Systematic Review Of The Effect Of Spleen-strengthening TCM Compound On Insulin Resistance In Prediabetes

Objective:The main objective is evaluating the effect of spleen-strengthening traditional Chinese medicine(TCM)compound on insulin resistance(IR)in prediabetic population through systematic review and meta-analysis,which may provide guidance for clinical application and further researches.Methods:Our study included the randomized controlled clinical trial of the intervention of Chinese traditional medicine compound in prediabetes patients with spleen strengthening mainly by electronic retrieval.The primary outcome was insulin resistance(using recognized methods such as homeostasis model assessment of insulin resistance(HOMA-IR)),secondary outcomes were fasting plasma glucose(FPG),plasma glucose 2 hours after meal(2h PG),fasting insulin(FINS),outcome of IGR,Safety and adverse reactions.Review Manager5.3 software was used for statistical analysis.The parts that could not be analyzed quantitatively were analyzed qualitatively.Results:1.29 studies were eventually included.2.Insulin resistance:(1)Experimental group(spleen-strengthening TCM compound + lifestyle intervention)VS control group(lifestyle intervention): I2=54%,SMD=-0.57,95% CI: [-0.75,-0.40],Z=6.44(P < 0.00001).(2)Experimental group(spleen-strengthening TCM compound + western medicine)VS control group(western medicine): I2 =66%,SMD=-0.99,95% CI:[-1.31,-0.68],Z=6.20(P < 0.00001).(3)Experimental group(spleen-strengthening TCM compound)VS control group(western medicine): I2=85%,MD=-0.45,95% CI:[-0.50,-0.40],Z=16.53(P < 0.00001).3.FPG,2h PG and FINS:The results showed that the experimental group was superior to the control group.However,there were no significant differences in the experimental group (spleen-strengthening TCM compound)versus the control group(western medicine)about FPG and 2h PG.4.The outcome of IGR:(1)In the experimental group(spleen-strengthening TCM compound + lifestyle intervention)VS the control group(lifestyle intervention),the experimental group was superior to the control group in promoting the recovery of plasma glucose and reducing the risk of type 2 diabetes mellitus.(2)There was no significant difference between the experimental group(spleen-strengthening TCM compound)and the control group(western medicine).5.Safety and adverse reactions:No abnormal safety indicators were found in the two groups.Adverse reactions: I =0%,RR=0.14,95%CI: [0.06,0.33],Z=4.59(P <0.00001).Conclusion:1.Compared with simple lifestyle intervention,spleen-strengthening TCM compound combined with lifestyle intervention has more advantages in improving IR,FPG,2h FPG and FINS,promoting the recovery of plasma glucose,and reducing the risk of type 2 diabetes mellitus.2.Compared with western medicine,spleen-strengthening TCM compound combined with western medicine intervention can significantly improve IR,FPG,2h PG,FINS,and reduce adverse reactions.3.Compared with western medicine,spleen-strengthening TCM compound can significantly improve IR(part of the subgroup showed no difference),FINS,and lower risk of adverse reactions.However,there were no significant differences in improving FPG,2h PG,promoting the recovery of plasma glucose,reducing the risk of type 2 diabetes mellitus.