reference. METHODS PubMed, EMBASE, Cochrane Library, Web of Science, China National Kno-wledge Infrastructure, The China Biology Medicine DVD, Wanfang, and CQVIP were searched from inception to September 17, 2022, to collect randomized controlled trials (RCTs) about TCM decoctions for DGP. Clinical effects and symptom scores were the primary outcomes. Additionally, we assessed motilin (MOT), somatostatin (SS), gastrin (GAS), gastric emptying rate, gastric emptying time, and adverse drug events as secondary outcomes. RESULTS A total of 67 eligible RCTs involving 4790 DGP patients and 7 TCM decoctions were included. The results of network meta-analysis (NMA) and surface under the cumulative ranking curve showed that with western medicine (WM) as a common control, the Banxia Xiexin Decoction (BXXD) + WM was most effective in clinical effects and enhancing early satiety scores; the Simo decoction (SMD) + WM was most effective in improving nausea and vomiting scores and anorexia scores, bloating scores; the Chaishao Liujunzi Decoction (CSLJD) was most effective in MOT, the Zhishi Xiaopi Decoction (ZSXPD) was most effective in SS and upgrading emptying rate; the Jianpi Xiaozhi Decoction was most effective in GAS; the CSLJD + WM was most effective in improving gastric emptying time. CONCLUSION These NMA results suggest that the BXXD + WM and SMD + WM may be one of the potential optimal treatments. Due to various limitations, further large-sample, double-blind, multi-center randomized RCTs are needed.

Enteric neuropathy in diabetes: Implications for gastrointestinal function

“…Alternative and complementary medicines, including acupuncture and herbal supplements, have been explored, though their efficacy is not fully established[ 135 ]. These methods should complement, not replace, conventional treatments.…”

Effect of Tangshen formula on the remodeling of small intestine and colon in Zucker diabetic fatty rats

“…Patients with diabetic GI disorders are treated conventionally with domperidone, metoclopramide, mosapride citrate, fiber laxatives, lactulose, polyethylene glycol and Cisapride, etc [ [3] , [4] , [5] , [6] , [7] ]. Although these western medications can reduce patients' GI symptoms, however they have certain side effects and are prone to relapse following drug discontinuation [ 8 ]. Furthermore, a considerable number of patients are not satisfied with these symptomatic treatments, therefore seeking alternative medicine is important.…”

“…It has been demonstrated that Chinese herbs were effective in the treatment of diabetic gastroparesis on clinical practice [ 8 ], and had effective in attenuating GI motility disorder in diabetic rats [ 9 , 10 ]. More recently, it has been demonstrated that Chang Run Tong (a formula of Chinese herbs) was better than Forlax to treat constipation, had better follow-up improvement after stopping drugs and no remarkably side effective was found in elderly diabetic patients [ 11 ].…”